Texas

Texas spends billions on healthcare and the bill keeps going up.

Texas spent $103.6 billion on healthcare in 2004. Texas’s healthcare bill keeps going up, at a 7% average annual increase between 1991 and 2004.[1]
Texas spent $4,601 (in 2004) per capita on healthcare, more than twice the nation’s average per capita spending on food ($2,207).[2]
Yet nearly one in four Texans (24%) or 5.5 million Texans remain uninsured, the highest percentage among the states (16% on average).[3]
Between 2001 and 2005, family premiums in Texas increased 39.7%, while median earnings of people purchasing family coverage only increased by 3.51%.[4]
Private companies offer insurance to employees at a lower rate in Texas than nationwide.[5]
Texas law is generally considered to be less restrictive on insurers than many other states, as it allows insurers who sell to small employers with 2-50 employees to adjust premium rates based on age, gender, area, industry, and group size. Rates can also be increased up to 67% on the basis of health status.[6]
The self-employed and people who buy individual policies have few protections. They may pay very high rates or be permanently denied due to health status or other factors.[7]
The state has a high risk pool for people who can’t afford individual coverage or who are denied coverage, but they may be charged as much as twice the premium that a healthy person would pay a private insurer and there is no premium assistance to low income participants. Except for people who were continuously covered for 12 months prior to joining the pool, the plan excludes coverage for all preexisting conditions for 12 months.[8]

Patients in Texas receive lower quality care in most settings, according to standardized quality measures.

Lower percentages of heart patients are given necessary treatments and procedures that stabilize heart attacks than elsewhere nationally.[9]
A lower percentage of patients undergoing surgery in Texas hospitals receive appropriately timed antibiotic treatment than the national average, which puts them at risk of contracting an infection.[10]
Also, a lower percentage of pneumonia patients in Texas hospitals receive antibiotic treatment within four hours (compared to the national average).[11]
However, lower percentages of Texans living in nursing homes have urinary tract infections, have pressure sores, or have had a catheter inserted and left in their bladder, thereby reducing the risk of infection.[12]

Texas has made some progress in reporting hospital-acquired infections.

A law passed in 2007 requires the Department of State Health Services to publish healthcare acquired infection rates at hospitals and ambulatory surgical centers, for seven types of surgical procedures and central line associated blood stream infections in ICUs. The law establishes special reporting requirements for pediatric and adolescent hospitals and major pediatric units in general hospitals. However, the legislature did not fund the program and implementation is currently stalled.[13]
Texas passed a law that creates a pilot program to report MRSA infections in selected counties. The San Antonio Metropolitan Health District, the Brazos County Health Department and the Amarillo Bi-City-County Health District have agreed to conduct the pilot. Each will require labs to report cases of MRSA infections. A report summarizing the pilot results will be released to the public and the Texas Department of State Health Services will report on the pilot program to the legislature by September 2009.[14]
For several years, Texas hospitals were required to report certain medical errors. These errors range from doing surgery on the wrong part of the body to getting the wrong dose of medication. Reports issued by the Texas Department of Health Services revealed that 530 medical errors were reported from 2005 to 2007. The law requiring hospitals to report medical harm expired in 2007.[15]

Texas faces healthcare challenges.

An estimated 21% of children in Texas remain uninsured compared to the 12% national average.[16]
27% of working adults in Texas are uninsured, the highest rate of uninsured working adults compared to the average in other states.[17]

Diabetes patients in Texas with long-term complications are admitted to the hospital at much higher rates than the national average (147 per 100,000 Texans compared to 113 nationally). [18]
Children and seniors with asthma in Texas are admitted to the hospital at higher rates than average (159 children in Texas admitted per 100,000 compared to 132 children nationally; 234 seniors in Texas admitted per 100,000 compared to 203 seniors nationally).[19]
Texans die from heart disease and diabetes at higher rates than the national average (227 Texans with heart disease compared to 217 nationally; 29 Texans with diabetes compared to 25 nationally).[20]

Footnotes:

[1] http://www.statehealthfacts.org/profileind.jsp?rgn=45&cat=5&ind=592 ; http://www.statehealthfacts.org/profileind.jsp?ind=595&cat=5&rgn=45

[2] http://www.statehealthfacts.org/profileind.jsp?ind=596&cat=5&rgn=45 ; http://www.foodnavigator-usa.com/news/printNewsBis.asp?id=75043

[3] http://www.statehealthfacts.org/profileind.jsp?cat=3&sub=39&rgn=45 ; http://www.usatoday.com/news/nation/2007-06-18-texas-health-care_N.htm

[4] http://www.rwjf.org/files/research/042508ctuwfinalembargoed.pdf

[5] http://www.statehealthfacts.org/profileind.jsp?cat=3&sub=46&rgn=45 50% of private businesses in Texas offer health insurance to their employees compared to 56% of private businesses elsewhere offering coverage.

[6] Texas State Dept of Insurance, ‘Working Together for a Healthy Texas,’® March 2007, p..22; http://www.tdi.state.tx.us/reports/report7.html

[7] http://www.statehealthfacts.org/profileind.jsp?cat=7&sub=87&rgn=45 ; http://healthinsuranceinfo.net/getinsured/texas/individual-health-plans/individual-health-insurance-sold-by-private-insurers/

[8] http://www.statehealthfacts.org/profileind.jsp?cat=7&sub=89&rgn=45 ; http://healthinsuranceinfo.net/getinsured/texas/individual-health-plans/texas-health-insurance-risk-pool-the-health-pool/ ; http://www.txhealthpool.com/eligibil.html

[9] http://statesnapshots.ahrq.gov/snaps07/meter_metrics.jsp?menuId=4&state=TX&level=5&region=0&compGroup=N Reflects 2005 data.

[10] http://statesnapshots.ahrq.gov/snaps07/meter_metrics.jsp?menuId=4&state=TX&level=5&region=0&compGroup=N Reflects 2005 data.

[11] http://statesnapshots.ahrq.gov/snaps07/meter_metrics.jsp?menuId=4&state=TX&level=2&region=0&compGroup=N Reflects 2005 data.

[12] http://statesnapshots.ahrq.gov/snaps07/meter_metrics.jsp?menuId=4&state=TX&level=6&region=0&compGroup=N Reflects 2006 data ; http://www.cdc.gov/ncidod/dhqp/gl_catheter_assoc.html

[13] http://www.consumersunion.org/campaigns/CU%20Summ%20HAI%20state%20rpting%20laws%20as%20of%201-08.pdf

[14] www.dshs.state.tx.us/idcu/investigation/conditions/Summary.pdf; http://www.consumersunion.org/campaigns/CU%20summary%20of%20MRSA%20laws%20as%20of%201-08.pdf ; http://www.dshs.state.tx.us/idcu/investigation/conditions/Summary.pdf

[15] Institute of Medicine, To Err is Human, Kohn, Linda, Corrigan and Donaldson, 2000, pp.26, 35. ; http://www.dshs.state.tx.us/HFP/safety.shtm

[16] http://www.statehealthfacts.org/profileind.jsp?cat=3&sub=39&rgn=45

[17] http://www.rwjf.org/newsroom/newsreleasesdetail.jsp?productid=21802