Talk of the Town
Neighborhood clinics may help to heal Harris County’s ailing health care system.
By Harris County Judge Ed Emmett
The national debate over health care is good political theater and will no doubt continue in the foreseeable future. Whatever the outcome of that debate, though, local officials will have a daunting task providing health care to those who have no insurance, are underinsured or have special needs.
The Harris County Hospital District was created by the Texas Legislature largely in response to problems exposed at the old Jeff Davis charity hospital. Since that time, HCHD has developed a solid reputation at its flagship hospitals—Ben Taub and LBJ—and at its clinics around the county.
As Harris County’s indigent population has grown, the HCHD facilities have been stretched. And as more and more people have lost access to adequate insurance, the district’s emergency rooms have become inundated by patients with no other medical home. We must take steps to provide more neighborhood clinics so that these patients can have a real medical home and can access preventive care rather than waiting until a medical crisis forces them to visit an emergency room.
Recently, the hospital district signed innovative agreements with two private, federally qualified health clinics (FQHCs) in Denver Harbor and Spring Branch. By supporting existing neighborhood clinics, the hospital district does not have to spend capital dollars itself. Such an approach also retains flexibility. The indigent population is transient, moving from area to area within the county. Investing in bricks and mortar in a static location makes little sense.
Another issue facing the HCHD is its inability to control its emergency room patient load. There have been many observations and discussions of undocumented foreigners using the district’s emergency rooms and maternity wards. Beyond that situation is the reality that residents of surrounding counties also come to HCHD facilities. When the district was created, neither of these dynamics existed or was contemplated. I believe it is time for the Legislature to consider a regional approach, since indigent health care needs pay no attention to county lines.
In addition to moves toward neighborhood clinics and regionalization, there is a growing recognition of the need to focus much more on mental health issues, substance abuse and addiction. Many of those whose health care needs are met solely by HCHD and private neighborhood clinics suffer from these afflictions. This is particularly true among the homeless population.
Those suffering from mental health issues and/or addiction are most likely to spend time in the Harris County Jail. A sad note is that the jail is now the largest mental health facility in the state of Texas. It deals with more mental patients than any other facility. Unfortunately, those with mental health issues tend to get caught in the “revolving door” of the criminal justice system. While in jail and under the care of the jail’s medical staff, those with mental issues are stabilized. Upon their release from jail, however, they far too frequently fail to continue receiving adequate care, either through neglect or by choice. As a result, the behavior or activity that caused their arrest in the first place is too often resumed, leading to yet another arrest. Thus, the “revolving door.” The same situation is frequently descriptive of inmates who have substance abuse or addiction issues.
One of the best investments we can make is to construct a facility that would transition the appropriate inmates from the criminal justice system into the health care system and ultimately back into normal lives. Harris County, as the third-most populous county in the United States, is blessed with numerous public and private agencies structured to help those with mental health, substance abuse or addiction issues. All of those agencies could be better coordinated to maximize their effectiveness, but the biggest improvement that could be made would be to create a mechanism through which those in the criminal justice system are reintegrated into society through the appropriate agency or service provider.
There is no question that the direct cost of incarcerating someone in the criminal justice system is far more expensive than maintaining them in the proper health care environment. Of course, the benefits grow exponentially if that person remains connected to family and is a productive resident, rather than being a drain on resources and a potential danger to society.
Regardless of the outcome of the health care debate in Washington, we need to take steps now to create a local, public health care system that will best serve the target population—the uninsured and underinsured. We need to do this for the long term future of the Houston region.
Our focus should be on establishing medical homes through neighborhood clinics, providing preventive care, thereby reducing the load on emergency rooms.
The provision of indigent health care should be regionalized to meet the real needs of this rapidly growing urban area.
Many of those suffering from mental health issues, substance abuse or addictions need to be served by the health care system instead of the criminal justice system.
If those steps are taken, the public will be better served and the taxpayer will save money.
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