Health Care in the U.S. and the World

1. Health Care in the U.S. and the World Martin Donohoe

2. Determinants of Health • Era • Socioeconomic status • Sex • Race • Location • Environment • Genetics • Health Habits • Access to Care

3. Health Care • Prevention • Diagnosis • Treatment

4. The State of U.S. Health Care • 45 million uninsured • 45,000 deaths/year due • Millions more underinsured • Remain in dead-end jobs • Go without needed care and/or prescriptions • Marry

8. The State of U.S. Health Care • US ranks near the bottom among westernized nations in overall population health (#24), life expectancy (#42), infant and maternal mortality, etc. • 20-25% of US children live in poverty

12. Health Care Expenditures per Capita • U.S. = $8,160 • Canada, Australia, Japan, Europe: $3,000 to $6,000 • Typical poor African/Asian country = $5-$50

13. Who Pays for Health Care? • Government (federal, state, and local) • Medicare, Medicaid, VA, IHS, jails and prisons • Private insurance • Primarily employer-based • Out-of-pocket

19. Health Insurance Industry • Delisting • Cherry picking • Pre-existing conditions • High administrative costs • 15-30% (vs. 2-3% for Medicare and Medicaid) • Large profit margins • Loyalty: shareholders (not patients) • Corruption

22. Distribution of National Health Expenditures

23. Some Reasons for Rising Health Care Costs • Aging population • Chronic diseases • Technological advances • Exploding drug costs • Procedural variability • Administrative costs

26. Drug Companies’ Profits (“Drug companies prices barely cover R &D costs and risks.”) 3rd rank Fortune Magazine

27. Drug Companies’ Cost Structure

28. Innovation:Published Research Leading to Drugs

29. Lobbying • 15,000 full-time lobbyists • Health insurance, pharmaceutical, and organized medicine spend huge sums of money to influence legislation and policy

30. The “Global Economy” • 53 of the world’s 100 largest economies are private corporations; 47 are countries • Wal-Mart is larger than Israel and Greece • AT&T is larger than Malaysia and Ireland

31. Major Contributors to Illness and Death • 40% of US mortality due to tobacco, poor diet, physical inactivity, and misuse of alcohol • Every $1 invested in programs covering above items saves $5.60 in health care costs

32. Poverty and Hunger • US: 13% of residents and 18% of children live in poverty • Rates of poverty in Blacks and Hispanics = 2X Whites • Poverty associated with worse physical and mental health

33. Economic Disparities • Women 60ȼ/$1 Men • Median income of black U.S. families as a percent of white U.S. families approximately 60% (no change since late 1960s)

34. Racial Disparities in Health Care:African-Americans • Higher maternal and infant mortality • Higher death rates for most diseases • Shorter life expectancies • Less health insurance • Undergo fewer diagnostic tests / therapeutic procedures

35. Racial Disparities in Health Care:African-Americans • Equalizing the mortality rates of whites and African-Americans would have averted 686,202 deaths between 1991 and 2000 • Medical advances averted 176,633 deaths

36. Outside the US • One billion people lack clean drinking water and 3 billion lack sanitation • 13,000-15,000 deaths per day worldwide from water-related diseases • Hunger kills as many individuals in two days as died during the atomic bombing of Hiroshima

37. Water • Amount of money needed each year (in addition to current expenditures) to provide water and sanitation for all people in developing nations = $9 billion • Amount of money spent annually on cosmetics in the U.S. = $8 billion

38. Human Poverty

39. Percentage of population living on less than one dollar per day

40. HIV Prevalence

41. Malaria Deaths

42. Overpopulation • World population - exponential growth • 1 billion in 1800 • 2.5 billion in 1950 • 6 billion in 2000 • 6.8 billion in 2009 • est. 8-10 billion by 2050

43. Status of Women • Women do 67% of the world’s work • Receive 10% of global income • Own 1% of all property

44. Worldwide, every minute • 380 women become pregnant (190 unplanned or unwanted) • 110 women experience pregnancy-related complications • 40 women have unsafe abortions • 1 woman dies from childbirth or unsafe abortion • Reason: Lack of access to reproductive health services

45. Deaths in War • 18th Century = 19/million population • 19th Century = 11/million population • 20th Century = 183/million population • Civilian Casualties: • 10% late 19th Century • 85-90% in 20th Century

46. Contemporary Wars • 250 wars in the 20th Century • Most conflicts within poor states • Many over oil

47. War Deaths, 1945-2000

48. Inverse Care Law Those countries that need the most health care resources are getting the least

49. The Medical Brain Drain Five times as many migrating doctors flow from developing to developed nations than in the opposite direction

50. Tobacco • Cigarettes most heavily marketed products in the world • $2 billion/year in the U.S. • U.S. leading exporter of cigarettes