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Health Care

Health care is a vital part of the South Texas economy in metropolitan areas, and a growing industry. Health care employment in the region is increasing rapidly and the Texas Workforce Commission (TWC) expects strong employment growth in the health care industry to continue.¹ The region, however, faces a number of challenging issues in providing health care to its residents. Limited access to health care facilities and providers, high rates of the uninsured and a higher-than-average prevalence of chronic diseases such as diabetes pose difficult and expensive challenges for South Texas businesses, their employees and state and local governments.

Edinburg Children’s Hospital

PHOTO: HKS Architecture

South Texas counties and organizations, however, have been innovative in working with the state and federal governments to develop solutions for health care challenges. Colleges and universities have established research programs and health care professions training and educational opportunities. Both for-profit and nonprofit organizations have established new service sites, such as the new Valley Baptist Medical Center-Brownsville psychiatric center and one of Texas’ newest federal health clinics, the Amistad Community Health Center in Corpus Christi.

Health Care Infrastructure

Hospitals are key factors in any state’s health care infrastructure. They provide a central point for advanced medical services; encourage the growth of affiliated medical services in surrounding areas; and may even be a major employer in some areas. Valley Baptist Medical Center, for instance, is one of the ten largest employers in the Brownsville-Harlingen metro area, as are CHRISTUS Spohn Health System and Driscoll Children’s Hospital in Corpus Christi.²

The South Texas region is home to 24 for-profit hospitals, 9 nonprofit hospitals and seven public hospitals (Exhibit 50).³ Of the 40 hospitals, 7 are in Corpus Christi; Laredo, Brownsville, McAllen and Harlingen each have four; Edinburg has three; and the remaining 14 are in smaller communities.⁴

The region’s largest hospital is CHRISTUS Spohn Hospital in Corpus Christi with 1,049 beds. McAllen and Harlingen had the next largest hospitals in the South Texas region. In 2007, the region’s hospitals had a total 6,721 staffed beds.⁵

The South Texas region also has six hospital districts (Exhibit 51).⁶ Hospital districts established under Texas law have the authority to levy taxes in their districts for the support of health care and hospital services.

Fourteen of the 28 South Texas counties have no hospitals (Exhibit 52).⁷ Some residents must travel longer distances to reach hospitals, and this is especially critical in emergency situations.

Veterans’ Health Care

South Texas does not have a Veterans’ Affairs (VA) hospital. The closest VA hospital is in San Antonio, a long drive for many veterans. In 2007, a comprehensive consultant’s study by Booz Allen Hamilton on South Texas veterans’ health care needs revealed the region’s need for a specialty-care outpatient care center for veterans, but did not recommend the construction of a hospital. The study found that about 98 percent of South Texas veterans traveling to the VA hospital in San Antonio sought specialty care rather than inpatient hospital treatment. The study also found that the Rio Grande Valley has about 45,000 veterans, with about 15,000 enrolled for VA benefits.⁸

Based on this study, the U.S. Department of Veterans Affairs recommended the construction of a 158,000-square-foot VA Health Care Center in Harlingen devoted to specialty outpatient services such as cardiology, radiology, oncology, ophthalmology, psychiatry, physical therapy, dental care, audiology, podiatry, laboratory services and outpatient surgery.

The first phase in the long-term expansion of the Harlingen VA Health Care Center, a 34,000-square-foot facility, was completed in December 2007. This first phase provides new services such as mental health treatment, podiatry and computerized tomography. The second phase in the expansion is scheduled to add 21,000 square feet by December 2008 and offer new services such as cardiology, cancer treatment and neurology. The third phase will add another 102,000 square feet by December 2010, for a total of 158,000 square feet. This final phase will add outpatient surgical services.

According to Larry Alva, the center’s administrative officer, the expansion of the Harlingen VA Health Care Center not only helps the region’s veterans, but will also have a positive economic impact on the city, bringing high-paying medical professional jobs as well as hotel stays, restaurant visits and shopping by veterans and their families traveling to the city for health care.⁹

Psychiatric Care

The Texas Department of State Health Services (DSHS) operates the Rio Grande State Center/South Texas Health Care System (RGSC/STHCS), which includes a 55-bed inpatient psychiatric hospital and a 77-bed long-term residential facility for people with mental retardation. RGSC/STHCS is the only public provider of inpatient mental health services and long-term mental retardation services south of San Antonio. In addition, it offers an outpatient clinic providing primary health care services to residents of Cameron, Hidalgo, Willacy and Starr counties.¹⁰

The Valley Baptist Medical Center in Brownsville recently opened a 37-bed psychiatric facility with two full-time psychiatrists, and will offer an outpatient psychiatric clinic. Before the clinic’s opening, Cameron County had only two psychiatrists, and neither practiced in Brownsville. Even Brownsville Independent School District transported children in need of mental health care to Hidalgo County, incurring additional expense in order to get essential care for children. The new clinic is the result of the work of the Cameron County mental health task force, formed in 2007 when mental health care reached a critical point, and Valley Baptist Medical Center.¹¹

The region is scheduled to receive additional mental health care services, courtesy of state aid from DSHS. Tropical Texas Behavioral Health, which provides mental health, mental retardation and substance abuse services for residents of Cameron, Hidalgo and Willacy counties, received $1.3 million to obtain services from local private mental health care providers.

The additional money will allow patients to stay in the area and receive inpatient services, rather than being transported by police or constables to other public providers in the state. The center previously had transported about 400 patients a year to other facilities. The new funding is on top of $1.7 million in state money the center had received earlier this year to expand its crisis services.¹²

Health Care Employment

In the larger South Texas metropolitan areas – McAllen-Edinburgh-Mission, Corpus Christi, Laredo and Brownsville-Harlingen – health care is a vital and growing industry. The Federal Reserve Bank of Dallas reports that since 2000, the share of local employment represented by health care jobs has risen faster than the state average in every border metro area in the South Texas region.

South Texas’ rapid population growth is the main factor boosting health care employment in the region, according to the Federal Reserve Bank of Dallas. While Texas’ population grew by 38 percent between 1990 and 2006, McAllen’s population rose by 83 percent, Laredo’s by 74 percent and Brownville’s by 49 percent.¹³ Another factor contributing to the growth of the health care industry in South Texas is the large share of residents eligible for government health care programs. In addition, area residents may no longer have to travel to other areas of the state for medical procedures that are now available in the border area.

In 2006, health care jobs accounted for 22 percent of employment in Brownsville, 21 percent in McAllen and 14 percent in Laredo, compared to just 12 percent in the state as a whole.¹⁴ According to the Texas Workforce Commission (TWC), health care firms are among the top private sector employers in each metropolitan area of South Texas. For McAllen-Edinburgh-Mission, health care firms comprise seven of the area’s ten largest private employers; six of the Brownsville-Harlingen area’s top private employers are health care providers.¹⁵

TWC forecasts strong employment growth in the South Texas health care industry through 2014. It estimates that high-skill health care employment in the Lower Rio Grande Valley will increase by 46 percent between 2004 and 2014, compared to just 34 percent statewide. Health care-related support employment is expected to grow even faster, by 51 percent, compared to 40 percent for the state as a whole.¹⁶

Health Professional Shortage Areas

The increasing number of health care workers in South Texas is still not enough to meet the needs of a rapidly growing population. The U.S. Department of Health and Human Services has designated 16 of the region’s 28 counties as having a shortage of primary health care providers – primary care doctors, dentists and mental health professionals (Exhibit 52).¹⁷

Primary care doctors are in short supply in more than half of South Texas’ counties. Primary care practitioners include doctors of medicine (M.D.) and doctors of osteopathy (D.O.) who provide direct care in general or family practice, general internal medicine, pediatrics, and obstetrics and gynecology. Primary care physicians’ offices and clinics are usually the first stop for people seeking medical care.

Three South Texas counties – Kenedy, McMullen and Real counties – had no practicing direct care physicians as of August 2007.²¹ Families seeking medical care must travel to other counties, often many miles away.

Health Insurance

South Texas’ metropolitan areas have the highest uninsured rates of all metropolitan areas in Texas. Laredo had the highest metro uninsured rate in the entire state, with a three-year average of 36 percent uninsured (2001-2003), followed by Brownsville-Harlingen with 32.4 percent, Corpus Christi with 28.3 percent and McAllen-Edinburg-Mission with 27.8 percent. Only El Paso’s uninsured rate exceeded Brownsville-Harlingen, Corpus Christi, and McAllen-Edinburg-Mission. The statewide average rate was 24.7 percent.²²

Determining the rate of uninsured in individual counties is difficult because the surveys undertaken to measure such rates often include a small sample size at the county level. The U.S. Census Bureau, however, created county-level estimates for the uninsured in 2000. Based on these estimates, South Texas counties have rates of uninsured as high as 37.8 percent in Starr County; 37 percent in Zavala County; and 36.3 percent in Maverick County. Eleven South Texas counties had uninsured rates below the state’s three year average of 24.7 percent, with the lowest rate held by Live Oak County at 18.2 percent, making it the only county with fewer than 20 percent of its residents uninsured in all of South Texas.²³

Due to the large number of uninsured, many communities in the region are exploring ways to provide health care to persons without insurance. Nueces County, with an uninsured rate of about 24.9 percent, was selected to participate in Health Access America, a program that holds enrollment seminars, health fairs and other events to help the uninsured enroll in public and private insurance programs. The two-year campaign will end this summer.²⁴

Also in Corpus Christi, the Amistad Community Health Center began providing medical services in April 2008. The Center is a federally funded health center that provides care on a sliding scale based on family income. Instead of going to the Christus Spohn Hospital Memorial emergency room, uninsured patients can schedule appointments at the center for medical care.²⁵

Laredo’s Gateway Community Health Center, another federally funded health clinic, includes two primary clinics and other rotating clinic sites that provide medical care including pharmacy services, x-rays and laboratory tests; preventive and restorative dental care for children; and other preventive services such as immunizations, diabetes awareness and education programs, cancer screening programs, and worksite wellness. Gateway opened a new $11 million, three-story facility in August 2006 to meet the growing demand for its services.²⁶

At the state level, the Texas House of Representatives has a special interim study looking at some of the difficulties in purchasing health insurance, and the Texas Senate Finance Committee is directed to evaluate the effectiveness of state tax incentives encouraging employers to provide health coverage to their employees and make recommendations for additional deductions or credits that would increase the number of employees covered by health care insurance. The Senate’s Health and Human Services Committee was also given the assignment to report on existing Medicaid legislation that is intended to cover more uninsured in Texas with market-based plans or premium assistance for employer health plans. The Senate’s State Affairs Committee is also looking at insurance issues.²⁷

Infectious Diseases

South Texas has a greater incidence of infectious diseases such as tuberculosis, listeriosis and dengue fever than other parts of the state. The border area, with large population centers and multiple border crossings, make the prevalence of tuberculosis (TB) higher than in other regions of the state or the country.²⁸

TB is an airborne communicable disease caused by bacteria that is spread from person to person. The symptoms of TB are fever, night sweats, coughing, chest pains and weight loss.²⁹

South Texas had a higher rate of active TB disease during 2001-05, 8.6 persons per 100,000 population, than the rest of the state.³⁰ Of the 13 Texas counties with the highest incidence of TB, seven are located in South Texas. These counties have more than twice the state average rate of TB.³¹ Webb County alone had a TB rate of 19 persons per 100,000 population in 2001-2005.³² Selected urban or border local health departments offer TB screening for high-risk populations.³³

In an effort to address the high incidence of TB along the Texas-Mexico border, the Grupo Sin Fronteras TB Binational Project was established in 1995 by the commissioners of health for Texas and the Mexican state of Tamaulipas.³⁴ The program provides medical consultations and education on the transmission, prevention and treatment of TB. Successes of the program include the identification of high rates of drug-resistant TB in Mexico.³⁵

Diabetes and Obesity

The UT Health Science Center study found a higher prevalence of obesity and diabetes in South Texas than in the rest of Texas or the nation. Of the health conditions analyzed in the study, obesity had the most significant impact on the South Texas population, while diabetes ranked second. Between 2002 and 2005, almost 30 percent of adults living in South Texas were obese, compared to about 25 percent in the rest of Texas. Hispanics in South Texas had a slightly higher prevalence of obesity and diabetes than non-Hispanic whites in the area, but a significantly higher prevalence than Hispanics in the rest of Texas.³⁶

Untreated or poorly controlled diabetes can lead to long-term health complications including heart disease, stroke, vascular disease, blindness, kidney disease, nerve damage and amputations. Between 2002 and 2004, diabetes was the sixth-leading cause of death in both Texas and the U.S. Mortality from diabetes is probably higher since it is often listed as a contributing factor rather than as an underlying factor, and thus is not listed as a cause of death.³⁸

Texas hospital inpatient discharge data reveals that South Texas counties have a higher-than-average number of admissions for diabetes long-term complications per 100,000 residents (Exhibit 53). In 2005, seven South Texas counties had more than double the statewide average admission rates for long-term complications related to diabetes in comparison to the statewide average of 122 per 100,000 population.³⁹

A 2001 study by the U.S. Centers for Disease Control and Prevention found that being overweight or obese increases the risk of being diagnosed with diabetes.⁴⁰ The good news is that lifestyle changes such as increased physical activity, weight loss and eating healthy foods can prevent or control diabetes.

In the South Texas region, local groups are joining the fight against obesity and diabetes. In Corpus Christi, the Coastal Bend Diabetes Initiative recently funded three such projects. One will help diagnose and treat diabetes and educate uninsured Coastal Bend residents about the disease. A second project award went to the Education Service Center in Region 2 to fund the Healthy Active Early Years Program intended to prevent diabetes and obesity in children. A third award went to the Corpus Christi Parks and Recreation Department, to help it educate children about healthy living at 10 after-school locations. The initiative previously funded the staffing of a diabetes center at Del Mar College and other projects.⁴¹

A pediatric endocrinologist at Driscoll Children’s Hospital in Corpus Christi has initiated a South Texas Obesity Project focused on preventing childhood obesity and diabetes.⁴² In addition, a Borderplex Health Council formed by four universities – the University of Texas Health Science Center at San Antonio, the University of Texas-Pan American, the University of Texas at Brownsville/Texas Southmost College and the University of Texas Health Science Center at Houston – agreed to invest $1 million in programs for preventing diabetes and obesity and improving the region’s supply of nurses.⁴⁴

The University of Texas School of Public Health’s Brownsville Regional Campus recently received a five-year, $7 million federal grant to establish a “Center of Excellence” to research diabetes in Americans of Mexican descent. Center researchers also will work with the media to create positive messages about physical activity and food choices. A special study will examine the role of Mexican-American families in reducing the risk of obesity and diabetes in children through parental intervention.⁴⁵

In Laredo, a campus of the University of Texas Health Science Center at San Antonio, in partnership with Texas A&M International University, is developing a degree program in dietetics. The curriculum and program is anticipated to start in fall 2008.⁴⁶

Local health care initiatives plus the efforts of higher education in the health care arena have increased the availability of health care in South Texas over the last 20 years and are expected to continue expanding services in the region.

The Federal Reserve Bank of Dallas expects health care and education to continue to be important sources of growth to the border region. In a ten-year period (1995-2005), the share of health care jobs in McAllen rose from 12 to 21 percent, and from 15 to 22 percent in Brownsville.⁴⁷

Workforce Solutions for South Texas, a local workforce board serving Jim Hogg, Webb, and Zapata counties, reported that between the first quarter of 2004 and the first quarter of 2005, ambulatory health care services showed the greatest gain in employment numbers for its region. Moreover, they report an anticipated growth rate of 42.5 percent for the health care industry between 2002 and 2012.⁴⁸

Endnotes