Lessons to be Learned from Health Care Delivery Abroad

Presented by Shan Padda at the CEO Roundtable on August 12, 2015

With the Supreme Court's recent upholding of the Affordable Care Act, the need to improve America's health care delivery system is more acute than ever. Currently, the US spends about twice as much on health care than other countries without realizing significantly better outcomes. Additionally, 50 percent of health care costs are incurred by only five percent of the population. As the process of reforming our health care delivery system continues, it makes sense to examine what strategies other countries have successfully implemented to improve population health and reduce overall spending. Proven patient-centered care models include Singapore, Israel and the Netherlands, all of which take a hybrid public-private approach. In this presentation, Shan will review some of his own observations from traveling abroad and how other countries are building health care that is universal, affordable and effective.

Transcript

1. Shan Padda, Chairman & CEO, Health Integrated
2. Lessons to be Learned from Healthcare Delivery Abroad
3. Welcome and Agenda • Welcome • The State of Healthcare in the US • Lessons to Be Learned from Abroad • The Future of Healthcare in America 3
4. US Healthcare System is Broken • 17% of GDP • $600B avoidable spend • Lowest life expectancy in OECD • Lagging quality and outcomes 4 76 78 80 82 84 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% Health Spend % of GDP (Bar) Life Expectancy at Birth (Line) Spend v. Life Expectancy (2012) Rest of Economy $13.4T Health Care $2.3T Rest of Health Care Spend $1.7T Unwarranted Variation $0.6T USA GDP $15.7T (2012)
5. Americans and Healthcare 5 5% generate 50% of healthcare costs 37 million are still uninsured +130 million are plagued by chronic illness 70 million are on Medicaid
6. Lessons to Be Learned from Abroad  Patient-centered models with focus on prevention  Mandatory healthcare with a public-private approach  Full adoption of centralized, electronic medical records  Shift from fee-for-service model to quality and outcomes model  Health care guarantee – coverage for catastrophic medical problems 6 Singapore Israel Netherlands Cuba Chile
7. Singapore • Most efficient healthcare system in the world - Bloomberg. • Belief that “no one in their country, even a foreigner, will go without health care.” • Mandates citizens buy basic coverage with option to upgrade plan with purchase on free market. • Required to have a health savings plan as well – like a 401K. • Features elements of consumerization. • Hospitals required to post costs for common procedures on their website. • Mandatory coverage has coinsurance feature giving patients a financial stake in the pricing. • Government programs help support social issues such as housing = 85% own their own home. 7 Health Spend % of GDP US vs. Singapore 17.1% to 4.6% Health spend percentage of GDP from World Health Organization – 2013 data.
8. Israel • 4th most efficient healthcare system in the world – WHO. • Universal health care through one of the country’s four national carriers. • Tiered system • First Tier – free foundational level • Second Tier – supplemental, bought by 90% . Faster access to care, additional services such as drugs and fertility. • Third Tier – private coverage, bought by 30%. Access to long term care, dental services and medical tourism. • Centralized, electronic medical records model – shared across the system. • Physicians work with one plan reducing administrative burden. • Preventative care is a focus and addressed in school system. 8 Health Spend % of GDP US vs. Israel 17.1% to 7.2%
9. Netherlands • Leads the Euro Health Consumer Index. • Citizens are required to purchase basic health coverage from one of the country’s five private insurers. • Amount paid is determined by income and 2/3 thirds of the population receive government subsidy. • Government tracks health status of population. • Insurance companies who take on sicker individuals are paid more. • General practitioner is backbone of all health care. • Each citizen must register with one who acts as gatekeeper to more expensive care. • Insurers may provide incentives to primary care doctors to stimulate integrated and coordinated care. 9 Health Spend % of GDP US vs. Netherlands 17.1% to 12.9%
10. Cuba • Universal health care is free. • There is no alternative, private-payer health system. • The health system is strongly focused on prevention, using low- tech means extraordinarily effectively. • Everyone has a family physician and nurse. • Education is a priority, and there is almost universal literacy. • Health and sexual education are promoted; contraceptives are free. • Vaccination rates in Cuba are among the highest in the world. • Very successful biotech industry – produces its own vaccines and medication with generic drugs more common. • Physicians do not pay for their education but give back to the system. 10 Health Spend % of GDP US vs. Cuba 17.1% to 8.8%
11. Chile • Every worker contributes 7% of salary towards insurance – can select public or private insurance. – 80% elect public since they cannot afford private. • Hospital systems are public and private. – Public systems take both types of insurance while some Private systems do not accept the Public insurance. • Chile picks up the tab for catastrophic medical issues – based on the principle “health care is a right and not a privilege”. – System maintains list of qualified issues and treatment plans to be followed to keep costs controlled. – Citizens with private coverage can opt out of the system for catastrophic care and pay out-of-pocket. • Innovative fingerprint technology immediately verifies eligibility and benefits. 11 Health Spend % of GDP US vs. Chile 17.1% to 7.7%
12. What does the future hold for the US? 12
13. Reform is Making Change 13 • Uninsured rates are the lowest in 15 years. • Standardized coverage with 10 essential benefits (including mental health, addiction and chronic diseases). • More focus on wellness/prevention with free preventative screenings, immunizations and well visits. • Secure access to health insurance regardless of pre-existing conditions or job status. • Dramatically reducing the incidence of catastrophic medical costs for individuals and families. • Medicaid is implementing innovations – Patient-centered medical homes – Accountable care organizations (ACOs) • Payment reform linking to performance. • Accelerating the adoption of electronic health records.
14. What Does the Future Hold for the U.S.? 14 Adaptations and Change
15. Thank You 15