1 health policy issues facing states Dr. Jeanne Wendel

2 Consumer protection Competition State healthcare functions:(define licensure and scope of practice for medical professionals) Competition (among healthcare providers and health insurers) State healthcare functions: Payers: Medicaid recipients Prisoners Employees & retirees Public Health * Insurance Regulation

3 Payers for Medicaid recipients Prisoners Employees & retirees

4 Healthcare expenditures increasingtough choices

5 $$$ new treatments extend life.Will Medicaid cover them? Prison system?

6 When they consider these decisions: Serious IssuesHealth inequality State budget reality Costs and benefits of new technology

7 chart, http://www. ssa. gov/policy/docs/workingpapers/wp108health inequality

8 Ed. HHS

9 “cost-containment” ?

10 What is fueling the cost increases?Population aging Lack of competition Patients don’t shop wisely don’t embrace healthy behaviors Insurance companies/providers/ are “greedy” Real income has been increasing R&D Empirical evidence

11 Are the new treatments a good use for our money? Are the new treatments a good use for our money

12 actions outside the healthcare system that prevent injuries and illnesses:Highway design improvements EPA regulations to reduce chemical exposures Criteria for comparing costs & benefits Willing to spend: $100,000 - $150,000 per life-year

13 Cardiac care improved ≈ 1990Average $ per patient increased $10,000 Average life expectancy increased by 1 year

14 Has Medical Innovation Reduced Cancer Mortality? (pub. 2013): age-adjusted cancer mortality rate decreased 19% 2/3 of this decline: drug innovation and imaging innovation Value of the reduced mortality > cost of the drugs

15 Compared to spending to prevent injuries and illnesses, the new treatments are cost-effective.

16 Other options to reduce healthcare expenditures?

17 Efficiency revolutionstax accountants Simple tax returns: cheaper Turbotax Small retail High prices Lower prices Big box stores Word processing = mainframe task Specialists Desktops Laptops tablets Better cheaper faster

18 Efficiency revolutions Simple tax returns: cheapertax accountants Simple tax returns: cheaper Turbotax New definition of “the product” Less personal interaction (DIY) Only relevant for “simple” tax returns (still need skilled tax accountants for complex returns) Algorithm captures the logic  individuals can implement the process at home

19 Is the medical version of turbo-taxgood for patients? New types of providers New roles for consumer-patients

20 New types of providers: retail clinicsNurse practitioners Offer services with clear protocols Customer service Extended hours Drop-in Wait times ~15 min.

21 changing roles for patients and providers New electronic devices? changing roles for patients and providers New electronic devices Eric Topol (cardiologist):

22 For use in developing countriesProduction cost = $2. For use in developing countries

23 optometry licensure and scope of practiceWill you be allowed to purchase eyeglasses with a prescription written by your cell phone? State law: optometry licensure and scope of practice

24 Who should make the decision? What criteria should be used?If: Quality is lower than quality offered by optometrist Cost is substantially less Who should make the decision? What criteria should be used?

25 FDA approval of at-home screening test for colon cancer:Quality of the test is not as good as in-office test More people will be screened CDC: a good test for colon cancer is a test that people will complete.

26 Consumer protection increasingly important increasingly complexHealthcare quality Low cost Patient empowerment Health outcomes

27 Retaining in-state control vs. larger market area?Interstate competition Join the interstate insurance compact? Interstate medical licensure compacts? Telemedicine?

28 Interstate competition:Join the interstate insurance compact? Interstate medical licensure compacts? Telemedicine?

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30 Interstate issues Join the interstate insurance compact?Interstate Medical licensure compacts? Foreign medical graduates? Telemedicine?

31 State Boards of NursingState Medical Boards State Boards of Nursing State Psychology Boards State Boards of Physical Therapy

32 Nurse Licensure Compactallows nurses to have one multistate license Source: National Council of State Boards of Nursing

33 Interstate issues Join the interstate insurance compact?Interstate Medical licensure compacts? Telemedicine?

34 http://www. americantelemed

35 Regulators peer into the future.What policies balance cost and consumer protection issues for patients in NV?

36 How much/ what types of innovation are good for patients?How much competition is optimal? (insurance/ healthcare)

37 Implications of competition over a wider geographic area for healthcare in Nevada? Reduce range of services provided locally Allow new types of competition Lower prices for services

38 https://members.aamc.org

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40 College of Business resources to support and facilitate discussionCould people with business acumen enrich the discussion? College of Business resources to support and facilitate discussion Economists: Jeanne Wendel + Sankar Mukhopadhay (healthcare industry issues, HIE, and econometric analyses of employer wellness program, prenatal care, impacts of incentives on youth BMI reduction) University Center for Economic Development: Tom Harris (rural hospital issues and economic impact of healthcare industry in NV) Loretta Singletary (facilitating collaborations) Information Systems: Dana Edberg