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%
   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%
        US HEALTHCARE
          SPENDING
    Elementary & Secondary Higher
    Education Public
    Assistance Medicaid Corrections T
    ransportation 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%
         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%
HMO
PPO
           Govenrnment
          Responsibilities
   Medicare
   Medicaid
   SCHIP
   SSI
   VA
   Indian Health service
   GME
            MEDICARE

   Over age 65
   Legally Blind
   Certain Disabilities
   End-stage renal disease
               MEDICARE

   Part A-Hospitalization
    – payroll taxes
   Part B-Physician’s fees & home health
    – Pay premium $78.20/month
   Part D-Drugs
    – Pay premium
ALL FEDERAL PROGRAMS

   Budget
   Cost-control
              MEDICAID

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

   Matching Federal/State funds
   Eligibility and benefits packages
    determined by each state
   Premium paid by family for children
    not eligible for medicaid
            Terminology

   Disproportionate share funding (DSH)
   Upper payment level (UPL)
   EMTALA