President's Page

President's Page
September 2005

The North Texas Underinsured Healthcare Collaborative —
Voicing the needs of the public sector

by Leslie H. Secrest, MD
2005 DCMS President

The average DCMS member knows little about the North Texas Underinsured HealthCare Collaborative. Although its effort is ambitious and, most would say, impossible, it does provide the opportunity for conversations among parties that might not otherwise discuss health care in a spirit of cooperation and collaboration. Groundwork for the initiative began about a year ago when the DCMS Executive Committee and John Gavras, president/CEO of the Dallas-Fort Worth Hospital Council, met with then-Dallas County Commissioner Candidate Maurine Dickey to explore ways in which healthcare services to the uninsured could be considered more on a regional basis rather than a county-by-county basis.

Funding health care of the uninsured and underinsured in a region that contains one in four Texans is a challenge, and a situation destined to demand more attention from the region’s taxpayers and an increased percentage of the tax dollar. Traditional geographic boundaries of counties no longer apply to the delivery of health care. The private hospital systems have discovered the efficiencies of addressing the region as a single economic unit, while the public sector struggles with the inefficiencies and inequities of a structure more appropriately designed for the early 20th century.

All North Texas residents need access to effective healthcare delivery systems. Everyone can agree that some areas of health care, such as emergency services, must be available to every person in the region. But the protection of health departments and the availability of vaccinations and primary care to every person in the region will be vigorously debated. It became obvious during the collaboration’s initial meeting that the public’s need for access to
primary care was limiting the access for emergency care, and the funding for both was a problem of increasing magnitude and complexity. One meeting led to others, and in January, a more formal initiative was begun.

It was clear that it was not possible to exchange a system that was efficient last century for a system that would be efficient for health care in the 21st century. However, all parties agreed that addressing health care for the underinsured population would interest everyone in the region, regardless of the county in which they live. The underinsured is a unique group and might include any one of us, depending on the medical situation. It encompasses those who are employed and those who are unemployed. Collectively, small businesses are the largest employer in the region, but most often are unable to provide health insurance because of the premium expense. The uninsured also includes those employed people, generally young, who believe that the odds of needing health care are low, so they choose to pay for health care out of pocket or, in the case of a catastrophic event, use the public system with public funding.

The Dallas County Commissioners Court funded a facilitator who helped move the discussions forward. These discussions evolved into an agreement to try to address the healthcare needs of the underinsured. After learning that at least one metropolitan area—Pittsburgh—has no county hospital and provides care to the underinsured through a low-cost medical insurance policy sufficient enough that care could be provided by private hospitals in the community, the search for a local solution was on.

In 2003, the Legislature passed House Bill 897, which allows small business owners to form coalitions to purchase group health insurance based on the size of the coalition. This initiative has yet to gain a significant following but is a step in the direction the Collaborative would like to explore. If an insurance plan could be developed, several philosophical issues quickly appear. With a low premium, only limited services can be provided. Distribution of benefits must be focused on preventive care or on catastrophic care—but, most likely, not both.

Although this search is in its early phase, it has brought in an expanding group of parties across the region. Even if this initiative produces nothing definitive, it will have furthered the realization that health care will be most effective in the public sector as a regional healthcare system responsive to and supported by the taxpayers in the region.

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