The US Healthcare System For Dummies Who Are Also Visual Learners
September 19, 2011 4:48 PM Subscribe
Give me your best detailed, graphical overview of the U.S. healthcare system(s) - ideally with a view of number of covered lives.
I'm working with some European colleagues on a project that requires them to understand more about the complexity of U.S. health insurance and delivery systems, and seeking graphical resources that give a good overview of the agencies involved in U.S. healthcare delivery and drug pricing. I feel like there should be some good visuals of the entire U.S. population broken down by who's covered under private and public insurance that drills into specific number of insured lives for the larger private and public payer systems, but my searches have been drawing a blank so far. I could reinvent the wheel by pulling together various estimates, but before I do... does anyone have some recommendations for good visual overviews?
Public resources are great, subscription journals are ok too.
I'm working with some European colleagues on a project that requires them to understand more about the complexity of U.S. health insurance and delivery systems, and seeking graphical resources that give a good overview of the agencies involved in U.S. healthcare delivery and drug pricing. I feel like there should be some good visuals of the entire U.S. population broken down by who's covered under private and public insurance that drills into specific number of insured lives for the larger private and public payer systems, but my searches have been drawing a blank so far. I could reinvent the wheel by pulling together various estimates, but before I do... does anyone have some recommendations for good visual overviews?
Public resources are great, subscription journals are ok too.
Here are a few, although they are focussed on health reform, not the current world.
posted by Mr.Know-it-some at 6:58 AM on September 20, 2011
posted by Mr.Know-it-some at 6:58 AM on September 20, 2011
Are you just looking for the number of lives covered by different types of insurance? That's fairly simple to get, albeit not in graphical form; I would use the ACS data from the Census:
Coverage by Type of Health Insurance
The only chart I can recall that purports to show the entire U.S. health care system is this one from TNR:
Health Care Map
However I personally think that graphic obscures a lot more than it clarifies. There are a lot of government agencies involved in the delivery side of health care that are omitted from that chart but it's probably the closest you're going to get.
And just as a side note: this may be totally 'duh' obvious, so apologies for stating it, one of the reasons it's so difficult to show "the entire U.S. population broken down by who's covered under private and public insurance that drills into specific number of insured lives for the larger private and public payer systems" is because on the delivery side--unlike the financing side--it's not split into private and public payer systems. There is a rather small public delivery system, consisting of things like community health centers or federally qualified health centers (funded by HRSA), community mental health centers (funded by SAMHSA), public mental hospitals (funded by states), publicly-owned safety net hospitals (self-sustaining or supported somewhat by tax revenue on the local level), and the veterans health administration system (funded by the VA). For *all* of those delivery sites, you're going to see a mix of people served in terms of health insurance coverage; for example, community health centers serve a low-income population that may be 1/3 Medicaid and CHIP, 1/3 private health insurance, and 1/3 uninsured. The private delivery system (most doctors, hospitals, and drug companies)--which makes up the vast majority of the delivery system--provides care for people receiving insurance on both the public (Medicare, Medicaid, CHIP, military health insurance) and the private (employer-based insurance, direct purchase insurance, and out-of-pocket or uninsured) side.
posted by iminurmefi at 7:03 AM on September 20, 2011
Coverage by Type of Health Insurance
The only chart I can recall that purports to show the entire U.S. health care system is this one from TNR:
Health Care Map
However I personally think that graphic obscures a lot more than it clarifies. There are a lot of government agencies involved in the delivery side of health care that are omitted from that chart but it's probably the closest you're going to get.
And just as a side note: this may be totally 'duh' obvious, so apologies for stating it, one of the reasons it's so difficult to show "the entire U.S. population broken down by who's covered under private and public insurance that drills into specific number of insured lives for the larger private and public payer systems" is because on the delivery side--unlike the financing side--it's not split into private and public payer systems. There is a rather small public delivery system, consisting of things like community health centers or federally qualified health centers (funded by HRSA), community mental health centers (funded by SAMHSA), public mental hospitals (funded by states), publicly-owned safety net hospitals (self-sustaining or supported somewhat by tax revenue on the local level), and the veterans health administration system (funded by the VA). For *all* of those delivery sites, you're going to see a mix of people served in terms of health insurance coverage; for example, community health centers serve a low-income population that may be 1/3 Medicaid and CHIP, 1/3 private health insurance, and 1/3 uninsured. The private delivery system (most doctors, hospitals, and drug companies)--which makes up the vast majority of the delivery system--provides care for people receiving insurance on both the public (Medicare, Medicaid, CHIP, military health insurance) and the private (employer-based insurance, direct purchase insurance, and out-of-pocket or uninsured) side.
posted by iminurmefi at 7:03 AM on September 20, 2011
Response by poster: Iminurmefi, thanks for the direct link to the most recent Census data. I do understand how delivery is all mixed together, but no worries - it's good to see some breakdowns just for my own education.
Although I didn't make it particularly clear in my question, I'm more interested in illustrating the healthcare coverage market (that is, insurance) than delivery per se. For my European colleagues it's very hard to understand the concept of how drugs get added to U.S. formularies once they're FDA-approved, and what influences the decision to choose, say, a generic vs. a brand drug. In Europe you have direct negotiation with public payers and winner-takes-all bids, but in the U.S., that just doesn't exist. So my hope is to give them a picture of how many elements there are involved in formulary decisions (because there are so many different payers that drug manufacturers negotiate directly or indirectly with for access/price), and then also which of those coverage systems are most relevant by market share.
I thought I might find some good starting points with some kind of "by the numbers" picture of the channels through which people in the U.S. get healthcare, but I suspect I'll have to make my own illustration.
posted by deludingmyself at 10:39 AM on September 20, 2011
Although I didn't make it particularly clear in my question, I'm more interested in illustrating the healthcare coverage market (that is, insurance) than delivery per se. For my European colleagues it's very hard to understand the concept of how drugs get added to U.S. formularies once they're FDA-approved, and what influences the decision to choose, say, a generic vs. a brand drug. In Europe you have direct negotiation with public payers and winner-takes-all bids, but in the U.S., that just doesn't exist. So my hope is to give them a picture of how many elements there are involved in formulary decisions (because there are so many different payers that drug manufacturers negotiate directly or indirectly with for access/price), and then also which of those coverage systems are most relevant by market share.
I thought I might find some good starting points with some kind of "by the numbers" picture of the channels through which people in the U.S. get healthcare, but I suspect I'll have to make my own illustration.
posted by deludingmyself at 10:39 AM on September 20, 2011
If you're specifically interested in drugs, then I think you might be able to pull some graphics from the latest IMS market report. See, for example, page 13 on that report--it shows a breakdown of the number of prescriptions filled nationally by the primary payer (Medicare, Medicaid, cash, or private insurance).
Looking at that breakdown by dollars (available from the National Health Expenditure Accounts) rather than number of prescriptions shifts the numbers a fair bit as Medicare/Medicaid beneficiaries tend to be filling more expensive drugs on average than the commercially-insured. The NHEA also gives you a much more detailed look at which government programs are paying for prescription drugs--not just Medicare/Medicaid, but also CHIP and veterans health and the DoD.
With commercial insurance, which makes up between 45-65% of the prescription drug market depending on how you measure it, what you'd ideally like to find in order to illustrate your point to your European colleagues is the percentage of commercial plans nationally that contract out the negotiating and formulary-creation process to a Pharmacy Benefits Manager (PBM). I'm not sure of a good source of data for that, though--sorry.
posted by iminurmefi at 12:30 PM on September 20, 2011
Looking at that breakdown by dollars (available from the National Health Expenditure Accounts) rather than number of prescriptions shifts the numbers a fair bit as Medicare/Medicaid beneficiaries tend to be filling more expensive drugs on average than the commercially-insured. The NHEA also gives you a much more detailed look at which government programs are paying for prescription drugs--not just Medicare/Medicaid, but also CHIP and veterans health and the DoD.
With commercial insurance, which makes up between 45-65% of the prescription drug market depending on how you measure it, what you'd ideally like to find in order to illustrate your point to your European colleagues is the percentage of commercial plans nationally that contract out the negotiating and formulary-creation process to a Pharmacy Benefits Manager (PBM). I'm not sure of a good source of data for that, though--sorry.
posted by iminurmefi at 12:30 PM on September 20, 2011
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1) United States health care spending
2) Nation Master
3) Government Documents
. Link moved but you can follow up.
4)Health Statistics. Excellent resource for additional statistics.
I have many more--I just picked a few. If you want several more email me and I fill find a more convenient way to get them to you. Also check--World Health Organization (WHO) Most of the above have some graphical representations of data.
posted by rmhsinc at 5:59 PM on September 19, 2011