4. Guess ONE:
65m uninsured; 19% of GDP
2010 Reality?
&
Guess TWO:
52 million uninsured
$10,000 per capita
47m uninsured; 16% of
…leads to… spending only $8,300
Per capita GDP &
Reform after 2010
Share of GDP 17.3% $8,600 per capita
…leads to…
No Reform after 2010
5. Who do Americans Believe
Can Predict the Future?
50
45
40
35
30
25
20
15
10
5
0
Bi Fa As Ps Po Ou M
bl rm tro yc lls ag
Percentage who ic al er log hi
cs ter ija B ic
Pr 's er s oa 8B
believe op Al s rd all
he m
cy an
ac
Source: Peter D. Hart Research Associates, for the Shell Poll 1998
10. 7000
Dollars spent per capita
6000
Canada
France Us
Average
5000 Germany
spending on
health United Kingdom Them
per capita
United States
4000
($US PPP)
3000
2000
Source: Gerard F.
1000
Anderson, Ph.D.,
and Patricia
Markovich,
Data: OECD Health
Data 2008 (June 0
2008)
Commonwealth 1980 1984 1988 1992 1996 2000 2004
Fund 2008
11. Health spending as share of GDP
16
Average
spending on
14
health Us
per capita
($US PPP)
12 Them
10
Canada
France
8 Germany
Switzerland
United Kingdom
6 United States
Source: Gerard F.
Anderson, Ph.D.,
and Patricia
Markovich,
Data: OECD Health
Data 2008 (June
4
2008) 1980 1984 1988 1992 1996 2000 2004
Commonwealth
Fund 2008
12. I = f(PDI) = f(M5B + MBZ)
Where:
• I is increase in health care costs
• PDI is physicians’ desired
income
• M5B is mortgage payment on a 5
bedroom house with a pool
• MBZ is monthly lease on
a new 300 series Mercedes
13. Rapid Increase in Uninsurance; in the Middle
Working adults in US who were uninsured for at least 3 months in a 2 year period
60%
51% 52% Lowest
48% 50%
48% quintile
41%
44% Second
40% 39%
35% 37%
Third
24% 25%
20% 20% 21% Fourth
18%
8% 10% 10% 11% 11% Highest
4% 5% 6% 6% 5% quintile
0%
1999* 2000 2001 2002 2003
Source: Analysis of the March 1988–2004 Current Population Surveys by
Danielle Ferry, Columbia University, for The Commonwealth Fund
14. And it got much worse (2010)
Adults in Percentage of
families with a those who had
job loss in past insurance
2 years = 47%
= 24% or
Percentage of
43 million those who lost
insurance
= 57% or 9m
Source: The Commonwealth Fund Biennial Health Insurance Survey (2010).
15.
16.
17. But in health care:
the future is like the present,
only longer
18. We do a shitty job with
chronically ill patients
19. Who can’t do chronic care?
Views of the Health Care System from those with chronic illness
Percent AUS CAN FR GER NETH NZ UK US
Only minor changes
needed 22 32 41 21 42 29 38 20
Fundamental
changes needed 57 50 33 51 46 48 48 46
Rebuild completely 20 16 23 26 9 21 12 33
Base: Adults with any chronic condition
Data collection: Harris Interactive, Inc.
Source: 2008 Commonwealth Fund International Health
Policy Survey of Sicker Adults.
20. Disease managed? Maybe not…
% of diabetics who received four key preventative services*
80
67
59
60
43
39 40
40
31
20
0
CAN FR GER NETH UK US
* Hemoglobin A1c checked in past six months; feet examined for sores or irritations in
past year; eye exam for diabetes in past year; and cholesterol checked in past year.
Data collection: Harris Interactive, Inc.
Source: 2008 Commonwealth Fund International Health Policy
Survey of Sicker Adults.
21. Did Not Get a Recommended Test, Treatment
or Follow-up Due to Cost, by Income
50% Below average income Above average income
36%
25%
17% 18%
14% 14%
9% 11%
4% 4% 2%
0%
AUS CAN NZ UK US
2001Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
22. Adults Uninsured for Any Time Had Highest Rates
of Cost-Related Problems Getting Needed Care
Percent of adults ages 19–64 who had any of four access problems*
in past year because of cost
75 2001 2005 2010
63 66
60 59
55
52
50
37 41
29 28 31
25 21
0
Total Insured all year Insured now, time Uninsured now
uninsured in past
year
*Did not fill a prescription; did not see a specialist when needed; skipped recommended medical test, treatment, or follow-up; had a
medical problem but did not visit doctor or clinic.
Source: The Commonwealth Fund Biennial Health Insurance Surveys (2001, 2005, and 2010).
23. We do different things to the same
people in different places
24. Cost & Quality in Healthcare
Health Affairs
April 7, 2004
More spending
≠ better
Ritz-Carlton
outcomes
Quality
Motel 6
Cost
37. IT History Quiz, Part 1
• 1947 Christmas Eve
– Shockley & pals invent the transistor
• 1959
– Noyce (Intel) & Kilby (the other guy from TI) invent the integrated
circuit (separately)
• 1981
– IBM introduces the PC (Bonus Question--Why did they give it
away?)
– Expected to sell 295,000 in first ten years!
• 1986
– Microsoft and Oracle go public
38. IT History Quiz, Part 2
• 1991 & 1993
– WWW & Mosaic Browser
• 1998
– Google founded
• 2004
– Google goes public (Bonus Question--Why didn’t Matthew buy the
stock?)
– Thought it was overvalued at $80 a share!
• 2004
– Facebook (but for students only for 3 years)
• 2007
– Apple releases iPhone
• 2010
– Apple releases iPad
39. The Rise of the CyberChondriacs
2007
160 million adults
84% of those online
Source: Harris Interactive
53. What is “Health 2.0”
Holt’s best guess at the constituent parts
• Personalized search that looks into the long tail, and
cares about the user experience
• Communities that capture the accumulated
knowledge of patients and caregivers – and explain it to
the world
• Intelligent tools for content delivery -- and transactions
• Better integration of data with content
And not just a maybe….
Technologies fusing as patients increasingly guide their
own care
80. Can You and Your Loved Ones Answer These
Questions?
1.On a scale of 1 to 5, where do you fall on this continuum?
1 2 3 4 5
Let me die in my own bed, without any Don't give up on me no matter what, try any proven
medical intervention and unproven intervention possible
2.If there were a choice, would you prefer to die at home, or in a hospital?
3.Could a loved one correctly describe how you’d like to be treated in the
case of a terminal illness?
4.Is there someone you trust that you’ve appointed to advocate on your
behalf when the time is near?
5.Have you completed any of the following: written a living will, appointed
a healthcare power of attorney, or completed an advanced directive?
engagewithgrace.org The One Slide Project
