THE AMERICAN THE AMERICAN MEDICAL SYSTEMMEDICAL SYSTEM

C. Antonio Jesurun, MDC. Antonio Jesurun, MD

Professor PediatricsProfessor Pediatrics

HEALTHCARE HEALTHCARE SPENDINGSPENDING

US-$1.55 billion or 14% GDPUS-$1.55 billion or 14% GDP Texas-$105.5 million or 11.7 % Texas-$105.5 million or 11.7 %

GSPGSP

US HEALTHCARE US HEALTHCARE SPENDINGSPENDING

Hospital Care 36.5%  Hospital Care 36.5%   Physician & Other Professional Physician & Other Professional

Services 28.8%  Services 28.8%   Prescription Drugs 12.2%  Prescription Drugs 12.2%   Nursing Home Care 7.4%  Nursing Home Care 7.4%   Dental Services 5.3%  Dental Services 5.3%   Home Health Care 2.8%  Home Health Care 2.8%   Other Medical Nondurables 2.1%  Other Medical Nondurables 2.1%   Medical Durables 1.5%  Medical Durables 1.5%   Other Personal Health Care 3.4% Other Personal Health Care 3.4% 

US HEALTHCARE US HEALTHCARE SPENDINGSPENDING

  Elementary & Secondary Higher Elementary & Secondary Higher Education Public Education Public Assistance Medicaid Corrections TrAssistance Medicaid Corrections Transportation All Other ansportation All Other United States   35.7%  11.9%  2.3%  16.9%  7.0%  0. 35.7%  11.9%  2.3%  16.9%  7.0%  0.6%  25.6%6%  25.6%

Texas   41.3%  17.1%  0.9% 19.8%  10.9%  0 41.3%  17.1%  0.9% 19.8%  10.9%  0%  10.1%%  10.1%

Federal Poverty Federal Poverty GuidelinesGuidelines

United States PercentUnited States Percent Under  Under 100% 17%  100-199% 19%  --Low 100% 17%  100-199% 19%  --Low Income Subtotal 36%  200% Income Subtotal 36%  200% + 64%+ 64%

TexasPercentTexasPercent  Under  Under 100% 22%   100-199% 21%   --100% 22%   100-199% 21%   --Low Income Subtotal 43%   200% Low Income Subtotal 43%   200% + 57%+ 57%

HMOHMO

PPOPPO

Govenrnment Govenrnment ResponsibilitiesResponsibilities

MedicareMedicare MedicaidMedicaid SCHIPSCHIP SSISSI VAVA Indian Health serviceIndian Health service GMEGME

MEDICAREMEDICARE

Over age 65Over age 65 Legally BlindLegally Blind Certain DisabilitiesCertain Disabilities End-stage renal diseaseEnd-stage renal disease

MEDICAREMEDICARE

Part A-HospitalizationPart A-Hospitalization– payroll taxespayroll taxes

Part B-Physician’s fees & home Part B-Physician’s fees & home healthhealth– Pay premium $78.20/monthPay premium $78.20/month

Part D-DrugsPart D-Drugs– Pay premiumPay premium

ALL FEDERAL ALL FEDERAL PROGRAMSPROGRAMS

BudgetBudget Cost-controlCost-control

MEDICAIDMEDICAID

Low income families who have:Low income families who have: PregnancyPregnancy Disabilities-including blindnessDisabilities-including blindness ChildrenChildren Eligibility set by stateEligibility set by state Different formulas/state/federal Different formulas/state/federal

gov.gov.

MEDICAIDMEDICAID

SCHIPSCHIP

Matching Federal/State fundsMatching Federal/State funds Eligibility and benefits packages Eligibility and benefits packages

determined by each statedetermined by each state Premium paid by family for Premium paid by family for

children not eligible for medicaidchildren not eligible for medicaid

TerminologyTerminology

Disproportionate share funding Disproportionate share funding (DSH)(DSH)

Upper payment level (UPL)Upper payment level (UPL) EMTALAEMTALA