LDI Health Policy Seminar "Will Health Costs Bury American Manufacturing?" A View from Detroit Mark A. Kelley, M.D. Chief Henry Ford Medical GroupSlide 2
Henry Ford and Detroit - 1915Slide 3
Henry Ford and Detroit - 1915 Explosive development in auto generation 1913-15 300,000 autos yearly = 1/3 of the world\'s creation Recruited representatives from migrants and the South Large new plant on edges of town Highland Park – first significant sequential construction systemSlide 4
Henry Ford\'s "Modern Approach" to Health Care Employed full-time doctors, some enrolled from the East Full doctor\'s facility administer to altered cost ($5/day = day by day wage); no protection Latest innovation – clinic composed by Ford engineersSlide 5
The Auto Industry Labor Movement Brief History 1930-1940 UAW established in 1930s by Walter Reuther After common distress, work sorted out in Big Three (Ford toward the end in 1941) Major issues; working conditions, time-based compensationsSlide 6
The Auto Industry Labor Movement Brief History 1941-1950 Post war blast, rural extension, national roadway framework American auto ruled; rural livingSlide 7
The 1950\'s – Labor\'s Heyday 1950 : GM gifts annuities and programmed wage modification 1955 : Ford consents to unemployment advantages 1956 : UAW makes medical coverage organization – Health Alliance Plan (HAP) Mid 1950s : Major strikes in steel, coal industrySlide 8
Henry Ford Hospital – 1950s Regional scholarly restorative focus, backing of Ford family Ranked #6 doctor\'s facility in the country Major national preparing focus "Go-To" place in MichiganSlide 9
Troubles in the Motor City 1965-1975 Urban uproars disable Detroit Invincible picture of vehicle industry harmed Racial polarization Massive populace movement to rural areas "Athens of the Midwest" brokeSlide 10
Troubles in the Motor City 1965-1975 1973: Oil emergency requests fuel productive autos 1970s: American auto quality vacillates Honda, Toyota pick up business sector decent footing, by means of expense and qualitySlide 11
Henry Ford Hospital Becomes a System "White flight" to rural areas cracks the city foundation Hospital recognized as arranging zone for National Guard Launches first "satellite" to pull in rural patientsSlide 12
The 1980s: Save the Industry! Government bailout of Chrysler Corporation Focus on quality ("Job #1" at Ford) Young and alarmed workforce ("children of post war America") More collaborating with work and administrationSlide 13
Big Three Approach to Health Care – 1980-90s Predictable expenses without work strife HMO prepayment appealing for: Population-based aversion Community-based premium Little cost to representatives Arms length association with social insurance, aside from in the working environment This technique, energized by oversaw rivalry worldview, functioned admirably—for some timeSlide 14
HFHS Response 1980-99 Suburban rivalry HMO (HAP) obtained for access to UAW System develops rural essential care and secures local doctor\'s facilities Integrated conveyance framework as survival procedureSlide 15
OOPS!! Wellbeing Costs Are Out of Control (Again)Slide 16
GDP per Capita to % GDP Spent on Health Care: OECD Countries Source: Anderson, Health Affairs 22:2003Slide 17
Failure of Employer-Based Health Insurance Demand for decision vanquished HMO procedure Cannot confine supplier choice; social insurance conveyance divided Liability danger of limiting access Populations don\'t cost $$; high hazard patients represent 80% of costs Inability to check innovation development Source: Enthoven, Health Affairs, Spring 2003Slide 18
The Big Three\'s Health Crisis in 2003 Flat HMO premiums in 1990s impelled impermanent benefits Rebound of twofold digit premium expansion Unique issues: Aging workforce (normal age 45) Lifetime wellbeing scope past Medicare Higher actuarial danger workforce None of these issues are shared by universal contenders!Slide 19
18.2% 17.7% 18.0% 14.0% 13.5% 13.2% 13.0% 12.0% 11.7% 11.0% 10.4% 10.0% 9.0% 8.1% 8.0% 6.5% 5.7% 3.2% 2.1% 3.0% - 0.4% - 0.5% - 2.0% 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 Premium Inflation is Significant HMO Premium versus HMO Cost Increases 1988 - 2006 Annual premium expands MD I/P Rx 1999 2000 2001E 2002E 2003E 2004E 2005E 2006E Source: Salomon Smith Barney Research gauges in view of information from CMS, Milliman USA, AAHP, KPMG.Slide 20
Big Three Pays $900 More for Health Care per Vehicle Reasons: Rich post-retirement advantages for maturing workforce Workers resign well before age 65 First $ scope for most hourly laborers No national arrangement on innovation or medicationsSlide 21
Big Three\'s Challenges Reflect Those of the Nation Big Three couldn\'t anticipate or control: enhanced future innovation and drug store multiplication American human services consumerism Big Three ought to have anticipated impacts of: the child of post war America workforce life time social insurance advantages rich drug store advantages These are the exceptionally same issues confronting Medicare!Slide 22
The Auto Industry\'s Position on Health Care - 2003 The business case for quality functioned admirably for the Big Three producers – medicinal services ought to take after! Certainties: There is waste in social insurance, uneven quality, little institutionalization Health watch over quality and cost Health consideration is conveyed locally as a bungalow industry Human conduct is not effectively builtSlide 23
USA Health Expenditures Annual Percentage Growth Source: Levit, Health Affairs 21:2002Slide 24
Hospital Days/Capita 2000Slide 25
MD Visits/Capita 2000Slide 26
CT Scanners per Million Pop., 2000Slide 27
Angioplasties/100,000 1999Slide 28
Pharmaceutical Costs per Capita-2000 Source: Anderson, Health Affairs 22:2003Slide 29
2. Social insurance costs an excessive amount of and suppliers drive the inflation Facts: UAW contracts are excessively rich Hospital and drug store costs have commanded expansion U.S. specialists procure moderately the same western partners Utilization of wellbeing administrations same as other western countriesSlide 30
UAW Public Position on Health Care Etiology of issue: Administrative expenses of private protection For benefit segments of the business "Restorative weapons contest" Solution: National health care coverage and approach Positions: Support drug store advantage Oppose wellbeing vouchers/characterized commitments Support solid CON handle Source: UAW site 2003Slide 31
You be the Quarterback #1 What might be your prompt medicinal services technique on the off chance that you were: The UAW the Big ThreeSlide 32
Features of 2003 UAW Contract UAW Gains: 2-3% wage increment (past COLA) most recent two years of agreement Expanded therapeutic scope; retirees secured Pension increments for future retirees Unionize suppliersSlide 33
Features of 2003 UAW Contract Company Gains: Bonuses rather than compensation builds (saves the base) No expansions for current retirees Permission to offer/close plants Tighter remedy controlSlide 34
UAW Medical Benefits – Contract History 1993: Fully paid advantages, no new co-pays 1996: Drug co-pay up from $3 to $5. new individuals must enlist in HMO for a long time 1999: Expanded preventive consideration; compulsory HMO enlistment for a long time 2003: Expanded preventive consideration; three level medication co-pay; $10 office co-pay; HMO prerequisite dropped Source: Detroit Free Press 9/19/2003Slide 35
Henry Ford Health System\'s Perspective Financial Crisis 1998-2001 in view of capitation and level premiums Stability with twofold digit premium ascent Dilemma of owning a HMO Autos need to beat wellbeing expansion (by one means or another) Changing Delivery Tactics HMO worldview constrained Kaiser mindset Move to PPO permits equalization of AMC and conveyance framework AMC can\'t make due on capitation – no edgeSlide 36
Henry Ford Health System\'s Perspective Politics Underfunded, inadequately oversaw Medicaid Failing security net in Detroit Auto industry controls innovation through CON Recent enactment for HFHS rural doctor\'s facilitySlide 37
Henry Ford Health System\'s Perspective Patients Clueless about advantages (aside from drug store) Insurance scope always moving Two salaries normal Quality No advancement in paying for quality (in spite of Leapfrog) Early examinations about unending sickness administration Autos view medicinal services as a HR issueSlide 38
You be the Quarterback #2 As the auto organization executive accountable for social insurance, what is your long haul methodology to take care of the human services issue?Slide 39
What are the Options for the Big Three? Lessen Health Care Costs Curb social insurance innovation multiplication Local: CON, HMOs as slow down strategies National: No footing aside from in Medicare Push more cost choices to workers PPO\'s versus shut system Higher co-pays (ERs) Tiered drug store advantages Other moves – troublesome with national stage Reduce authoritative costs/waste Chronic infection administration May see significant bosses adjustSlide 40
Health Care\'s "Shut Box" . Representative Health $$ Health Providers Company GovtSlide 41
What are the Options for the Big Three? Entryway for National Health System/More Medicare Benefits Strong accentuation on solutions Aggressive methodology constrained by: Lack of political will in Washington Threat of expanded duties Other Tactics: Leverage neighborhood providers– just works in one industry town Hit UAW contract harder Restrict future advantagesSlide 42
What are the Options for the Big Three? Doomsday Scenario: Move fabricating seaward Developing nations have lower costs (for everything) American interest for low value favors seaward Detroit confronts same emergency as Boston and NYC did in 1900s Irony: For Toyota, "seaward" is American SouthSlide 43
HFHS Long Range Tactics Work to Curbs Costs when Possible Chronic infection administration (perhaps) Educate patients about buying decisions Re-engineer hone (like assembling) To enhance access Reduce revamp (quality and correspondence) Use elective techniques (open
with them their music (Dixieland and Jazz!) Detroit. 1960s mid 1970s ... Reconciliation of Popul ...
I Come to Bury Agile, Not to Praise It Effective Software Development in the 21st Century Al ...
Story of Diversity: Not a solitary ordeal or single
Voltage Dip Contracts Between Detroit Edison and Automobile Manufacturers ... Erich W. Gunther, ...
Breen N, Woods J, Bury G, Murphy A, Brazier H. A national enumeration of rescue vehicle reaction ...
1. Direct and fork get together 2. Edge wheel gathering 3. Deck gathering ... Roundup(700/202.3) ...
?. . . ?. . . About us:. Lord Edward VI School. Cover St Edmunds. 13-18 upper schoolMixed town/c ...
Robert Hayden (1913-1980). Conceived August fourth, 1913 as Asa Bundy Sheffey in Detroit, Michig ...
Supplement Nine. Utilizing direct relapse to partitioned altered and variable work costs. Chart ...
Financial Costs. Monetary expenses are the expenses confronted when choosing how to utilize reso ...
Content. Expenses Fixed/variableDirect/indirectRevenueProfit Contribution Break Even Analysis. C ...
Expense of value. Counteractive action costsAppraisal costsInternal disappointment costsExternal ...
Pre-healing facility crisis care . Drivers for changeComhairle - Report of the Committee on A
Financial COSTS. Monetary Costs or Opportunity CostsForgoing the chance to deliver option mercha ...
Why consider kanban control?. Lower stock investmentBetter
Picture Based Rendering. . . . . Geometry-based. Picture based. . Display/Environment Map. . Spr ...
2. Recognize the key part of expense allocationExplain the moral issues of expense allocationUse ...
2 SIDES TO VOLUNTARY TURNOVER. FIRM\'S VIEW Replacement Costs Loss of venture. WORKER\'S VIEWDir ...
Target I: Facilitate access to an incorporated database comprehensive of physical wellbeing and ...