February 9, 2005
Texas-Style Health Planning
We're all used to reading stories about desperately poor counties and their residents and the hurdles they face in getting affordable health care services. Descriptions of facilities in such places often sound like they're coming from third-world countries, not from the richest country (not counting public debt) on earth. Sunday's Houston Chronicle, however, had a different kind of story (one all too familiar to residents of Dallas County).
The richest county in Texas is Collin, whosed median income is almost double the state's median. Immediately to the north of Dallas County, Collin is home to thousands of McMansions, corporate campuses, and luxury stores. It also killed a $16 million bond proposal to renovate its old public hospital in 1983, after which it sold the facility for $13 million and created a trust fund for indigent health care. The fund is valued today at $24 million.
Under state law, counties without a public hospital are obligated to pay for the indigent health care of their residents. The tricky part is that counties are free to set the income levels to qualify for indigent health benefits at any level tghey want.
The story describes one recently unemployed and uninsured Collin County resident who racked up a relatively modest $50,000 hospital tab after a near-fatal motor vehicle accident last June. He applied to the county for benefits and was turned down. To qualify he would have had to have earned less than $2,328. In addition to the eligibility standard, Collin doesn't make the process easy on applicants:
[C]ounty officials handed [the patient] a list of 31 documents he was required to supply with his application, including canceled rent checks, automobile registrations, savings and checking account statements, and a reference list. "Every time I'd hand one thing in, they'd ask for another," Wright said. "They even asked for my dad's W-2s. He's a truck driver."
The county is, shall we say, tax-averse: "'You bet. We don't like to pay taxes,' said Collin County Commissioner Jerry Hoagland. 'Nobody I'm talking with wants to raise taxes to pay for this.'"
So what's a Collin County resident to do? There's a one-day-a-week adult clinic and a two-day-a-week children's clinic, but the appointment list fills up fast at those charity-run facilities. So many indigent patients head south to Dallas' Parkland Hospital, one of the premier public hospitals in the country, which faces its own mounting deficits each year. In 2003, Parkland treated 237 Collin County in-patients (for which it received payment for 1) and had 4,575 outpatient visits from Collin residents, leaving Parkland with a $6 million unpaid bill for the care provided to Collin's indigent population. (Little wonder Dallas residents' county tax bill is about double that of Collin County.)
Meanwhile, Collin County officials are unrepentant:
"Parkland believes anybody who shows up should get health care. It's not our problem they don't qualify patients before they admit them," said Collin County Commissioner Phyllis Cole, who said she believes health care should be left to charities and the private sector. "I wish they would get off my back."
As long as Texas' state laws set no standards for the indigent health-care obligations of individual counties, and as long as we continue our fractionated health-insurance system, which rewards cost-shifting behaviors by private and public health plans, the situation can only get worse. [tm]
February 9, 2005 | Permalink