Transcript Legislative Appropriations Request for Fiscal Years 2010

Legislative Appropriations Request
for Fiscal Years 2010-11
Governor’s Office of Budget, Policy and Planning
Legislative Budget Board
Friday, September 19, 2008
David L. Lakey, M.D.
Commissioner
1
Presentation Overview
• Health Challenges in Texas
• The DSHS Budget
• Exceptional Items
2
Health Challenges
• Maintaining public health activities, such as immunizations,
sanitation and food quality
• Preventing and treating chronic disease
• Preventing and treating substance abuse and mental illness
• Preparing for and responding to public health threats, such as
hurricanes, pandemic influenza and bioterrorism
• Monitoring and controlling infectious diseases
• Supporting the state’s health services delivery system
• Using health care data to improve services and guide decisionmaking
3
U.S. Life Expectancy at Birth
80
75
70
65
60
55
50
45
40
35
1918 Flu
Epidemic
30
1900 1910 1918 1920 1930 1940 1950 1960 1970 1980 1990 2000
4
Increased Life Expectancy Driven by
Public Health Improvements
80
Increased years due to
public health measures:
25
60
40
20
0
77 years
5
47 years
1900
Increased years due to
medical care advances:
2000
Source: Ten Great Public Health Achievements – United States, 1900-1999 MMWR, April 02, 1999 /
48(12);241-243 http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm
5
Leading Causes of Death
•
•
•
•
•
1900
Pneumonia
Tuberculosis
Diarrhea
Heart Disease
Intracranial Lesions
•
•
•
•
•
2005
Heart Disease
Cancers
Cerebrovascular Disease
Chronic Lower
Respiratory Diseases
Accidents
6
Leading Causes of Death
Texas 2001
Heart Diseases
Cancer
Stroke
Accidents
Lower Respiratory Disease
Diabetes
Flu & Pneumonia
Alzheimers
0
10000
20000
DSHS Center for Health Statistics
30000
40000
50000
7
Actual Causes of Death*
Shaped by Behavior
Tobacco
Overweight/Obesity
Alcohol
Auto Accidents
Drugs
Suicide
DWI
Homicide
Sexual Behavior
0
*Texas 2001
5000
10000
15000
Chronic Disease in Texas 2007, DSHS
20000
25000
30000
8
Impact of Mental Illness
• Individuals with schizophrenia have a
20 percent shorter life expectancy than the
overall population
• Significant mental illness is often linked to
obesity, smoking and substance abuse
• Underserved populations with MH or SA
issues often go to ERs for treatment
9
Disaster Preparedness and Response
• INSERT SLIDE ON HURRICANES
Storms lined up across the Atlantic – September 2008
10
TB Case Rates in Texas, 2005
1
3
2
Dallas
4
Tarrant
9
El Paso
5
7
10
Travis
Harris
6
8
Top 10 High-Morbidity
Counties
Harris
Dallas
Tarrant
Hidalgo
Bexar
Cameron
El Paso
Travis
Webb
Fort Bend
Cases
380
224
129
92
74
68
49
48
42
34
Bexar
Fort Bend
Rate per 100,000
0.0 - 2.2
State Rate: 6.7/100,000
2.3 - 6.7
Webb
Nueces
11
6.8 - 15.2
15.3 - 29.0
29.1 - 69.4
County with Cases > 24
Hidalgo
Cameron
Source: Texas Department of State Health Services - Tuberculosis Statistics
11
FY 2008-9 DSHS budget by source
5%
37%
General Revenue
General Revenue-D
Federal
Other
44%
14%
• $5.5 billion biennial budget
12
Exceptional Items
• Stakeholder meetings
• In priority order, ranked according to:
– Maintaining operating capacity in existing
programs
– Ensuring compliance with current state and
federal requirements
– Moving health forward in Texas
13
Maintaining Operational Capacity
Exceptional Item 1
• Biennial funding for crisis services
• Progress in delivery of crisis services
–
–
–
–
–
–
–
AAS Accredited Hotlines
Mobile Crisis Outreach Teams
Crisis Stabilization Units
Extended Observation Units
Crisis Residential Facilities
Crisis Respite Facilities
Outpatient Competency Restoration
FY 2007
FY2008
1
4
3
3
10
4
1
38
38
3
6
13
14
4
14
Maintaining Operational Capacity
Exceptional Item 1 – Crisis Services
Adults
Children
100%
75%
50%
25%
24%
15%
24%
15%
23%
20%
19%
15%
13%
13%
10%
0%
16%
SFY2008
Annual Target = 17%
10%
Q
3
Q
2
Y2
00
8
SF
Y2
00
8
Q
1
SF
Y2
00
8
Q
4
SF
Y2
00
7
Q
3
SF
Y2
00
7
Q
2
SF
Q
1
Y2
00
7
SF
Q
4
Y2
00
7
SF
Y2
00
6
Q
3
SF
Y2
00
6
Q
2
SF
SF
Y2
00
6
Q
1
5%
Y2
00
6
SF
16%
15%
13%
26%
25%
22%
21%
20%
Percent of Persons Receiving Crisis Services Followed by a
Psychiatric Hospitalization within 30 Days Already Better than Target
Sources: DSHS Client Assignment and Registration (CARE) system. Note: SFY2008 YTD includes persons served with old + new GR.
15
Maintaining Operational Capacity
Exceptional Item 1 – Trauma Funding
• Maintain funding for trauma reimbursement
– Uncompensated trauma care at designated facilities
– Grants to EMS providers and regional systems
• Since the enactment of trauma reimbursement (2003-8):
– 1 additional Level I and 1 additional Level II trauma
center
– 4 additional Level III centers and 53 new Level IVs
– Coverage has increased by 59 centers (31%)
– 31 additional counties served since 2003
16
Texas Designated Trauma Facilities
2008
17
Maintaining Operational Capacity
Exceptional Item 1
• Annualized funding for Alberto N settlement
services
– Personal care services for children on Medicaid
• Align family planning reimbursement rates and
service package with Medicaid
– Potential loss of primary care services
• Cover increase in transportation costs for the
rabies bait drop
– Potential rabies in South and West Texas
18
Maintaining Operational Capacity
Exceptional Item 1
• Rising costs across the agency
– Laboratory
– Hospital pharmaceuticals, medical supplies and
food
– Travel/fuel costs
– Utilities
19
Maintaining Operational Capacity
Exceptional Item 1
08-09 Phased-In Services – Crisis Maitenance
FY2010*
FY2011*
$13.7
$13.7
08-09 Phased-In Services – Trauma Funds
$23.2
08-09 Phased-In Services – Alberto N
$1.1
$1.1
Increased Costs
$10.6
$13.3
$25.4
$51.4
Total:
* All figures in millions
20
Ensuring Compliance
Exceptional Item 2 – Regulatory Services
• DSHS Regulatory Division ensure the safety of
the products and services Texans use every day
– Food
– Hospitals, surgical centers and dialysis centers
– Health professionals, including EMS, Medical
Radiologic Technicians, Professional
Counselors
– Medical Devices
– Radiation
21
Ensuring Compliance
Exceptional Item 2 – Regulatory Services
• Regulatory programs are supported by fees
• Texas is a growing state
– From 2002 and 2007, the number of licenses in some
programs increased by as much as 80%
• New licenses require compliance inspections, response to
complaints, enforcement
• DSHS already uses risk-based inspections in most
programs
• Total, Exceptional Item 2
– FY 2010: $7.3 million
– FY 2011: $11.5 million
22
Ensuring Compliance
Exceptional Item 2 – Regulatory Services
Increase in licenses for the Division of Regulatory Services
2002 thru 2007
100.00%
95.00%
90.00%
83.07%
85.00%
80.00%
76.60%
75.00%
70.00%
Percentage of Increase
65.00%
60.00%
Summary of all Regulatory licenses
55.00%
50.00%
13038 - Food and Drug
45.00%
13039 - Environmental
40.00%
13040 - Radiation
35.00%
32.52%
30.76%
13041 - Professional Licensing
30.00%
24.49%
25.00%
13042 - Health Care Facilities
20.00%
15.00%
10.73%
10.00%
5.00%
0.00%
Licenses by Regulatory Strategy
23
Ensuring Compliance
Exceptional Item 3 – Health Care Data
• Cancer Registry
– Children’s cancer research
– Helping communities assess risk
• Kelly Air Force Base, San Antonio
• Houston Ship Channel
• El Campo trichlorethylene
– Improving access to breast cancer services
24
Ensuring Compliance
Exceptional Item 3 – Health Care Data
• Birth Defects Registry
– Evaluation of strategies to reduce risk of birth
defects
– Evaluation of factors playing a role in survival
of children with birth defects
– Participation in CDC’s National Birth Defects
Prevention Study
– Identify areas where children with birth defects
have little access to pediatric genetics clinics
25
Ensuring Compliance
Exceptional Item 3 – Health Care Data
• EMS/Trauma Registry
– Evaluate local injury prevention planning
– Analyze ambulance diversion patterns
– Compare patients across service areas to
improve timeliness and quality of patient care
– Identify hazardous environments, such as
dangerous intersections
26
Ensuring Compliance
Exceptional Item 3 – Health Care Data
• Healthcare Associated Infections (HAI)
– Leading cause of death from infectious disease
– 200,000 infections and 8-9,000 deaths in Texas
each year
– HAI deaths in Texas exceed those in
automobile accidents and homicides combined
– Up to 60 percent of infections are preventable
– Annual cost in Texas: more than $500 million
27
Health Care Data and Analysis
Exceptional Item 3
FY2010*
FY2011*
Disease Registries – Chronic
$4.1
$2.6
Disease Registries – Healthcare
Acquired Infections Reporting
$1.5
$2.8
Newborn Screening Linkage
$0.81
$0.26
Center for Health Statistics
$0.122
$0.128
Recruitment and Retention
$0.051
$0.051
$6.6
$5.8
Total:
* All figures in millions
28
Ensuring Compliance
Exceptional Item 4 – Vital Records
• Vital Records – birth and death certificates
• REAL ID Act of 2005
– Requires states to issue secure driver’s licenses and identity cards
– Will require other states to verify validity of birth certificates for
individuals born in Texas
– Consequences of not complying – Texans will have to prove
identity beyond a driver’s license in banks and federal buildings
and prior to domestic flights
– Total:
• FY 2010
$3.5 million
• FY 2011
$3.2 million
29
Ensuring Compliance
Exceptional Item 5 – Data Systems
Maintain and Enhance Technology
• 400 programs in 9 health regions, 11 state hospitals, and a major
laboratory
• Patient records, client case files, pharmacy inventories and disease
registries at risk
• Internet connectivity between offices unreliable
• Major telephone outages
• Impacts:
– Patient health care and client management for mental and
behavioral health
– Preparedness and response activities
– Protection of sensitive data
– Data center consolidation
• FY 2010
$7.8 million
• FY 2011
$6.3 million
30
Data Systems
Exceptional Item 5
FY2010*
FY2011*
Network Interoperability, Video & Voice
Communications and Security
$6.2
$5.5
Seat Management
$1.5
$1.5
Consolidated Heatlh Care Data Collection
$1.2
$1.0
Clinical Mangement for Behavioral Health Services
$2.7
$3.8
Client Record System – Capacity & Bandwidth
$0.36
$0.30
Hospital Automated Medication Dispensing System
$3.6
$2.5
Total:
$15.7
$14.6
* All figures in millions
31
Ensuring Compliance
Exceptional Item 6 – Disaster Response
• Disaster Recovery and Public Health Preparedness
– Expanding core response for all-hazards, natural or
manmade – hurricanes to salmonella
– Improve timeliness of laboratory tests, environmental
analysis and disease surveillance
– Need to maintain skilled workforce for rapid
deployment in event of emergency or disease outbreak
– Local Health Department Expansion
32
Disaster Recovery and
Public Health Preparedness
Exceptional Item 6
FY2010*
FY2011*
Laboratory
$2.0
$1.0
Local Health Department Expansion
$0.45
$0.45
Behavioral Health positions in DSHS Regional Offices
$0.64
$0.7
Public Health Emergency Preparedness Response
$3.9
$3.4
Recruitment and Retention
$0.76
$0.76
$7.8
$6.3
Total:
* All figures in millions
33
Salmonella Saintpaul Outbreak
Impact of Hurricane Ike
35
Ensuring Compliance
Exceptional Item 7
• Stipends for Psychiatric and Preventive Medicine
Residents
– Residency placement slots in state hospitals
• Only 6.4 psychiatrists per 100,000 Texans
– Preventive Medicine residencies to strengthen the workforce
• 67.9 physicians per 100,000 Texans
– Cost-effective means of increasing medical care in underserved
areas and in hospitals
– Physicians often remain in the community where they served as a
medical resident
• FY 2010
$1.4 million
• FY 2011
$1.35 million
36
Psychiatrists and Child Psychiatrists,
Texas, 2007
Psychiatrists per
100,000 Population
0
0.1 - 5.1
5.1 - 10.7
10.7 - 19.6
19.6 - 36.5
37
Ensuring Compliance
Exceptional Item 8
Building & Equipment Repair & Replacement
• Hospitals must comply with Life Safety Code
• Joint Commission accreditation
• Replace only broken, unsafe or unusable
equipment and patient furniture
38
Ensuring Compliance
Exceptional Item 8
Infrastructure Description
• Eleven State Mental Health
Facility campuses
• 3,032 acres, 552 buildings, 4.9
million square feet
• $866 million replacement value
• Average age is 55.2 years old.
• Most buildings were well built
and remain structurally sound,
but are in need of renovation to
meet today’s standards and
programmatic requirements.
• Over 84% of total building area
is dedicated to patients and
patient support.
39
Ensuring Compliance
Exceptional Item 8
FY10-11 Capital Construction Needs
• Identified deficiencies
(deferred maintenance):
$233 million
• $198.3 million in capital
construction needs have
been identified for FY10-11
funding for State Hospitals.
• Of that, $67 million has
been identified as the most
critical.
$250
$233M
$198.30M
$200
$150
$100
$67M
$50
$0
Deferred
Maintenance
Needs
Requested
40
Ensuring Compliance
Exceptional Item 8
Categories of Capital Equipment
• Furniture
• Medical/Adaptive
• Food Service
• Grounds
• Heating
• Air conditioning
• Motorized
• Emergency
• Other
•
Average Life Expectancy of most of the State
Hospital capital equipment is 5 to 8 years.
•
Average years of actual use for much of the State
Hospital capital equipment is 11+ years, far
surpassing its life expectancy, creating a potential
risk to patients and staff.
41
Moving Health Forward
Exceptional Item 9 – Substance Abuse
• Increase treatment rates to maintain
provider base
• Increase treatment capacity to serve
individuals
• Expand prevention services
• Provide Medicaid outpatient benefit to
leverage federal funds
42
Moving Health Forward
Exceptional Item 9 – Substance Abuse
Percent of need met in Texas for
DSHS-funded substance abuse
treatment in SFY2007, adjusting
for poverty (200% FPL).
2007
Texas Population
(age 12+)
19,463,968
2007
Estimated Number
with Chemical
Dependency
1,825,591
SFY2007
Number Served in
DSHS-Funded
Substance Abuse
Treatment Programs
Who Are
Also Poor
853,982
(including NorthSTAR)
63,929
(7.5%)
Note:
The % of need met is [the unique number of served] divided by [the number in need of treatment], Where [the unique number of served] is the distinct count of clients served in DSHS-funded
substance abuse treatment programs during a year, and [the number in need of treatment] is the estimated number of persons with a substance abuse problem and in poverty during a year.
And, [the number in need of treatment] is measured by applying the prevalence rates derived from various surveys to the general population in Texas.
Data Sources:
1. [the unique number of served]: Behavioral Health Integrated Provider System (BHIPS), DSHS.
2. [the number in need of treatment]: (a) Population projections in Texas, (b) National Survey on Drug Use and Health for Texas, and (c) Texas School Survey of Substance Use.
43
Moving Health Forward
Exceptional Item 9 – Substance Abuse
$136
Untreated
$136
ER Cost
per Medicaid Client
per Month
ER COST OFFSET
- $46
Average per Client per Month
35%
REDUCTION
Treated
$89
$0
Texas monthly hospital emergency room costs are 35 percent lower for medicaid clients receiving
dshs-funded substance abuse treatment who needed it.
Source: FY2005 ER Cost per Medicaid Client per Month for Those Who Needed Substance Abuse Services But Did Not Receive Them (Untreated) vs. Those Who Needed
Substance Abuse Services and Did Receive Them (Treated): Initial data set consisted of all persons who had Medicaid paid Substance Abuse ER visits during FY2005.
Clients were divided into those who received DSHS Substance Abuse services based on match between DSHS Substance Abuse dataset with Medicaid dataset. Dependent
variable was Total ER costs or dates or service during FY2005. Data sources: DSHS Substance Abuse services = BHIPS, Medicaid ER = TMHP AHQP Claims Universe.
Prepared by Research Team, Strategic Decision Support, HHSC, 3/23/2006.
44
Moving Health Forward
Exceptional Item 9 – Substance Abuse
• Reduced use of medical services, leading to cost
savings
• Lower medical costs by reducing low birth weight
babies, Fetal Alcohol Spectrum Disorders and use of
neonatal ICU
• Benefit to the child welfare system through services to
women of childbearing age
• In 2006, twenty percent of inmates in TDCJ
were convicted of drug offenses
– That doesn’t count those convicted of other offenses
to which substance abuse was a contributing factor
• Services eligible for Medicaid leverage state funds with
federal funds (40 percent state/60 percent federal)
45
Substance Abuse
Exceptional Item 9
FY2010*
FY2011*
Treatment Services
$21.6
$21.6
Prevention Services
$4.5
$4.5
Medicaid for Outpatient Substance Abuse Services
$13.8
$13.8
Increased Contract Management Costs
$0.91
$0.99
$40.8
$40.9
Total:
* All figures in millions
46
Moving Health Forward
EI 10 – Community Mental Health
Offering services in the community
1) Expand community mental health crisis
services
2) Develop transitional services for difficult-toengage high-need individuals
3) Increase capacity for intensive services for
current clients
47
Moving Health Forward
EI 10 – Community Mental Health
• Part 1: Community mental health services
– Expand options to underserved communities
with crisis funds, assuring targeted services to
children and adolescents
– Provide more Psychiatric Emergency Services
Centers and Children’s Crisis Projects (e.g.,
Respite)
– Serve an additional 8736 individuals/year
– Serve an additional 226 children/year
48
Moving Health Forward
EI 10 – Community Mental Health
Part 2: Transitional services for difficult to
engage high-need individuals
• Goal is to break the cycle of
crisis-stabilization-crisis
• Serves 4,163 adults/year
• Serves 630 children/year
49
Moving Health Forward
EI 10 – Community Mental Health
• Part 3: Increase capacity for intensive services for
current clients
• Focus on difficult-to-serve clients transitioning
from crisis
• Serves 1,984 persons in FY10 and 3,967 in FY11
• Total, Exceptional Item 10
• FY 2010
• FY 2011
$39.3 million
$49 million
50
Moving Health Forward
EI 10 – Community Mental Health
$93
Untreated
$93
ER Cost
per Medicaid Client
per Month
ER COST OFFSET
- $25
Average per Client per Month
27%
REDUCTION
Treated
$68
$0
Texas Monthly Hospital Emergency Room Costs Are 27 Percent Lower for Medicaid Clients Receiving
DSHS-Funded Community Mental Health Treatment Who Needed It
Source: FY2005 ER Cost per Medicaid Client per Month for Those Who Needed Community Mental Health Services But Did Not Receive Them (Untreated) vs.
Those Who Needed Community Mental Health Services and Did Receive Them (Treated): Initial data set consisted of all persons who had Medicaid paid Mental
Health ER visits during FY2005. Clients were divided into those who received DSHS Mental Health services based on match between DSHS Mental Health dataset
with Medicaid dataset. Dependent variable was Total ER costs or dates or service during FY2005. Data Sources: DSHS Mental Health services = CARE, Medicaid
ER = TMHP AHQP Claims Universe. Prepared by Research Team, Strategic Decision Support, HHSC, 3/23/2006.
51
Moving Health Forward
EI 10 – Community Mental Health
IMPLEMENTATION OF CRISIS REDESIGN
5,000
3,940
4,000
2,885
3,000
2,548
2,442
1,997
2,433
2,381
2,859
2,692
2,609
1,868
2,000
1,000
0
20
Y
SF
06
Q
1
20
Y
SF
06
Q
2
20
Y
SF
06
Q
3
20
Y
SF
06
Q
4
20
Y
SF
07
Q
1
20
Y
SF
07
Q
2
20
Y
SF
07
Q
3
20
Y
SF
07
Q
4
20
Y
SF
08
Q
1
20
Y
SF
08
Q
2
20
Y
SF
08
Q
3
Average Monthly Number of Persons Receiving
Community Mental Health Front-Door Crisis Services Increasing
Sources: DSHS Client Assignment and Registration (CARE) system. Note: SFY2008 YTD includes persons served with old + new GR.
52
Moving Health Forward
EI 10 – Community Mental Health
Crisis Residential
Crisis Outpatient
45,000
43,629
40,000
35,000
SFY2008 Annual Target = 30,717
30,000
25,000
28,047
26,319
20,000
SFY2008 Annual Target = 16,467
15,000
10,000
14,545
14,601
12,664
5,000
0
SFY2006
SFY2007
SFY2008 YTD
Number of Persons Receiving Crisis Services Per Year
Funded by General Revenue Exceeding/Approaching Targets
Sources: DSHS Client Assignment and Registration (CARE) system and DSHS NorthSTAR Data Warehouse.Note: SFY2008 YTD includes persons served with old
+ new GR as of August 28.
53
Community Mental Health
Exceptional Item 10
FY2010*
FY2011*
Psychiatric Emergency Centers & Childrens Respite Services
$14.2
$14.2
Transitional Services
$14.5
$14.5
Intensive ongoing services targeting recipients of transition
services
$9.6
$19.1
Increased contract management
0.86
0.94
External Evaluation of Crisis Projects
$0.21
$0.21
$39.3
$49.0
Total:
* All figures in millions
54
Moving Health Forward
Exceptional Item 11 – Chronic Disease
– 70% of deaths are related to chronic disease
– 10% of population have major limitations in daily
living
– About 75% of health care costs come from obesity,
high blood pressure, cholesterol and Type 2 diabetes
– Tobacco is implicated in 25,000 deaths in Texas
annually, about as much as alcohol, auto accidents and
suicide combined
– Cost of $3.3 billion to Texas businesses in 2005
– Health care costs for ERS have increased by 50 percent
since 2000
55
Moving Health Forward
Exceptional Item 11 – Chronic Disease
Many of these conditions are preventable.
We can reduce the disease burden and the
economic burden by promoting:
– Avoidance of tobacco
– Healthy eating
– Physical activity
– Maintaining a healthy weight
– Controlling blood pressure and cholesterol
56
Obesity Trends* Among U.S. Adults
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
1998
1990
2007
No Data
<10%
10%–14%
15%–19%
20%–24%
Source: CDC Behavioral Risk Factor Surveillance System
25%–29%
≥30%
57
Moving Health Forward
Exceptional Item 11 – Chronic Disease
• Obesity
– Interventions to improve nutrition and increase physical activity
– Improved screening, diagnosis and treatment for cardiovascular
disease and stroke
– Support of the Mayor’s Fitness Council Grant program
• Tobacco
– Expand cessation services for Texans who want to quit
– Increase partnerships with communities with anti-smoking
activities
• Newborn Screening
– Expand detection of cystic fibrosis and case management
58
Chronic Disease
Exceptional Item 11
FY2010*
FY2011*
Obesity Prevention
$3.3
$5.9
Tobacco Prevention
$3.8
$4.7
Cardiovascular Council Projects
$1.0
$1.0
Cystic Fibrosis
$2.9
$3.4
$10.9
$15.0
Total:
* All figures in millions
59
Moving Health Forward
EI 12 – Infectious Disease
• Infectious Disease Prevention
– Like chronic disease, early detection and
effective treatment are critical
– Persons with these diseases can spread them
– Interrupted treatment makes the disease more
difficult and expensive to treat
– HIV, tuberculosis and sexually-transmitted
diseases are co-morbid
60
Moving Health Forward
EI 12 – Infectious Disease
• CDC recommends expanded testing for HIV
– Earlier detection leads to earlier, more effective
treatment
– Reduces the rate of transmission
• Texas is second nationally in TB cases
• Exceptional 12 item includes
–
–
–
–
Improved HIV testing
Expand improved testing for TB and STDs
Tuberculosis services
Upgrade cervical cancer screening
61
Moving Health Forward
EI 12 – Infectious Disease
HIV/AIDS in Texas: Persons Living with HIV/AIDS, New Diagnoses of HIV/AIDS, and
Deaths among those with HIV/AIDS
70,000
Number: PLWHA
60,000
50,000
40,000
5,000
New Cases
4,000
PLWHA
3,000
30,000
2,000
20,000
10,000
1,000
Deaths
0
Number: New Cases and
Deaths
6,000
0
2001
2002
2003
2004
2005
2006
Year
New diagnoses are holding steady. The number of persons living with HIV/AIDS is
rising because they are surviving longer.
Moving Health Forward
EI 12 – Infectious Disease
Racial Disparity in Persons Living with HIV/AIDS in Texas, 2001 - 2006
1000
25,000
23,119
868.3
900
22,439
Number
16,388
15,000
14,417
15,184
10,000
8,936
800
Rate per 100,000
20,000
700
600
500
400
300
200
5,000
615.9
100
196.7
146.6
170.2
128.4
0
0
2001
2002
2003
2004
2005
2006
2001
2002
Year
White
Black
Hispanic
White
2003
2004
Year
Black
2005
2006
Hispanic
The number (left graph) of black persons living with HIV/AIDS surpassed that of whites in
2005. The rate (right graph) in 2006 was 5 times higher for blacks than for others.
63
Moving Health Forward
EI 12 – Infectious Disease
In 2005, the incidence of Tuberculosis in Texas was 39% higher than the U.S. incidence rate
64
Infectious Disease Prevention
Exceptional Item 12
FY2010*
FY2011*
HIV/STD Viral Hepatitis Testing
$4.4
$4.7
Tuberculosis Services
$3.2
$3.6
Cervical Cancer Screen
$0.53
$0.53
$8.1
$8.8
Total:
* All figures in millions
65
Other Agency
Legislative Appropriations Requests
• Health and Human Services Commission
– Critical health care shortage positions
• Physicians, psychiatrists, nurses
– Waiting lists for Children with Special Health Care Needs,
Children’s Mental Health Services
– Consolidated enterprise requests for technology and vehicles
• Department of Assistive and Rehabilitation Commission
– Accessibility of information technology
• Comptroller’s Judiciary Section
– Increase in number of Sexually Violent Predators monitoring
66
Concluding Thoughts
• In the 21st century, Texas faces new and evolving
health challenges
• There are effective ways of reducing the personal
and economic toll of the disease burden
• What DSHS is presenting in its LAR represents our
best effort to improve health for individual Texans
and the state as a whole
67