THE COMMONWEALTH FUND Why Universal Health Insurance is Necessary for a High Performance Health...
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THE COMMONWEALTH FUND Why Universal Health Why Universal Health Insurance is Necessary for a Insurance is Necessary for a High Performance Health High Performance Health System System Sara R. Collins, Ph.D. Sara R. Collins, Ph.D. Assistant Vice President Assistant Vice President The Commonwealth Fund The Commonwealth Fund Alliance for Health Care Reform Briefing Alliance for Health Care Reform Briefing Washington, D.C. Washington, D.C. October 26, 2007 October 26, 2007
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Transcript of THE COMMONWEALTH FUND Why Universal Health Insurance is Necessary for a High Performance Health...
THE COMMONWEALTH
FUND
Why Universal Health Insurance is Why Universal Health Insurance is Necessary for a High Performance Necessary for a High Performance
Health SystemHealth System
Sara R. Collins, Ph.D. Sara R. Collins, Ph.D. Assistant Vice PresidentAssistant Vice President
The Commonwealth FundThe Commonwealth FundAlliance for Health Care Reform BriefingAlliance for Health Care Reform Briefing
Washington, D.C.Washington, D.C.October 26, 2007October 26, 2007
THE COMMONWEALTH
FUND
2
Why Does the Current Health Why Does the Current Health Insurance System Fail to Promote High Insurance System Fail to Promote High
Performance? 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
47 Million Uninsured in 2006, Increase of 8.6 Million Since 2000, Adults Under-65 Accounted for Most of the Increase
WA
ORID
MT ND
WY
NV
CAUT
AZ NM
KS
NE
MN
MO
WI
TX
IA
ILIN
AR
LA
AL
SCTN
NCKY
FL
VA
OH
MI
WV
PA
NY
AK
MD
MEVTNH
MARI
CT
DE
DC
HI
CO
GAMS
OK
NJ
SD
WA
ORID
MT ND
WY
NV
CAUT
AZ NM
KS
NE
MN
MO
WI
TX
IA
ILIN
AR
LA
AL
SCTN
NCKY
FL
VA
OH
MI
WV
PA
NY
AK
ME
DE
DC
HI
CO
GAMS
OK
NJ
SD
19%–22.9%
Less than 14%
14%–18.9%
23% or more
1999–2000 2005–2006
MA
RI
CT
VTNH
MD
NH
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.
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.
Percent of Uninsured Children DeclinedSince Implementation of SCHIP, But Gaps Remain
WA
ORID
MT ND
WY
NV
CAUT
AZ NM
KS
NE
MN
MO
WI
TX
IA
ILIN
AR
LA
AL
SCTN
NCKY
FL
VA
OH
MI
WV
PA
NY
AK
MD
MEVTNH
MARI
CT
DE
DC
HI
CO
GAMS
OK
NJ
SD
10%–15.9%
Less than 7%
7%–9.9%
16% or more
1999–2000
DE
MARI
WA
ORID
MT ND
WY
NVUT
KS
NE
MN
MO
WI
TX
IA
ILIN
LA
AL
SCTN
NCKY
FL
VA
OH
MI
WV
PA
NY
AK
ME
DC
HI
CO
GAMS
NJ
SD
2005–2006
CT
VTNH
MD
AR
CA
AZ NMOK
U.S. Average: 11.3%U.S. Average: 12.0%
THE COMMONWEALTH
FUND
6Previously Uninsured Medicare Beneficiaries With History of Cardiovascular Disease or Diabetes Have Much Higher Self-Reported Hospital Admissions After Entering Medicare Than Previously Insured
Source: J. M. McWilliams, et al., “Use of Health Services by Previously Uninsured Medicare Beneficiaries,” NEJM 357;2, Jul 12 2007.
Number of hospital admissions per 2-year period
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
58 60 62 64 66 68 70 72
Uninsured before age 65 Continuously insured before age 65
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THE COMMONWEALTH
FUND
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
THE COMMONWEALTH
FUND
8Design Matters: How Well Do Different StrategiesDesign Matters: How Well Do Different StrategiesMeet Principles for Health Insurance Reform?Meet Principles for Health Insurance Reform?
Principles for Reform
Tax Incentives and Individual Insurance
Markets
Mixed Private-Public Group Insurance with Shared Responsibility
for Financing Public Insurance
Covers Everyone 0 + +Minimum Standard Benefit Floor – + +Premium/Deductible/Out-of-Pocket CostsAffordable Relative to Income
– + +
Easy, Seamless Enrollment 0 + ++Choice + + +Pool Health Care Risks Broadly – + ++Minimize Dislocation, Ability to Keep Current Coverage + ++ –
Administratively Simple – + ++Work to Improve Health Care Quality and Efficiency 0 + +
0 = Minimal or no change from current system; – = Worse than current system; + = Better than current system; ++ = Much better than current systemSource: 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.
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THE COMMONWEALTH
FUND
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
