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Code Red The Critical Condition of Health Care in Texas 2006 Texas Oral Health Summit For Healthy Beginnings November 17, 2006 George B. Hernandez, President/CEO, University Health System. Task Force organized in July 2004 - PowerPoint PPT Presentation
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Code RedCode Red The Critical Condition of The Critical Condition of
Health Care in TexasHealth Care in Texas
2006 Texas Oral Health Summit
For Healthy Beginnings
November 17, 2006
George B. Hernandez, President/CEO, University Health System
Task Force organized in July 2004
Sponsored by the 10 major academic health institutions in Texas and 6 health institutions of the UT System
Nonpartisan group of 19 individuals representing business community, medical schools, health care industry and local government leaders
HistoryHistory
Task force was committed to preparing a high quality analysis of indigent health care data to policy makers, health care groups and public
Final Report released 18 months later; “Code Red: The Critical Condition of Health in Texas”
Website: www.CodeRedTexas.org
The ReportThe Report
We’re Employed - 79% are Texans who work or have a working family member
We’re Texas/U.S. Citizens - 76-82% of the uninsured are U.S. citizens
We’re Children – 22% of Texas children are uninsured (national average is 12%)
We’re Working/Non-poor – fastest growing group of uninsured individuals
Who are the uninsured? Who are the uninsured?
Uninsured ResultsUninsured Results
1million do not receive care for their chronic diseases
3 million uninsured Texans less likely to receive preventative care and screening services
5.6 million continuously without health insurance throughout the year
8.5 million without insurance at some point of the year
Why Are Texans Uninsured?
High Premiums – Average cost of health insurance premiums is $9,100
State Medicaid Program – Medicaid does not cover most adults
County Indigent Care Program – current state program affords no real coverage
Uninsured Results Uninsured Results continuedcontinued
Bankruptcies - medical expenses leading cause of personal bankruptcies
Lower Quality of Life – poor health compromises quality of life, educational attainment, workforce efficiency
Higher Premiums - responsibility of providing care is borne by insured individuals and businesses
Higher Local Taxes - burden on local taxpayer increases to cover the community’s uninsured
FindingsFindings
We’re Number One – Highest percentage of uninsured in the country (25.1%) totaling 5.6 million Texans
Texas cannot sustain the continued rise in the cost of providing care to uninsured
Emergency Room services over-extended, improperly used for primary care
Ambulatory (outpatient) strategies need development and investment
FindingsFindings (continued) (continued)
County based approach to funding health care is inadequate
Texas needs to leverage federal matching funds
Shortage in healthcare professionals adds to the cost
Healthcare for the mentally ill continues to be a challenge (and expense) for Texas
Trauma Service Area-P
AACOG Counties
Wilson307 Unfunded Visits
Cost:$335,400Reimb:$47,900
Loss: ($287,400)
Wilson307 Unfunded Visits
Cost:$335,400Reimb:$47,900
Loss: ($287,400)
Karnes62 Unfunded Visits
Cost:$168,600Reimb:$7,500
Loss :($161,038)
Karnes62 Unfunded Visits
Cost:$168,600Reimb:$7,500
Loss :($161,038)
Guadalupe689 Unfunded Visits
Cost:$498,300Reimb:$87,900
Loss: ($410,400)
Guadalupe689 Unfunded Visits
Cost:$498,300Reimb:$87,900
Loss: ($410,400)
Comal548 Unfunded Visits
Cost:$626,300Reimb:$108,400Loss:($517,900)
Comal548 Unfunded Visits
Cost:$626,300Reimb:$108,400Loss:($517,900)
Frio167 Unfunded Visits
Cost:$339,900Reimb:$19,100
Loss: ($320,700)
Frio167 Unfunded Visits
Cost:$339,900Reimb:$19,100
Loss: ($320,700)
Gillespie48 Unfunded VisitsCost:$97,100Reimb:$29,600Loss: ($67,500)
Gillespie48 Unfunded VisitsCost:$97,100Reimb:$29,600Loss: ($67,500)
Kendall393 Unfunded Visits
Cost:$418,900Reimb:$70,400
Loss: ($348,500)
Kendall393 Unfunded Visits
Cost:$418,900Reimb:$70,400
Loss: ($348,500)
Kerr111 Unfunded Visits
Cost:$362,400Reimb:$31,700
Loss: ($330,700)
Kerr111 Unfunded Visits
Cost:$362,400Reimb:$31,700
Loss: ($330,700)Bandera
306 Unfunded VisitsCost:$393,428
Reimb:$110,200Loss: ($283,200)
Bandera306 Unfunded Visits
Cost:$393,428Reimb:$110,200Loss: ($283,200)
Medina360 Unfunded Visits
Cost:$430,800Reimb:$37,600
Loss: ($393,200)
Medina360 Unfunded Visits
Cost:$430,800Reimb:$37,600
Loss: ($393,200)
Atascosa683 Unfunded Visits
Cost:$1,144,000Reimb:$18,425
Loss: ($1,125,000)
Atascosa683 Unfunded Visits
Cost:$1,144,000Reimb:$18,425
Loss: ($1,125,000)
Bexar County: 2005 Uncompensated Care CostsBexar County: 2005 Uncompensated Care Costs
Trauma Service Area-P
AACOG Counties
Real21 Unfunded
VisitsCost: $21,500Reimb: $445Loss: ($21,100)
Real21 Unfunded
VisitsCost: $21,500Reimb: $445Loss: ($21,100)
Maverick97 Unfunded VisitsCost: $386,400Reimb: $6,200Loss: ($380,200)
Maverick97 Unfunded VisitsCost: $386,400Reimb: $6,200Loss: ($380,200)
Zavala49 Unfunded VisitsCost: $134,600Reimb: $2,200Loss: ($132,400)
Zavala49 Unfunded VisitsCost: $134,600Reimb: $2,200Loss: ($132,400)
Uvalde111 Unfunded VisitsCost: $270,900Reimb: $15,500Loss: ($255,500)
Uvalde111 Unfunded VisitsCost: $270,900Reimb: $15,500Loss: ($255,500)
Kinney5 Unfunded VisitsCost: $25,700Reimb: $2,100Loss: ($23,600)
Kinney5 Unfunded VisitsCost: $25,700Reimb: $2,100Loss: ($23,600)
Edwards4 Unfunded VisitsCost: $2,326Reimb: $866Loss: ($1,400)
Edwards4 Unfunded VisitsCost: $2,326Reimb: $866Loss: ($1,400)
Val Verde45 Unfunded Visits
Cost: $64,100Reimb: $4,000Loss: ($60,100)
Val Verde45 Unfunded Visits
Cost: $64,100Reimb: $4,000Loss: ($60,100)
La Salle52 Unfunded VisitsCost: $159,200Reimb: $21,300Loss: ($137,900)
La Salle52 Unfunded VisitsCost: $159,200Reimb: $21,300Loss: ($137,900)Dimmit
80 Unfunded VisitsCost: $315,000Reimb: $750Loss: ($314,200)
Dimmit80 Unfunded VisitsCost: $315,000Reimb: $750Loss: ($314,200)
Gonzales37 Unfunded VisitsCost: $61,576Reimb: $23,100Loss: ($38,400)
Gonzales37 Unfunded VisitsCost: $61,576Reimb: $23,100Loss: ($38,400)
Bexar County: 2005 Uncompensated Care CostsBexar County: 2005 Uncompensated Care Costs
Funding RecommendationsFunding Recommendations
Increase Statewide FPL from 21% to 100%
Maximize State Match of Federal Medicaid Program Dollars
Create incentives for small businesses to provide employee health care insurance
Establish Quality Assurance Fee for health care providers
Policy RecommendationsPolicy Recommendations
Move from a County Based Delivery Model
Expand coverage through CMS Waivers, Pilot Programs, Grants
Create a local structured and connected system of care
Increase/develop community ambulatory care facilities and services
Education and Prevention
Findings – Success in education is closely linked to health status Recommendation - Integrated approach to school health includes an emphasis on nutrition, exercise, dental health, and disease managementHealth Programs in dental hygiene are valuable in view of the prevalence of dental disease
ConclusionConclusion
Is NowIs Now the time for Texas to take bold stepsbold steps to address the problems with the lack of health insurance coverage and health care access to protect and assure economic vitality and the health of the State ??