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
Employer-financed Health Care
and the Uninsured
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
• 2005
69%
60%
– State of Texas employee health care costs up
53% since 2000
2005 Kaiser Foundation Survey
Employer-Sponsored
Insurance 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
Government-Sponsored
Insurance Coverage in Texas
• Medicaid
• CHIP
• County-based medical programs
• Health insurance for employees/retirees
Texas Hospital Association, April 2006
Spiral of Health Cost
Increases with
High Numbers of Uninsured
Uninsured utilize higher
than necessary levels of care
More uninsured
More employers drop coverage
because of high premiums
Higher
uncompensated costs
Increased charges
to paying customers
Insurance companies
Raise premiums for insured
For More Information
Task Force Website
http://www.utsystem.edu/hea
/taskforce/homepage.htm
Report Website
http://www.coderedtexas.org
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
The Healthcare Equation is Out
of Balance
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
Health Promotion
• Health literacy initiatives
• Healthier lifestyles
• Access to care (clinical
preventive services)
•
•
•
•
•
•
Supply
Increasing Access
Increasing Workforce
System Redesign
Improving Quality of Care
Improving Technology
Improving Meds
Demand Reduction Is Imperative
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)
How can the spiral be interrupted?
• Transform the health care delivery system
– Invest in and connect to public health
– Primary-care centered health system
Concept
Primary-care Centered Health
System
Public Health
Medical Care
Primary Care
Tobacco
Prevention
And Cessation
Comprehensive
School Heath
Education
Specialty/Tertiary Care
Specialty Care
Patient Centered
Medical Home
(mental/dental/medical)
1. Easy access
2. Continuity of care
3. Comprehensive care
4. Coordination of all care
(Includes disease management)
Diagnostic
Testing
Hospital Based
Care
Inpatient Care
Worker and
Worksite
Wellness
Emergency and
trauma care
= Optimal Communication (Integrated Virtual System)
Including best use of health informational technology
Two questions to ponder
• Who pays and how?
– Financing
• What are we buying?
– Population health