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Health Care

Health care is one of the major engines of economic growth in the Gulf Coast region, particularly in the greater Houston area. The health care industry is adding jobs at a rapid pace and accounts for some of the region’s largest construction projects.1

M.D. Anderson Cancer Center is consistently ranked first in cancer care in the U.S.

In 2008, the world-renowned Texas Medical Center (TMC) in Houston had a regional economic impact of $14 billion, according to a TMC-commissioned study.2 TMC attracts patients seeking high-quality specialized medical care from throughout the nation and the world. TMC’s M.D. Anderson Cancer Center is consistently ranked first in cancer care in the U.S., and its other hospitals also are highly ranked.

Yet one challenge facing the Gulf Coast region is providing access to primary health care. While Houston is home to some of the nation’s finest health institutions, the federal government has designated many of the surrounding rural counties as Health Professional Shortage Areas. Meanwhile, the region’s obesity and diabetes rates have risen significantly, adding to its need for more health care professionals.

Health Care Infrastructure

According to the Federal Reserve Bank of Dallas, from February 2000 to 2008 private health care employment rose faster in Houston (35 percent) than other large Texas metro areas (34.1 percent in Dallas-Fort Worth, 30.5 percent in San Antonio and 25.6 percent in Austin).3 The Texas Medical Center, when considered as a single entity, is the city’s largest employer, with 72,600 employees in 2008.4

The Gulf Coast region has 62 for-profit hospitals, 32 nonprofit hospitals and 13 public hospitals, for a total of 107 (Exhibit 42). Houston accounts for 47 of these, including 28 for-profit hospitals, 16 nonprofits and three public hospitals – Ben Taub General Hospital, University of Texas M.D. Anderson Cancer Center and Harris County Psychiatric Center. The rest of the region’s hospitals are spread among numerous cities and counties.5 Only one of the region’s 13 counties, Waller County, lacks a hospital.

In 2008, the region’s hospitals had a total of 20,503 staffed beds (19,465 acute-care beds and 1,038 psychiatric beds). Houston has the region’s largest number of acute-care beds – 12,260 beds for patients receiving short-term medical care at a hospital or other facility. The Methodist Hospital in Houston is the region’s largest, with 1,352 beds. Memorial Hermann Hospital is next-largest, with 1,062 beds, followed by Ben Taub General Hospital with 975 acute-care beds. Galveston’s University of Texas Medical Branch Hospital (UTMB) was the third-largest hospital in the region before Hurricane Ike struck in September 2008. As of October 2009, UTMB had 400 beds, down from about 680 beds before the storm.6

Exhibit 42

Gulf Coast Region Hospital Ownership, 2008

58.0% of hospitals in the region are for profit. 29.9% are non-profit. 12.1% are public.

Source: Texas Department of State Health Services.

Exhibit 43

Gulf Coast Region Hospital Districts

County Hospital District Name
Austin Bellville Hospital District
Brazoria Angleton-Danbury Memorial Medical Center
Sweeny Hospital District
Chambers Chambers County Public Hospital District #1
Colorado Rice Hospital District
Harris Harris County Hospital District
Liberty Liberty County Hospital District #1
Matagorda Matagorda County Hospital District
Montgomery Montgomery County Hospital District
Walker Walker County Hospital District
Wharton West Wharton County Hospital District

Source: Texas Department of State Health Services.

UTMB’s Level 1 trauma center was downgraded to a Level 3 after Hurricane Ike, leaving the region with only two, Ben Taub and Memorial Hermann, both in Houston’s Texas Medical Center. (A Level 1 center is specifically designed to handle patients with serious and complex injuries; at present, Texas has 15 of them.)7

The Gulf Coast region also has 11 hospital districts (Exhibit 43). Once approved by voters, a hospital district can levy property and sales taxes for the support of health care and hospital services.8 Just three of the region’s counties – Galveston, Fort Bend and Waller – do not have a hospital district.

Texas Medical Center

The Texas Medical Center comprises 48 nonprofit institutions including academic institutions, hospitals and support-services organizations located on 1,000 acres adjacent to downtown Houston (Exhibit 44). TMC is the world’s largest medical center, with 72,600 employees, 5.1 million annual patient visits, 160,000 daily visitors and 29.6 million gross square feet of space for patient care, education and research in 2008.

Exhibit 44

Texas Medical Center Institutions

Patient Care Institutions

  • Baylor Clinic
  • Harris County Hospital District
  • Memorial Hermann-Texas Medical Center
  • Children’s Memorial Hermann Hospital
  • Texas Children’s Hospital
  • The Methodist Hospital
  • St. Luke’s Episcopal Hospital
  • The Houston Hospice and Palliative Care Systems
  • Shriners Hospital for Children – Houston
  • The University of Texas M.D. Anderson Cancer Care
  • Michael E. DeBakey Veterans Affairs Medical Center in Houston
  • St. Dominic Village
  • The Institute for Rehabilitation and Research (TIRR)

Other TMC Institutions:

  • City of Houston Department of Health and Human Services
  • Gulf Coast Regional Blood Center
  • Harris County Medical Society
  • Harris County Public Health and Environmental Services
  • Houston Academy of Medicine
  • Houston Academy of Medicine - Texas Medical Center Library
  • The Institute for Spirituality and Health
  • Joseph A. Jachimczyk Forensic Center - Office of the Medical Examiner of Harris County
  • LifeGift
  • Ronald McDonald House of Houston, Inc.
  • John P. McGovern Museum of Health and Medical Science
  • Texas Medical Center (corporation)
  • Thermal Energy Corporation
  • Texas Medical Center Hospital Laundry Cooperative Association
  • YMCA Child Care Center at the Texas Medical Center


Academic and Research Institutions:

  • Baylor College of Medicine
  • Michael E. DeBakey High School for Health Professions
  • Houston Academy of Medicine-Texas Medical Center Library
  • Houston Community College System, Health Science Programs
  • The Methodist Hospital
  • Prairie View A&M University, College of Nursing
  • Rice University
  • Texas A&M Health Science Center - Institute of Biosciences and Technology
  • Texas Heart Institute
  • Texas Southern University College of Pharmacy & Health Sciences
  • Texas Woman's University Institute of Health Sciences-Houston
  • University of Houston/ University of Houston College of Pharmacy
  • The University of Texas Health Science Center at Houston
    • Dental Branch, Graduate School of Biomedical Sciences, Harris County Psychiatric Center, Medical School, School of Health Information Sciences, School of Nursing, School of Public Health, Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases
  • The University of Texas M. D. Anderson Cancer Center

Source: Texas Medical Center.

TMC institutions are recognized world-wide for innovations including pioneering heart and vascular surgical procedures, and for establishing Texas’ first air ambulance service. TMC’s reputation attracts patients from around the world, with 14,600 international patient visits in 2008.9

About $1 billion supported research at TMC in 2008. In September 2009, three TMC institutions – Baylor College of Medicine, University of Texas M.D. Anderson Cancer Center and UT Health Science Center at Houston – received $100 million in research grants under the American Recovery and Reinvestment Act to pursue “high risk/high reward” projects.10

TMC got its start after the trustees of the M.D. Anderson Foundation, created by wealthy Houstonian Monroe Dunaway Anderson, offered a grant, temporary facilities and land to attract a new University of Texas cancer research center to Houston in 1945. The center was named the University of Texas M.D. Anderson Cancer Center and became the first of many institutions to join TMC over the last 64 years. TMC has grown from 134 acres in 1945 to 1,000 acres in 2009.

Chartered as a nonprofit corporation in 1945, TMC has continued to acquire land for future growth. This land is offered to member institutions for a token $1 per year.11 Often called a “city within a city,” the TMC campus includes 26 miles of public and private streets and more than 48,000 parking spaces.12 TMC’s area in 2007 was greater than the combined square footage of downtown buildings in San Antonio, El Paso and Fort Worth. As of October 2009, TMC’s 31 million square feet of space made it the 12th largest downtown business district in the U.S. – larger than downtown Los Angeles.13

TMC is governed by a policy council comprising the chief executive officers of each member institution that is responsible for campus-wide issues such as strategic and master planning. TMC institutions benefit from economies of scale generated by the use of common services such as thermal energy from steam and chilled water, a hospital laundry cooperative, conference center, library facilities, security services and a campus newspaper.14

Health care topped the list of Texas’ top construction projects by revenue in 2008 and 2009.

TMC is driving a hospital construction boom in Houston. In November 2007, TMC announced plans to spend more than $7 billion on the construction of hospitals, clinics, research facilities, office space and infrastructure through 2014. Forty-six percent of the new construction will be for patient care space; 28 percent for education and office space; and 26 percent for research space. TMC facilities have plans to expand to 40 million gross square feet in 2014.15

Health care topped the list of Texas’ top construction projects by revenue in 2008 and 2009. TMC projects in Houston were listed among the 10 largest projects in both years. As of August 2009, 17 projects valued at $3.3 billion are under way at TMC.16 These projects include hospitals, clinics, medical offices, research labs as well as upgrades to TMC roads and underground utilities. Four of TMC’s health institutions – Methodist Hospital System, Baylor College of Medicine, Texas Children’s Hospital and University of Texas M.D. Anderson Cancer Center – have major construction projects in progress.

Texas Children’s Hospital has two construction projects – a Maternity Center and a Neurological Research Institute–that are among the five largest construction projects breaking ground in Texas in 2008.17 A new, $430 million maternity center at Texas Children’s Hospital is scheduled for completion in mid-2011 and will include clinic and office space.18 The Jan and Dan Duncan Neurological Research Institute at Texas Children’s, the first facility of its kind to use a multidisciplinary research approach bringing together diverse researchers to collaborate on children’s neurological diseases, will cost an estimated $215 million and should open in 2010.19

The Methodist Hospital System has two major projects under construction at the Texas Medical Center, a $237 million Outpatient Center and a $218 million Methodist Hospital Research Institute that will include laboratories, a surgical training facility and conference center. In the next two years, Methodist Hospital also plans to replace an older hospital at TMC with a new 1 million-square-foot inpatient tower.

Construction is also under way at the M.D. Anderson Cancer Center, which is adding a $220 million addition atop the original 12-story Albert B. and Margaret M. Alkek Hospital to be completed in summer 2010. U.S. News & World Report once again ranked M.D. Anderson Cancer Center as number one in cancer care in its 2009-10 America’s Best Hospitals rankings

The national economic recession has slowed construction projects at some TMC health institutions and put others on hold. Construction continues on the exterior of the new $230 million Baylor College of Medicine Clinic and Hospital, but plans to finish the interior are on hold due to economic factors. St. Luke’s Episcopal also has put a TMC project on hold and will pursue less capital-intensive projects at its community hospitals.20

In Galveston County, UTMB has $1 billion in repairs and new construction planned or in progress.

Even so, work continues on numerous infrastructure projects that will support TMC. In September 2009, the city of Houston, Harris County and TMC completed construction of the Richard E. Wainerdi Bridge, which connects TMC’s two Level 1 trauma centers to Interstate Highway 610 and is less prone to flooding than a previous bridge.

Houston continues to make improvements to roads in and around TMC, and Harris County plans to widen Brays Bayou, thus improving flood control in the area. A $370 million, three-phase expansion of Thermal Energy Corp., which provides TMC with power, will double its generation capacity.21

Other Projects

To meet the medical needs of the region’s rapidly growing population, several major hospital systems have construction projects under way or planned. In May 2008, the initial phase of construction began on the Texas Children’s West Campus, a suburban pediatric hospital located in the greater Houston area that was the eighth-largest Texas construction project in 2009.22

The Methodist Hospital System also has numerous ongoing expansions and construction projects worth more than $1 billion, two in the Texas Medical Center and the rest in community hospitals located throughout greater Houston. The Memorial Hermann Healthcare System and St. Luke’s Episcopal Health System also have several facility projects under way or recently completed.

In Galveston County, UTMB has $1 billion in repairs and new construction planned or in progress. Construction of a new $61 million UTMB outpatient specialty care and surgical center in League City is nearing completion.23

Galveston County must spend from $12 to $15 million of its own funds before it can access $150 million in new state funding the Texas Legislature has made available to rebuild UTMB. Some county officials support the creation of a countywide hospital district to raise the local share, while others favor raising the property tax rate.24

Veterans’ Health Care

Houston’s Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) provides health care services for veterans and active military personnel in the Gulf Coast region. Built in 1991 on 118 acres, MEDVAMC is a state-of-the-art facility consisting of 386 hospital beds, a 40-bed Spinal Cord Injury Center and a 120-bed transitional-care unit for long-term care. The main building features a computer-controlled transport system that delivers food, laundry and various supplies throughout the building. It has four exterior sections and four atriums that contain patio gardens, wheelchair basketball courts and a rehabilitation pool.

Between fiscal 2000 and 2008, MEDVAMC saw significant growth in the number of veterans it serves annually, from 73,879 to 121,624 patients. MEDVAMC’s inpatient admissions also increased, from 10,222 to 14,057, while outpatient visits within the region rose from 474,901 to 799,928. To help improve veterans’ access to health care, MEDVAMC has added two satellite clinic locations, one in Conroe and the other between Galveston and Texas City.26

MEDVAMC employs nearly 3,500 health care professionals annually.

While MEDVAMC serves as the primary health care provider for more than 121,000 veterans and their dependents in the Gulf Coast region, veterans from around the country are referred to it for specialized diagnostic care, radiation therapy, surgery and medical treatments including cardiovascular surgery, gastrointestinal endoscopy, nuclear medicine, ophthalmology, and treatment of spinal cord injury and diseases.

MEDVAMC is also home to a Post Traumatic Stress Disorder Clinic, a rehabilitation center focusing on mild to moderate brain injuries, a Polytrauma Center or trauma center that serves patients with multiple injuries or disabilities, a Cardiac and General Surgery Program, a Liver Transplant Center, an Epilepsy Treatment Center and one of the Veteran Affair’s six Parkinson’s Disease Research, Education, and Clinical Centers.27

Psychiatric care for veterans and active military personnel in the region is administered through a coordinated effort led by the Baylor College of Medicine’s Menninger Department of Psychiatry and Behavioral Sciences and including MEDVAMC, Ben Taub General Hospital, Menninger Clinic, Methodist Hospital, St. Luke’s Episcopal Hospital and the Texas Children’s Hospital. MEDVAMC is the largest partner in this effort, with about 1,000 inpatient admissions, 107,000 outpatient visits, 5,000 emergency visits, 600 inpatient consultations and 2,500 follow-up visits annually.

This coordinated effort provides ongoing care in both inpatient and outpatient settings to veterans who have severe and persistent mental illness, including schizophrenia, manic-depressive illness (bipolar disorder), post-traumatic stress disorder (PTSD), geriatric psychiatry needs, substance abuse, sleep disorders, chronic pain and other related disorders. The program offers inpatient and outpatient evaluation and crisis stabilization services 24 hours a day year-round. After a veteran is stabilized, he or she is referred to a partner institution for outpatient follow ups or long-term care, depending on their individual needs.28

MEDVAMC, in coordination with Baylor College of Medicine, also operates the nation’s largest veteran affairs residency program, with more than 250 positions. Each academic year, nearly 2,000 medical students are trained through 144 affiliation agreements with institutions of higher education in 19 different states. Students from fields such as nursing, dietetics, social work, physical therapy, and a wide variety of medical specialties receive training at MEDVAMC each year. In all, MEDVAMC employs nearly 3,500 health care professionals annually.

MEDVAMC receives more than $16 million annually for research from the federal government, which helps ensure veteran access to cutting-edge medical and health care technologies. In all, the center has 729 active research projects aimed at developing new techniques and products to improve disease prevention, diagnosis and treatment.

These efforts have led to many achievements, including a study that found angioplasty to be more cost-effective than bypass surgery; a new type of prosthetic hand providing sensory feedback to the brain; research into preventing outbreaks of an increasingly antibiotic-resistant germ; animal and cell-culture tests that found that goldenseal root is an effective cholesterol-lowering agent; and an exploration of the depletion of B cells, a type of lymphocyte that makes antibodies that can be used as a potential therapy for autoimmune diseases.29

Psychiatric Care

The region’s psychiatric care is coordinated by a number of community mental health and mental retardation (MHMR) centers affiliated with the Texas Department of State Health Services. These community MHMR centers provide the usual entry point for mental health treatment in the state.

They provide a number of services that can be divided into two general categories: mental health assessment and referral and outpatient treatment and counseling. Each community MHMR center provides assessment and treatment services to both children and adults through interdisciplinary treatment teams that either refer clients to specialized service providers or develop treatment plans to serve their individual needs (Exhibit 45).30

Exhibit 45

Gulf Coast Region, Community MHMR Center Services Areas

See text version.

Source: Texas Department of State Health Services.

View MHMR center services areas.

In addition, the region is served by two state-administered inpatient crisis stabilization centers and long-term care facilities housed at the Austin and Rusk state hospitals. The two inpatient public psychiatric state hospitals that serve the Gulf Coast region, Rusk State Hospital and Austin State Hospital, are located outside the region, to the northeast and west, respectively. Both provide crisis stabilization and long-term psychiatric care for adults; Austin State Hospital provides these services for children for all Gulf Coast counties in the region except Harris County.

Harris County children aged three to 17 years who need acute inpatient mental health care are served by the MHMR Authority of Harris County, which has a Psychiatric Emergency Services Unit that is staffed 24 hours a day with psychiatrists, registered nurses, clinical social workers, licensed professional counselors and psychiatric technicians.

Each child seen receives an individualized clinical service plan that can include medication administration; reinforcement of coping skills; close observation by clinical staff; family meetings; and the determination of appropriate community supports such as day care, food or cash assistance. Of those served, on average 78 percent were referred to an outpatient provider or clinic without hospitalization, annually.

For those who do require hospitalization, the authority has a 16-bed Crisis Stabilization Unit for adults and children in crisis who need more intensive psychiatric treatment and observation. The average length of stay is three to five days, after which time clients are referred to other community providers.31

Harris County’s Neuropsychiatric Center (NPC) is a crisis and emergency center that serves more than 10,000 adults, adolescents and children a year. Its goal is to evaluate persons with mental health emergencies quickly and accurately and to refer them to appropriate community mental health providers.

The majority of people seen by NPC are referred to public or private community mental health providers, although some are referred to NPC’s Crisis Residential Unit (CRU), which serves chronically and seriously ill adults. Individuals may stay in the CRU from three days to four weeks, with stays averaging 10 to 14 days. The CRU has 18 beds and usually serves as a provider “of last resort,” since most of those it serves are indigent or uninsured.32

The University of Texas Harris County Psychiatric Center (UTHCPC), part of the University of Texas Health Science Center at Houston, offers both inpatient and outpatient care for patients referred from the MHMR Authority of Harris County, as well as those with insurance who are referred by private physicians or other hospitals or care providers. UTHCPC averages more than 6,100 inpatient admissions and 14,000 outpatient visits each year. It is located in the Texas Medical Center and all attending physicians are also faculty members of the University of Texas Medical School at Houston.

UTHCPC provides short-term inpatient mental health services for all persons aged three and above. The average length of stay is 11 days for children and adolescents and nine days for adults. The center specializes in treating bipolar disorder, schizophrenia, depression, anxiety disorders, disruptive behavior disorders and attention deficit/hyperactivity. UTHCPC programs focus on stabilizing individuals in crisis in a safe, structured environment. Once clients are stabilized, they are referred to long-term community treatment facilities or to outpatient services provided either through UTHCPC or another outpatient program near the client’s home.35

The Gulf Coast region is also home to a number of large private psychiatric programs, many operated by or affiliated with the area’s higher education institutions (Exhibit 46). These programs provide both inpatient and outpatient services and can treat a wide range of mental health disorders including bipolar disorder, schizophrenia, depression, anxiety disorders, disruptive behavior disorders, attention deficit/hyperactivity, personality disorders, obsessive-compulsive disorders, eating disorders, PTSD and addictive disorders.

Exhibit 46

Gulf Coast Region, Large Private Psychiatric Facilities

Facility Name Population Served Higher Education Affiliation
Lyndon B. Johnson General Hospital Children, Adolescents and Adults UT Health Science Center at Houston
Memorial Hermann Hospital Children, Adolescents and Adults UT Health Science Center at Houston
UT Mental Sciences Institute Children, Adolescents and Adults UT Health Science Center at Houston
M. D. Anderson Cancer Center Children, Adolescents and Adults UT Health Science Center at Houston
St. Joseph Medical Center Adults Only Texas A&M University, Houston
Methodist Hospital General Psychiatry Unit Adults Only Baylor College of Medicine, Houston
Menninger Clinic Adolescents and Adults Baylor College of Medicine, Houston
West Oak Hospitals Children, Adolescents and Adults
Cypress Creek Hospitals Children, Adolescents and Adults

Note: Children ages 3 through 12, adolescents 13 through 18 and adults are over the age of 18.
Source: The University of Texas Medical School at Houston, Psychiatry and Behavioral Sciences.

Professional Shortages and Rural Health Care

The U.S. Department of Health and Human Services designates Health Professional Shortage Areas – geographic areas or certain populations that have a significant shortage of available health care personnel. Eight of the 13 counties in the Gulf Coast region (Austin, Brazoria, Chambers, Liberty, Matagorda, Montgomery, Walker and Waller) have health professional shortages. Austin, Liberty and Waller lack primary-care physicians and mental health professionals, while Waller also needs dental services (Exhibit 47).36

Chambers County has seven direct-care physicians for its 34,810 residents, or one for every 4,973 individuals. Austin County, with a population of 28,205, has 10 physicians, or one for every 2,821 residents. Waller County has the fewest physicians per capita among all Texas counties that have at least one doctor. With a population of 41,352 and just three direct-care physicians, the county has just one doctor for every 13,784 residents (Exhibit 48).37

Exhibit 47

2009 Primary Care Health Professional Shortage Areas

See text version.

Source: Texas Department of State Health Services.

View health professional shortage areas.

Exhibit 48

Gulf Coast Region, Direct Patient Care Physicians by County, 2009

County Population Physicians Ratio Rank
Austin 28,205 10 2,821 173
Brazoria 310,491 235 1,321 99
Chambers 34,810 7 4,973 217
Colorado 22,074 29 761 41
Fort Bend 551,328 535 1,031 71
Galveston 289,203 313 924 58
Harris 4,016,367 7,857 511 22
Liberty 80,721 52 1,552 120
Matagorda 38,759 39 994 68
Montgomery 455,104 708 643 32
Walker 65,255 69 946 62
Waller 41,352 3 13,784 229
Wharton 43,560 59 738 38
Texas Total 24,873,773 39,374 632 -

Source: Texas Department of State Health Services.

The Chambers County Public Hospital District provides a good example of how local, state and federal resources can be used to attract health care professionals to their area. The hospital district has used a number of programs offered by the Texas Department of Rural Affairs, including the Medical Underserved Community-State Matching Incentive Program (MUC-SMIP) to assist one health care provider and the Texas Health Service Corps Stipend Program (THSCP) to attract two doctors to this shortage area.38

MUC-SMIP provides matching funds to primary-care physicians to help them cover the cost of establishing a practice in underserved communities. THSCP provides a state-funded stipend to resident physicians who commit to provide primary care to medically underserved communities in Texas for a minimum of one year.39

Chambers County also has had two health care professionals take advantage of the National Health Service Corps Loan Repayment Program, which provides $50,000 to primary care medical, dental and mental health clinicians in exchange for two years of service in a county designated as a Health Professional Shortage Area. Health professionals may be eligible to receive additional support for extended service.40

Exhibit 49

Harris County Hospital District Patient-Payor Mix, FY 2009

See text version.

Source: Harris County Hospital District.

View patient-payor mix.

The Uninsured

Texas has the nation’s highest share of uninsured residents. In 2008, 25.1 percent or 6.1 million Texans had no insurance at any time during the year, including 27.7 percent of all those under the age of 65 and 17.9 percent of children under 18.41

In 2006, the uninsured rate for those under 65 in the Gulf Coast region was 30.7 percent. Harris County had the highest rate, with an estimated 33.4 percent of residents uninsured; Galveston had the lowest rate, at 22.4 percent.42

The Harris County Hospital District (HCHD) is the primary health care provider for the Houston area’s uninsured. It comprises Ben Taub General Hospital and Lyndon B. Johnson General Hospital, Quentin Mease Community Hospital, 13 community health centers, one free-standing dental center, eight school-based clinics, 13 homeless shelter clinics and five mobile health units that are a part of an immunization and medical outreach program. In fiscal 2009, HCHD had 40,681 hospital admissions, 150,647 emergency visits, 891,475 outpatient visits, and delivered 9,722 babies.43

More than half of HCHD’s total revenue of $1 billion in fiscal 2009 came from property taxes ($522.1 million), with the remaining from patient services ($237.5 million), federal payments to states to reimburse hospitals that serve Medicaid patients and those with no means to pay for health care services ($179.2 million) and other sources ($62.8 million).

In fiscal 2009, HCHD provided $928 million of charity care. The majority of its charges for patient services were for those without health insurance or other sources of funding (61.5 percent). Those with commercial health insurance accounted for 2.1 percent of charges (Exhibit 49).44

To address the needs of the uninsured, the Harris County Health Alliance, United Healthcare and Community Health Choice have partnered to create the TexHealth Harris County 3-Share Plan. The plan will offer two affordable health benefit options to uninsured employees of small businesses.

Other Texas Medical Center hospitals also provide charity care. M.D. Anderson Cancer Center reported spending $208.7 million on such care in fiscal 2008.45 In 2008, the Methodist Hospital System provided $517 million in uncompensated charity care and community benefit activities.46 The University of Texas Health Science Center at Houston delivered $217.7 million in uncompensated care in 2008.47

To address the needs of the uninsured, the Harris County Health Alliance, United Healthcare and Community Health Choice (nonprofit health maintenance organizations affiliated with HCHD) have partnered to create the TexHealth Harris County 3-Share Plan. The plan will offer two affordable health benefit options to uninsured employees of small businesses. Businesses that wish to participate must be located in Harris County, employ between two and 50 and have not offered health insurance in the last 12 months. Eligible employees must work at least 30 hours a week. The cost of the plan will be shared by employers, employees and a subsidy fund with revenue from federal and state government sources, the city of Houston and Community Health Choice.48

All counties in the Gulf Coast region have county indigent health care programs (CIHCPs).

TexHealth Coalition is piloting a similar three-share program in Galveston County. The plan will contract with UTMB HealthCare Systems. The pilot program has similar eligibility requirements with slight differences in hours worked, income and business participation.49

St. Vincent’s House in Galveston provides free primary care to indigent, uninsured residents. Its clinic is a partnership with UTMB, which uses volunteer medical students to deliver services under the supervision of physicians. The clinic’s focus is on the prevention, early detection and treatment of chronic diseases. Among other services, the clinic provides pediatric care, mammograms, HIV testing and prescription assistance.

In Matagorda and Wharton counties, the Matagorda-Wharton Health Access Consortium provides health and dental care to low-income, uninsured residents. Along with health and dental services, the consortium provides education on diabetes and other chronic diseases and case management for those seeking medical or social services.

Exhibit 50

Gulf Coast Region, Rural Health Clinics and Federally Qualified Health Clinics, 2009

See text version.

Source: Texas Department of State Health Services.

View rural and federally qualified health clinics.

Underserved communities often turn to Rural Health Clinics (RHCs) and Federally Qualified Health Clinics (FQHCs) to meet health care demands (Exhibit 50). These clinics provide access to primary care by physicians, nurse practitioners and physician assistants. Some clinics carry both designations.

All counties in the Gulf Coast region have county indigent health care programs (CIHCP). These are required by state law to provide funding for basic health care services for indigent residents whose income is below 21 percent of the federal poverty level. CIHCPs often contract with FQHCs and RHCs to provide services.

CIHCPs use local and state funds to pay health care providers for services for eligible patients. To receive state funds, counties must spend more than 8 percent of their general revenue tax levy on qualified health care.50

Diabetes and Obesity

The Gulf Coast region has rates of adult diabetes that mirror those of Texas as a whole. Adult diabetes rates have been rising at an alarming rate in Texas, from 7.7 percent in 2004 to 9.7 percent in 2008.51 In the Gulf Coast region, the prevalence of diabetes also rose, from 7.8 percent in 2004 to 10.1 percent in 2008.52 Hispanics, who make up 33.6 percent of the Gulf Coast region population, have higher rates of diabetes than blacks and whites, at 16.8 percent versus 14.7 percent and 7.5 percent, respectively.53 The same period saw a corresponding increase in the prevalence of overweight or obesity in Texas adults and children.54

Obesity is a major risk factor for diabetes.55 The percentage of adult Texans that are overweight or obese rose from 62.9 percent in 2004 to 66.2 percent in 2008. In the Houston-Sugar Land-Baytown MSA, this share increased at an even faster pace, from 59.3 percent of the adult population in 2004 to 66 percent in 2008, with considerably higher rates for Hispanics and blacks – 76.5 percent and 73.1 percent, respectively.56 A 2005 study noted that by the 1990s, three out of four Mexican-American adults were either overweight or obese.57 Mexican-Americans are the largest Hispanic subgroup in the Houston-Sugar Land-Baytown MSA, accounting for 78.3 percent of all Hispanics in 2008.58

Diabetes was the sixth most-common cause of death in Texas from 2002 through 2006.59 The statewide diabetes mortality rate for that period was 29.8 deaths per 100,000 persons. In the Gulf Coast region, the diabetes mortality rate was 26.2 deaths per 100,000 overall, with considerably higher rates for Hispanics and blacks – 38.8 per 100,000 and 48 per 100,000, respectively.61 Mortality from diabetes is probably higher than indicated in statistics, since it is often listed as a contributing factor rather than a cause of death.62

Untreated or poorly controlled diabetes can lead to long-term health complications including heart disease, stroke, vascular disease, blindness, kidney disease, nerve damage and amputation. Texas hospital data indicate that five of the Gulf Coast region’s 13 counties – Walker, Galveston, Wharton, Liberty and Harris counties –had higher-than-average admission rates per 100,000 residents for long-term diabetes complications in 2005 (Exhibit 51). In that year, the state average for such admissions was 122 per 100,000 residents.63

Exhibit 51

Admissions for Diabetes-Related Long-Term Complications per 100,000 Population, by Texas County, 2005

See text version.

Source: Texas Department of State Health Services.

View diabetes-related hospital admissions.

In 2008, the Gulf Coast region became home to one of only 17 National Institutes of Health (NIH) diabetes centers in the U.S., when Baylor College of Medicine (BCM) in Houston was designated a Diabetes and Endocrinology Research Center.

In 2008, the Gulf Coast region became home to one of only 17 National Institutes of Health (NIH) diabetes centers in the U.S., when Baylor College of Medicine (BCM) in Houston was designated a Diabetes and Endocrinology Research Center. This designation provides BCM with additional resources to enable it to become a national resource on diabetes research. Fifty-seven researchers in 10 different departments make up BCM’s Diabetes and Endocrinology Research Center.64

BCM collaborates with numerous entities on diabetes research and participates in programs that increase community awareness of the disease. As one of 16 Look AHEAD (Action for Health in Diabetes) clinical centers in the U.S., BCM researchers are conducting clinical trials to determine the long-term health effects of weight loss in individuals with Type 2 diabetes as well as the long-term impact of lifestyle counseling.

BCM’s Children’s Nutrition Research Center, one of six federally funded human nutrition research centers, is collaborating with Texas Children’s Hospital on a study called HEALTHY that attempts to reduce childhood diabetes by promoting changes in school food programs, healthy behaviors and physical education programs. BCM also designed the Choosing Health and Sensible Exercise (CHASE) program, an eight-week course that teaches overweight children, adolescents and their families how improved nutrition and exercise can lower their risk of developing diabetes.65 Both health departments and schools can use the CHASE program.

In the past 20 years, the prevalence of excessive weight among U.S. children has doubled, making it a major public health concern, since obesity is a risk factor for many chronic diseases. And the problem is more severe in Texas.

Across the nation, 17 percent of children aged six to 11 were classified as obese in 2006, up from 6.5 percent in 1980, according to the U.S. Centers for Disease Control and Prevention (CDC).66 The prevalence of childhood overweight or obesity is even higher in Texas. The School Physical Activity and Nutrition (SPAN) III survey reported that between 2004 and 2005 the rates of overweight or obesity for Texas school children were 42 percent of Texas fourth-graders, 39 percent of eighth-graders, and 36 percent of eleventh-graders. In 2007, the CDC’s Youth Risk Behavior Surveillance System reported that 32 percent of Texas high school students were classified as overweight or obese.67

The University of Texas Health Science Center at Houston has developed a variety of programs designed to prevent obesity and diabetes in children.68 The University of Texas School of Public Health in Houston was one of four academic institutions that developed the award-winning Coordinated Approach to Child Health (CATCH) program, which teaches elementary school children healthy eating and physical activity behaviors. As of October 2009, 50 percent or more than 2,500 elementary schools in Texas and 7,000 schools nationwide had adopted the CATCH program. Several medical journals have reported on its effectiveness.69

In August 2008, the University of Texas Health Science Center in Houston, the Mayor’s Wellness Council, Houston Wellness Association and other community partners launched a pilot project – Children and Neighbors Defeat Obesity (CAN DO Houston) – to fight obesity in two city neighborhoods. CAN DO Houston targets children 12 and under and their families and provides numerous activities including after-school programs that promote physical activity and healthy snacks, cooking classes for parents and students, grocery store tours, nutrition education, school gardens and fitness and nutrition carnivals.70

Local hospitals and community health centers also provide educational and treatment programs to persons with diabetes. The American Diabetes Association has recognized the Houston Northwest Medical Center, Memorial Hermann Memorial City Medical Center and the Memorial Hermann Katy Hospital among others for Quality Self-Management Education.71 Diabetes self-management education teaches people to manage their diabetes and avoid related complications.

In Galveston County, UTMB’s Stark Diabetes Center is known for its comprehensive approach to the disease, which includes clinical care, education and diabetes research. Since its creation in 2001, the Stark Diabetes Center has made community outreach and education a priority.

The center holds community health fairs that provide diabetes screening and education throughout the region, and has formed partnerships with local health care workers to educate the public about lifestyle changes that can prevent and control diabetes. It also uses “telehealth” technology – use of telecommunication equipment and information technology – to disseminate information about diabetes care to health professionals and patients alike. It broadcasts a continuing medical education lecture series to health care providers throughout Texas, and also offers an American Diabetes Association-certified self-management training program to patients in surrounding counties via telehealth technology.72

In 2009, the Texas Legislature appropriated $6 million to the Stark Diabetes Center to expand its community-based diabetes education program, which focuses on the prevention and control of diabetes through lifestyle changes. According to UTMB, comprehensive diabetes prevention services provided through the Stark Center model of community-based care and patient education cost just $21.50 per at-risk individual per year, compared to an average annual cost of $12,000 to treat a person with diabetes. In August, the center announced it will partner with the Texas Diabetes Council to offer four regional community-based diabetes prevention programs in Texas.74

Baylor College of Medicine, Houston

PHOTO: Greater Houston Convention and Visitors Bureau

Endnotes

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