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
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