Hospital Districts of the Future
posted by John Guest on March 31st, 2010 5:02 PM
While I didn't take it all in word for word, I was generally impressed with Commissioner Suehs presentation at the joint hearing today chaired by Senators Nelson and Duncan. I was not overly pleased with the discussion about hospital districts. Suehs suggested that State law needed to be totally revamped to address hospital districts after health reform. He and Senator Nelson discussed how hospital districts would be left serving undocumented residents after federal health reform solves the problem of the uninsured.
I would like to offer several preliminary observations that I would hope others would expand upon. First, the major hospital districts in the big cities in
Texas were created in the 1950's well before Medicare and Medicaid "solved" their big part of the uninsured problem. Post-1965, these hospital districts have actually taken on a larger responsibility in their communities. I would argue that assuming a reduced hospital district role after the health reforms of 2010 may be a bit premature.
There are reasons to assume some volume shifts . . .I wrote an analysis on this issue that was distributed at the November, 2009 Board meeting and is posted on our website.
I would also suggest that hospital districts play some significant roles that should robably continue - they underpin the trauma system . . . hospital districts support health professional education - in many cities, the medical school would not be able to exist without a close affiliation with these public institutions . . . in many communities we see evidence that they are managing to mold themselves into vibrant and competititive organizations (a la UMC in
Lubbock).
It should also be noted that many of the large hospital districts serve individuals with discounts who are at or below 200, 250, even 300 percent of the federal poverty level. Yes, insurance reform may solve this problem, but when
Texas Medicaid stops at 133 of FPL, there will still be a substantial population needing help and finding themselves unable to get it beyond a community resource.
There . . . that's a start. What say ye?
