THE STATE OF PUBLIC HEALTH CARE IN HOUSTON/HARRIS COUNTY
Despite Houston’s world-class medical center and globally renowned physicians, our lo
w
-income and uninsured
residents are frequently unable to access the most basic of health care services. Limited access to outpatient
preventive, primary and specialty care, fragmented public health delivery system, and an unacceptably high and
growing number of low-income and uninsured residents obtaining non-urgent care from Houston/Harris County’s
emergency rooms has weakened our area’s already fragile health care safety-net. The Houston/Harris County
metropolitan area health care system is facing a growing crisis.
HOUSTON/HARRIS COUNTY’S
UNINSURED RESIDENTS
• Of Harris County’s 3.5 million residents, 1.1
million (31.4%) are uninsured.
• An additional 500,000 residents are
underinsured, meaning that their plan is not
adequate to meet their health care needs.
• 25% of Harris County’s children are
uninsured.
• 51.7% of Harris County’s Hispanic population
– the fastest growing ethnic group in the
region – is uninsured.
• The vast majority of Harris County’s
uninsured are working people and their
dependents; 43% of those have annual
family incomes below $43,000.
• The fastest growing segment of uninsured in
Harris County are the middle class, those
with annual family incomes exceeding
$50,000.
• The area’s public/private safety-net system is
able to meet less than on-third of the
demand for services.
• Outpatient services for the
uninsured/underinsured include:
• 11 community-based primary care
clinics operated by Harris County
Hospital District
• 7 preventive clinics operated by the
City Health and Human Services
Department
• 6 preventive clinics operated by the
County Health Department
• 3 Federally Qualified Health Centers
(FQHC)
• numerous small nonprofit clinics
T
HE UNINSURED AND THEIR EFFECT ON
HARRIS COUNTY’S EMERGENCY ROOMS
• Limited access to outpatient primary, preventive and specialty care
for the uninsured/underinsured has resulted in Harris County’s
ER’s being overburdened by non-urgent patients.
• The University of Texas School of Public Health estimates that non-
optimal use of ER’s by the uninsured is greater than 50%.
• ER resources – capacity and personnel – are already scare; time
spent on non-urgent/primary care patients is less time and money
that can be spent on true emergencies.
• Many of Harris County’s ER’s and trauma centers are on diversion
status 30% of the time.
• The cost of treating a non-urgent condition in an ER setting is, on
average, three times as high as the cost of outpatient treatment.
• Emergency health care providers are, on average, able to recoup
less than 10% of their incurred costs for serving the uninsured.
• In order to avoid bankruptcy, emergency health care providers
must shift the cost burden of caring for the uninsured on to those
with the ability to pay.
o For publicly funded agencies, the costs are shifted to the
county taxpayer.
o Private hospital systems shift their costs to insurers – who
in turn pass these increased costs along to their customers,
e.g., employers who sponsor health plans for their
employees. Employers, in an effort to absorb these higher
costs, may reduce benefits, or simply shift the cost burden
on to their employees in the form of higher premiums,
deductibles, & co-pays. The result of this cost shifting is
often more uninsured!
o Eventually – if this scenario is allowed to continue repeating
itself – Harris County’s insured population will no longer be
able to sustain these growing costs, and the system will
breakdown.
FRAGMENTATION OF OUR PUBLIC HEALTH
DELIVERY SYSTEM
• City of Houston and Harris County’s scope of work substantially
overlaps, with no formal method to coordinate services (often
resulting in duplication).
• Area agencies (public and private) often compete with one another
for state and federal grant funds, thereby reducing each other’s
chances of securing additional dollars.
• Varying eligibility standards & procedures confuses patients and
requires duplication of effort by providers.
