Meets September – June

The Health Care Committee works to analyze the current state of health care in San Mateo County and relates it to those developments locally, statewide and nationally.  The perspectives below give a sampling of the issue the Committee must embrace and  then determine positions which serve the Voice of Business as well as the welfare of those in need. Positions are recommended to the Board for action.  Committee also works to collaborate with other related agencies, organizations and government.

ISSUE OVERVIEWS: Throughout our country, there is widespread agreement that the health care system is too expensive and inefficient, yet there is little agreement on what reforms and solutions we need. Despite this lack of consensus, changes are underway, including here in this region, which could lead to permanent structural improvements in cost and quality.

Any discussion of the health care system in San Mateo County and, indeed, the United States, requires careful definition. First, is health care a quality of life or a cost of doing business issue?  Is there a greater social good or a long term cost incentive in providing universal access to care? While the system provides for our wellbeing, a deeply personal human need, it is provided as a quantified benefit of employment, or even a government sponsored program. In addition, any significant changes in the regulation of the system could pose a potential threat to its cluster of supporting industries.

According to the Centers for Medicare & Medicaid Services, health care expenditures in the US were over $1,877 billion in 2004; this represented about 16% of GDP. Per capita expenditures were $6,280 per person in the same year.  How, therefore, do we approach reform and improvements in the system? What best practices and emerging trends hold the most promise? This section will offer some different perspectives and seek to identify common ground.

The Employer Perspective
Costs, as measured by annual premium increases, are rising at a rapid rate. Many recent studies peg the rate of increase in health care costs in the US ranging from 812% per year over the past 5 years, compared with an economy growing at 4% or less. Regional business leaders are becoming more interested about the system, due largely to increased healthcare costs. Hospitals, clinics, medical practices, insurers, biotech and pharmaceutical companies, and medical device companies are among the major business interests in the health care field.

The Consumer
According to the Centers for Medicare & Medicaid Services, households expended 32% of the dollars for health care in the US in 2003. Private sector employers represented 26%, and the government paid 39%.

While a plurality of health care expenses continue to be borne by government, the trend in spending is toward greater consumer costs and away from employer costs. There are several components to this equation: increased employee participation in their premiums, larger co-pays, and a new "consumerism" represented by trends such as high deductible plans with health savings accounts. Ideally this trend would also reflect a growing number of individuals having insurance coverage; unfortunately, it is not. Rates of uninsured adults continue to rise in the US.

The interest of the medical community in adopting evidence-based medicine is increasing. This body of practice emphasizes clinically validated best practices and protocols, an area that has been somewhat neglected in the past. These practices are as simple as regularizing inventory control procedures for drugs, or more complicated, such as adopting four effective practices to prevent ventilator acquired pneumonia (VAP). While not every aspect of evidence based medicine will be adopted by all practitioners (or institutions), there is great promise for increased effectiveness and decreased avoidable errors, which have very dear human and fiscal costs.

While it appears that Americans on the whole are becoming less healthy, the resurgence of wellness programs discussed in last year's Projections continues. As data continues to point towards greater proportions of obesity and other risk factors for complex chronic illnesses (diabetes, heart disease, etc.), prevention has never been more important.   Current budget constraints make these programs difficult to begin and sustain.