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The Employer-based Health Care System: Shifting Responsibilities

The Employer-based Health Care System: Shifting Responsibilities. 2007 National Health Policy Conference Eduardo Sanchez, M.D., M.P.H. Director, Institute for Health Policy School of Public Health University of Texas Health Science Center at Houston February 12, 2007.

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The Employer-based Health Care System: Shifting Responsibilities

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  1. The Employer-based Health Care System: Shifting Responsibilities 2007 National Health Policy Conference Eduardo Sanchez, M.D., M.P.H. Director, Institute for Health Policy School of Public Health University of Texas Health Science Center at Houston February 12, 2007

  2. Employer-financed Health Careand the Uninsured

  3. The Rising Spiral of Health-Care Costs • Healthcare premiums are growing more than 3 times faster than workers’ wages and 2.5 times faster than the inflation rate • Percentage of employers providing health benefits • 2000 69% • 2005 60% • State of Texas employee health care costs up 53% since 2000 2005 Kaiser Foundation Survey

  4. Employer-SponsoredInsurance Coverage • 61% have insurance through their employer in the United States • In Texas, only 53% have insurance through their employer • 43% of companies with 50 or less employees provide insurance nationally • In Texas, only 31% of companies with 50 or less employees provide insurance Texas Hospital Association, April 2006

  5. Government-SponsoredInsurance Coverage in Texas • Medicaid • CHIP • County-based medical programs • Health insurance for employees/retirees Texas Hospital Association, April 2006

  6. Spiral of Health Cost Increases withHigh Numbers of Uninsured Uninsured utilize higher than necessary levels of care Higher uncompensated costs More uninsured More employers drop coverage because of high premiums Increased charges to paying customers Insurance companies Raise premiums for insured

  7. For More Information Task Force Website http://www.utsystem.edu/hea/taskforce/homepage.htm Report Website http://www.coderedtexas.org

  8. How can the spiral be interrupted? • Reduce the number of uninsured • Increase numbers of eligible and enrolled in Medicaid/CHIP/state or local government programs • Make insurance more accessible/affordable • Individually purchased • Employer provided • Necessary but not sufficient

  9. Demand Older Heavier More Sedentary Un & Underinsured Health Illiterate Supply Increasing Access Increasing Workforce System Redesign Improving Quality of Care Improving Technology Improving Meds The Healthcare Equation is Out of Balance Demand Reduction Is Imperative

  10. Supply Increasing Access Increasing Workforce System Redesign Improving Quality of Care Improving Technology Improving Meds The Healthcare Equation is Out of Balance • Health Promotion • Health literacy initiatives • Healthier lifestyles • Access to care (clinical preventive services) Demand Reduction Is Imperative

  11. How can the spiral be interrupted? • Improve population health • Traditional and chronic disease-focused public health • School-based health education and management • Worker health promotion (worksite wellness)

  12. How can the spiral be interrupted? • Transform the health care delivery system • Invest in and connect to public health • Primary-care centered health system

  13. Concept Primary-care Centered Health System Medical Care Public Health Specialty/Tertiary Care Primary Care Tobacco Prevention And Cessation Specialty Care Diagnostic Testing • Patient Centered • Medical Home • (mental/dental/medical) • Easy access • Continuity of care • Comprehensive care • Coordination of all care • (Includes disease management) Comprehensive School Heath Education Hospital Based Care Inpatient Care Emergency and trauma care Worker and Worksite Wellness = Optimal Communication (Integrated Virtual System) Including best use of health informational technology

  14. Two questions to ponder • Who pays and how? • Financing • What are we buying? • Population health

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