Question 1.

There are a variety of health care systems across the globe. A recurring message gleaned from all developed countries is the issue of cost. No country, however, has higher health care expenditures than the United States. Please refer to several publications in your handout section that offers information on how we spend our money for health care. National Health Expenditures Projections—2011 to 2021 is the most current trending document issued by CMS. CMS estimates that by 2020 we will be spending upwards of $4.6T with health expenditures representing over 19% of GDP. The CMS document, Factors Accounting for Growth in Person Health Expenditures (1993-2019) projects that economy wide prices and utilization are to two factors that will represent the largest increases in cost. (By the way SGR means the sustainable growth rate formula, which links physician reimbursement rates to increases in the gross domestic product. Because spending on physician services has outpaced increases in the GDP, the formula has called for cuts in reimbursements each year over most of the past decade, and Congress has always voted to push those cuts down the road, granting small rate increases instead.) As we discuss consumption we cannot dismiss the cost of pharmaceuticals. In the article, Prescription Drug Accessibility and Affordability in the US and Abroad the Commonwealth Fund compares seven countries and observes that despite certain barriers, Americans spend much more than other countries on medications. In the end can cost be contained or will Americans continue to consume—because we can?

Question 2:
Most would agree that the Patient Protection and Affordable Care Act (ACA) is the most significant attempt to change our health care system since the enactment of Medicare and Medicaid in 1965. The PowerPoint, Home Sweet Home offers a quick overview of our current system and a historical perspective. It also provides a brief summary of what ACA will impact from now until everything is implemented by 2018. Despite the enormous amount of money we spend each year for health care services, some might argue that our outcomes are not as desirable as they should be. A great overview of OECD nations as it compares to the US is offered in the Commonwealth Fund PowerPoint entitled, Multinational Comparison of Health Systems (2011). A complimentary document, Measuring the US Health Care System: A Cross-National Comparison, the Commonwealth Fund reports that we fail miserably compared to other OECD countries. Although this document was published in 2010, I think it adds to the narrative in the PowerPoint. [Also, check out WHO World Health Statistics (2012); it is a wonderful reference document that can be used throughout the course.] In addition to the Johnson et al text, the report, International Profiles of Health Care provides the reader with a relatively comprehensive look at our health system as it looks today. Finally, the article A New Era in American Health: Realizing the Potential for Reform calls for all the stakeholders to embrace the principals for reform. As such, will reform have an impact on how we deliver services in the United States? You be the judge!

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