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Why Universal Health Insurance is Necessary for a High Performance Health System

Why Universal Health Insurance is Necessary for a High Performance Health System. Sara R. Collins, Ph.D. Assistant Vice President The Commonwealth Fund Alliance for Health Care Reform Briefing Washington, D.C. October 26, 2007.

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Why Universal Health Insurance is Necessary for a High Performance Health System

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  1. Why Universal Health Insurance is Necessary for a High Performance Health System Sara R. Collins, Ph.D. Assistant Vice President The Commonwealth Fund Alliance for Health Care Reform Briefing Washington, D.C. October 26, 2007

  2. Why Does the Current Health Insurance System Fail to Promote High Performance? • Access to care is unequal • Poor access to care is linked to poor quality • Care delivery is inefficient • Fragmented health insurance system makes it difficult to control costs • Financing of care for uninsured and underinsured families is inefficient • Positive incentives in benefit design and insurance markets are lacking

  3. 1999–2000 2005–2006 NH NH ME WA NH VT ME WA VT ND MT ND MT MN MN OR NY MA WI OR MA NY ID SD WI RI MI ID SD RI WY MI CT PA WY NJ CT IA PA NJ NE IA OH DE IN NE OH NV DE IN IL MD NV WV UT VA IL MD CO DC WV UT VA KS MO KY CA CO DC KS MO KY CA NC NC TN TN OK SC AR OK AZ NM SC AR AZ NM MS GA AL MS GA AL TX LA TX LA FL FL AK AK 23% or more HI HI 19%–22.9% 14%–18.9% Less than 14% 47 Million Uninsured in 2006, Increase of 8.6 Million Since 2000, Adults Under-65 Accounted for Most of the Increase U.S. Average: 20.0% U.S. Average: 17.3% Source: J. C. Cantor, C. Schoen, D. Belloff, S. K. H. How, and D. McCarthy, Aiming Higher: Results from a State Scorecard on Health System Performance (New York: The Commonwealth Fund, June 2007). Updated Data: Two-year averages 1999–2000, updated with 2007 CPS correction, and 2005–2006 from the Census Bureau’s March 2000, 2001 and 2006, 2007 Current Population Surveys.

  4. 1999–2000 2005–2006 NH ME WA NH VT ME WA VT ND MT ND MT MN MN OR NY MA WI OR MA NY ID SD WI RI MI ID SD RI WY MI CT PA WY NJ CT IA PA NJ NE IA OH DE IN NE OH NV DE IN IL MD NV WV UT VA IL MD CO DC WV UT VA KS MO KY CA CO DC KS MO KY CA NC NC TN TN OK SC AR OK AZ NM SC AR AZ NM MS GA AL MS GA AL TX LA TX LA FL FL AK AK 16% or more HI HI 10%–15.9% 7%–9.9% Less than 7% Percent of Uninsured Children DeclinedSince Implementation of SCHIP, But Gaps Remain U.S. Average: 11.3% U.S. Average: 12.0% Source: J. C. Cantor, C. Schoen, D. Belloff, S. K. H. How, and D. McCarthy, Aiming Higher: Results from a State Scorecard on Health System Performance (New York: The Commonwealth Fund, June 2007). Updated Data: Two-year averages 1999–2000, updated with 2007 CPS correction, and 2005–2006 from the Census Bureau’s March 2000, 2001 and 2006, 2007 Current Population Surveys.

  5. Previously Uninsured Medicare Beneficiaries With History of Cardiovascular Disease or Diabetes Have Much Higher Self-Reported Hospital Admissions After Entering Medicare Than Previously Insured Number of hospital admissions per 2-year period Source: J. M. McWilliams, et al., “Use of Health Services by Previously Uninsured Medicare Beneficiaries,” NEJM 357;2, Jul 12 2007.

  6. Roadmap to Health Insurance for All: Principles for Reform • Builds an essential foundation for quality and efficiency as well as access • Benefits cover essential services with financial protection • Premiums/deductibles/out of pocket costs affordable • Coverage is automatic, stable, seamless • Choice of health plans or care systems • Broad health risk pools; competition based on performance not risk or cost shift • Simple to administer: lowers overhead costs providers/payers • Minimizes dislocation • Financing adequate/fair/shared across stakeholders

  7. Design Matters: How Well Do Different StrategiesMeet Principles for Health Insurance Reform? 0 = Minimal or no change from current system; – = Worse than current system; + = Better than current system; ++ = Much better than current system Source: S.R. Collins, et al., A Roadmap to Health Insurance for All: Principles for Reform, Commission on a High Performance Health System, The Commonwealth Fund, October 2007.

  8. Related Commonwealth Fund Reports • S. R. Collins, C. Schoen, K. Davis, et al., A Roadmap to Health Insurance for All: Principles for Reform, The Commonwealth Fund Commission on a High Performance Health System, October 2007. • A High Performance Health System for the United States: An Ambitious Agenda for the Next President, The Commonwealth Fund Commission on a High Performance Health System, forthcoming. • C. Schoen, R. Osborn, M. M. Doty, et al., “Toward Higher-Performance Health Systems: Adults’ Health Care Experiences in Seven Countries, 2007,” Health Affairs, forthcoming. • S. R. Collins, C. White, and J. L. Kriss, Whither Employer-Based Health Insurance? The Current and Future Role of U.S. Companies in the Provision and Financing of Health Insurance, The Commonwealth Fund, September 2007. • J.C. Cantor, D. Bellof, C. Schoen, et al., Aiming Higher: Results from a State Scorecard on Health System Performance, The Commonwealth Fund Commission on a High Performance Health System, June 2007 Visit the Fund at: www.commonwealthfund.org

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