US Health Care Industry

Gaps in US Health Care System and Possible Solutions

Health Care in the United States

Major Public Schemes

Overview
Medicare
Administered : Federal Government
• In USA, 283.2 million people had some
Target: Everyone including elderly
type of health insurance, with 66
percent of workers covered by a private people(> 65Y) and disabled
health insurance plan.
Medicaid
Administered: State Government
• Among the insured, 115.4 million
Target: Population below a certain poverty
people, received coverage through the
U.S. government through Medicare, threshold and disabled
Medicaid and/or Veterans
Administration or other military care. Veterans Administration
Administered : Federal Government
Target: Military veterans
Medicare Mediaid Others
No Insurance Private

US vs Other High Income Countries US vs Other High Income Countries

Health Spending Individual Statistics
• U.S. spending on health care is nearly twice • Life Expectancy: 78.8 years was lower
the rate of 10 other high-income countries than the average of 81.7 years among
the countries studied
• Health-care spending ballooned to nearly 18
percent of the U.S. gross domestic product in • Infant Mortality:Rate:highest, at 5.8
2016, compared with a range of about 10 deaths per 1,000 live births in the U.S.,
percent to 12 percent in the other 10 nations compared with the average of 3.6 per
1,000.
• The U.S. had the highest pharmaceutical
spending per capita among its peers at $1,443, • U.S. also has the highest percentage of
the researchers found, compared with an residents without coverage for basic
health care services.
What is factors affect the efficiency of Health Care System?

"I have argued for years that we do not have a health care system in America. We
have a disease-management system - one that depends on ruinously expensive
drugs and surgeries that treat health conditions after they manifest rather than giving
our citizens simple diet, lifestyle and therapeutic tools to keep them healthy”
- Andrew Weil

5 A’s of Health Care

Availability
• Availability has been limited by the distribution of hospitals, primary and specialty physicians, and other healthcare providers in
rural areas as compared to metropolitan areas. Urban areas has twice as many doctors as rural areas

Accessibility
• Only 30% of Americans report that they can access a doctor on the very day they need one, as opposed to 41% Britons and 55%
Germans.
• 67% percent of Americans -- more than in any other country -- say it's difficult to get care on nights, weekends, or holidays with
resorting to the emergency room, where care is costlier and, if your injury is not grievous, less efficient

Accommodation
• Americans are the least likely to report that their doctors explain things in ways they understand or say doctors spend enough
time with them (56%of Americans say they do, as compared to 70% of Germans). Americans are most likely to report that test
results or medical records were unavailable during our scheduled appointments. They also don’t have ideas about the doctor-
patient relationship.

Acceptability
• Americans are the most likely to report a medical, medication, or lab error, with 20% saying they've experienced one of the above
over the past year. For those of us with chronic diseases, the rates are even higher. Our overall self-evaluation of the treatment
we receive is solidly in the middle of the pack, with 70% expressing satisfaction.

Affordability
• The U.S. had the highest pharmaceutical spending per capita among its peers at $1,443, the researchers found, compared with
an average of $749 for all 11 countries.
Why is US behind other countries despite large spending?
Drivers of Health Care Spending in US Uneven Coverage of Health Insurance

Prohibitively high cost
• 31% of uninsured adults reported not getting or delaying
medical care because of cost, compared to 5% of
privately insured adults and 27% of those on public
insurance, including Medicaid/CHIP and Medicare.
Rise of chronic diseases, including obesity
• Patients with chronic illness in their last two years of life
account for about 32% of total Medicare spending
High administrative costs
• Larger firms spend a smaller percentage of their total
expenditures on administration, and nationwide
estimates suggest that as much as half of the $361
billion spent annually on administrative costs is wasteful
• Health insurance premiums in the U.S. are rising fast.
From 2005 to 2015, average annual health insurance
premiums for family coverage increased 61%, while
worker contributions to those plans increased 83% in the
same period. This rate of increase outpaces both
inflation and increases in workers’ wages.
• While the majority of U.S. citizens have health
insurance, premiums are rising and the quality of the
insurance policies is falling. Average annual premiums
for family coverage increased 11% between 1999 and
2005, but have since levelled off to increase 5% year
between 2005 and 2015.
• Deductibles are rising even faster. Between 2010 and
2015, single coverage deductibles have risen 67%

The Affordable Care Act: Still Not a Success

• In March, 2010, President Obama signed the ACA into law that made hundreds of significant changes to the U.S. healthcare system
between 2011 and 2014. Provisions included in the ACA are intended to expand access to healthcare coverage, increase consumer
protections, emphasises prevention and wellness, and promote evidence- based treatment 

• Beginning in January 2014, almost all Americans are required to have some form of health insurance from either their employer, an
individual plan, or through a public program such as Medicaid or Medicare.

• A major provision of the ACA was the creation of health insurance marketplace exchanges where individuals not already covered by
an employer-provided plan or a program such as Medicaid or Medicare can shop for health insurance. Individuals with incomes
between 100% and 400%of the federal poverty line would be eligible for advanceable premium tax credits to subsidise the cost of
insurance. Currently, only 14 states operate their own exchanges
Digitisation of Health Care-The way forward
• Digital health care technology is delivering solutions to tackle the increasing need for better diagnostics and more
personalised therapeutic tools.
• It also is creating challenges for governments, health systems, and insurers, which must collect, analyse, and store more
and more data.
• Digital and AI technologies will help enable on demand interaction and seamless processes to improve patient
experience.
• Robotic process automation (RPA) and AI will allow caregivers to spend more time providing care and less time
documenting it as well as help enhance their development and learning.
• Digital supply chains, automation, robotics, and next-generation interoperability will drive operations management and
back-office efficiencies.

Internet of Things Cognitive Computing Cloud-based, interoperable health

Development of the IoT in the health care
market (where it is also called the Internet of
Medical Things, or IoMT) has been proving
particularly valuable in remote clinical
monitoring, chronic disease management,
preventive care, assisted living for the elderly,
and fitness monitoring. IoT’s application is
lowering costs, improving efficiency, and
bringing the focus back to quality patient care.
Cognitive computing (machine learning,
neural networks, deep learning, etc.) is a
common technique for dealing with large
volumes of rapidly changing data. It can be
used to predict (disease onset, for
example), detect patterns in data (a drug’s
effects on populations or individuals, for
example), or to classify populations (patient
subpopulations, for example). Machine
learning can also be used to combine data
across disparate data sources.
records
Interoperable EHRs coupled with AI could
create process efficiencies and improve
decision making necessary to boost quality.
Data could be better integrated into daily
care, and patients could play a role in
curating their own data. The data could
include genetic, social, and behavioral
patient information, as well as financial,
clinical, and administrative records. It could
be securely stored in the cloud and
accessed on an as-needed basis—perhaps
on a blockchain
References

• https://www.theatlantic.com/health/archive/2017/07/us-worst-health-care-commonwealth-2017-report/533634/
• https://www.theguardian.com/us-news/ng-interactive/2017/jul/25/us-healthcare-system-vs-other-countries
• https://www.newyorker.com/magazine/2009/12/14/testing-testing-2
• https://www.vox.com/policy-and-politics/2017/5/4/15545068/ahca-expert-analysis

• World Industry Outlook, Healthcare and Pharmaceuticals, The Economic Intelligence Unit, June 2017

•  High-value health care: Innovative approaches to global challenges, Deloitte, 2016, citing Roberto Tapia-Conyer et
al., “Enablers and inhibitors of the implementation of the Casalud model, a Mexican innovative healthcare model for
non-communicable disease prevention and control,” Health Research Policy and Systems 14, no. 51 (2016), DOI:
10.1186/s12961- 016-0125-0.