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THE AMERICAN MEDICAL SYSTEM

THE AMERICAN MEDICAL SYSTEM. C. Antonio Jesurun, MD Professor Pediatrics. HEALTHCARE SPENDING. US-$1.55 billion or 14% GDP Texas-$105.5 million or 11.7 % GSP. US HEALTHCARE SPENDING. Hospital Care 36.5%   Physician & Other Professional Services 28.8%   Prescription Drugs 12.2%  

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THE AMERICAN MEDICAL SYSTEM

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  1. THE AMERICAN MEDICAL SYSTEM C. Antonio Jesurun, MD Professor Pediatrics

  2. HEALTHCARE SPENDING • US-$1.55 billion or 14% GDP • Texas-$105.5 million or 11.7 % GSP

  3. US HEALTHCARE SPENDING • Hospital Care 36.5%   • Physician & Other Professional Services 28.8%   • Prescription Drugs 12.2%   • Nursing Home Care 7.4%   • Dental Services 5.3%   • Home Health Care 2.8%   • Other Medical Nondurables 2.1%   • Medical Durables 1.5%   • Other Personal Health Care 3.4% 

  4. US HEALTHCARE SPENDING •  Elementary & Secondary Higher Education Public Assistance Medicaid Corrections Transportation All Other United States 35.7%  11.9%  2.3%  16.9%  7.0%  0.6%  25.6% • Texas 41.3%  17.1%  0.9% 19.8%  10.9%  0%  10.1%

  5. Federal Poverty Guidelines • United States Percent Under 100% 17%  100-199% 19%  --Low Income Subtotal 36%  200% + 64% • TexasPercent  Under 100% 22%   100-199% 21%   --Low Income Subtotal 43%   200% + 57%

  6. HMO

  7. PPO

  8. Govenrnment Responsibilities • Medicare • Medicaid • SCHIP • SSI • VA • Indian Health service • GME

  9. MEDICARE • Over age 65 • Legally Blind • Certain Disabilities • End-stage renal disease

  10. MEDICARE • Part A-Hospitalization • payroll taxes • Part B-Physician’s fees & home health • Pay premium $78.20/month • Part D-Drugs • Pay premium

  11. ALL FEDERAL PROGRAMS • Budget • Cost-control

  12. MEDICAID • Low income families who have: • Pregnancy • Disabilities-including blindness • Children • Eligibility set by state • Different formulas/state/federal gov.

  13. MEDICAID

  14. SCHIP • Matching Federal/State funds • Eligibility and benefits packages determined by each state • Premium paid by family for children not eligible for medicaid

  15. Terminology • Disproportionate share funding (DSH) • Upper payment level (UPL) • EMTALA

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