PUBLIC HEALTH FUNDING IN TEXAS

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PUBLIC HEALTH FUNDING IN TEXAS

• BOB GALVAN, DrPH, MPH, MS

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HISTORY

• INADEQUATE PUBLIC HEALTH COVERAGE IN TEXAS
• ASSURING A STRONG HEALTH SAFETY NET IN TEXAS

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SHCC REPORT CONSLUSIONS

• Many counties in Texas have limited or no public
  health presence
• State law does not mandate local governmental
  entities to provide public health services. Local
  health departments have been asked to absorb
  indigent patient care
• Federal and state Medicare cutbacks and federal
  welfare reform resulted in local public health
  health entities losing reimbursement for services
  provided in indigent patients

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SHCC REPORT RECOMMENDATIONS

• All Texans should have the benefit of
  appropriately funded core (essential) public
  heath services
• Public entities should have oversight of core
  public health functions
• Core PH activities should be undertaken
  collaboratively and guided by priorities set by
  the community
• Long-term funding mechanism should be developed

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House Concurrent Resolution HCR 44

• HRC 44 was established by the 75th Texas
  Legislature in summer 1997
• The purpose of HCR 44 was to
• study the current role of local governments in
  providing public health services
• Submit a full report of their findings and
  recommendations to the 76th Legislature when it
  convenes in January 1999

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HCR 44 PROCESS

• Convene a group of individuals representing
  stakeholders to review Public Health in Texas
• Provide a model that would completely revamp
  Public Health in Texas
• Provide a fiscal model for funding the New
  Public Health Model

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HCR 44 PROCESS, CONTINUED

• The Stakeholders which started with 4
  individuals representing 4 agencies resulted in
  having 55 individuals representing 55 agencies
• The difficulties dealing with agendas and
  personalities and the dynamics of such

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HCR 44 PROCESS, CONTINUED

• The Current Pubic Health Model in Texas
• Local Health Departments
• County Health Departments
• TDH Regional Offices
• City/County Health Departments

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HCR 44 PROCESS, CONTINUED

• 64 Local Health Departments in Texas which
  receive funding from TDH and are classified as
  state participating
• 8 City Health Departments
• 31 County Health Departments
• 25 Public Health Districts (including City/County
  and County/County Districts)

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HCR 44 PROCESS, CONTINUED

• Over 80 Local Health Departments that are
  classified as non-participating
• Several are large, full service departments but
  some are small
• Provide mainly Environmental Services
• Non-Participating Health Departments are still
  eligible for certain federal funds

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HCR 44 PROCESS, CONTINUED

• The New Model of Public Health in Texas
• Provide per capita funding to health departments
• Set up a system where Public Health services are
  available to all Texans
• Provide the opportunity to set up unique
  agreements between city and county county and
  county city and other cities county and other
  cities and require TDH to provide PH services if
  no other agency could provide these services

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HCR 44 PROCESS, CONTINUED

• The funding issues were the most challenging
• State Appropriations
• Tobacco Windfall
• Regional Office Administrative Budget

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HCR 44 RECOMMENDATIONS

• Incorporate Core Essential Services as defined by
  IOM 1988 Report
• Fund Public Health Services at 5.00 per capita
• Provide Public Health Services to all Texans
  through innovative arrangements by various
  agencies

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HOUSE BILL 1444

• HB 1444 introduced by Rep. Dianne Delisi
• Defined Essential Public Health Services
• Created Grants for Essential Public Health
  Services
• Created a Public Health Consortium

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HOUSE BILL 1444

• Funding The initial request for 5.00 per
  capita was reduced to a total of 10 million
• As a result, Innovation Grants were made
  available to local health departments for
  demonstration projects

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HOUSE RESOLUTION 257

• House Resolution 257 was introduced by
  Representative Villarreal in the 2005 Regular
  Legislative Session
• More than 3 million Texans reside in 121
  federally designated whole county health
  professional shortage areas
• Three point three million (3.3 million) Texans
  were living in an additional 47 partial county
  and 47 special population health professional
  shortage areas as of June, 2004

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HOUSE RESOLUTION 257

• The Federal Government has also identified 359
  medically underserved areas and medically
  underserved populations in Texas
• Five point five million (5.5 million) Texans are
  living without health insurance and resort to
  primary care in Hospital ERs
• Prescriptions costs are projected to rise by 11.2
  between 2000 and 2010

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HOUSE RESOLUTION 257

• In 2001, Health Care expenditures alone accounted
  for 40 of total net expenditures in Texas
• Public Hospital Districts reported1.2 Billion in
  un-reimbursed care
• Without revisiting HB 1444, there could be a
  crisis in Public Health in Texas

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HOUSE RESOLUTION 257

• Request the Speaker of the House to provide for
  an interim house study to make recommendations to
  the legislature relating to the delivery of
  public health and medical care services more
  effectively in rural and suburban areas

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HOUSE RESOLUTION 257

• 1, Identify incentives and resources necessary to
  promote personal responsibility, encourage
  preventive care, and expand use of available
  primary care services
• 2. Identify cost-effective technological
  innovations to improve health care access and
  coordination

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HOUSE RESOLUTION 257

• 3. Improve access to secondary and tertiary care
  in rural communities
• 4. Identify how health care services can be
  improved through collaboration across funding
  streams
• 5. Identify how public health can be improved in
  Texas through incentives tied to the CDC National
  Public Health Performance Standards

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HOUSE RESOLUTION 257

• 6. Develop multi-county public health entities
  authorized to collaborate to ensure that the
  essential public health services outlined in
  Subchapter E, Chapter 121, Health and Safety
  Code, are available to all Texans
• 7. Create regional planning authorities or
  designate existing organizations to assume
  responsibilities for the foregoing purposes

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HOUSE RESOLUTION 257

• HR 257 was passed unanimously by the House
  Committee on Public Health
• The resolution language was amended and included
  in SB 1188 on the House side but was not included
  in the final conference report (the house and
  senate committee formed to reconcile the
  different versions of the bill it was removed)

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HOUSE RESOLUTION 257

• No Action by the Legislature to form an interim
  committee to explore this directive

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ACCESS TO CARE

• 27 Counties have zero to one physician
• 9 counties have no primary care physician,
  nurse practitioner or physician assistant
• 64 counties have no hospital
• 54 counties are health professional shortage
  areas
• 80 counties are medically underserved and have
  limited public health services

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PH INFRASTRUCTURE

• Texas per capita public health spending is
  currently 50 of the national average
• Retirees outnumber those entering the field
• 78 of local health department personnel did not
  graduate with public health degrees
• Less than 50 of all public health agencies have
  adequate communications and infrastructure

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SO WHAT????

• Local PH agencies serve a surveillance role to
  prevent disease spread BUT only 74 of LPHA
  serving jurisdictions less than 25.000 provide
  any surveillance or epidemiology
• In a 1999 CDC test (e-mail alert), only 35 of
  local health departments received the message
• 2001 CDC study showed only 68 of county health
  agencies have internet connectivity
• 69 of local health agencies serve jurisdictions
  less than 50,000 persons and ½ serve less than
  25,000 individuals

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CAPACITY BUILDING

• There persists the need for investment in
  capacitance issues
• More than two of every three dollars spent by the
  nine states on essential public health services
  (6.1 billion of 8.8 billion) went for personal
  health services
• Population-based health services spending was
  only one percent of total health care

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CAPACITY vs. WILL

• States provide the largest amount of funds for
  population-based health services providing 50
  percent of the funding for these activities
• Federal funding accounted for 32, while local
  and other sources (fees and reimbursements)
  accounted for the remaining 18 of
  population-based health expenditures

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CAPACITY vs. WILL

• But in 2000 in Texas
• The state spent 49 per capita while locals spent
  62
• On a nation wide basis states spend 98 and
  locals spend 85

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THE UNINSURED

• Texas is the uninsured capital of the United
  States
• 52 of Texans are covered by private insurance
• State spent 17 billion on 2.7 million recipients
  over 7,000 per man, woman and child on
  Medicaid or CHIP
• Costs are increasing 13 15 annually

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ALTERNATIVES

• We need to provide a uniform front in addressing
  the Public Health funding issues that face Texas
• We need to develop collaborative and informed
  constituents and bring this issue to legislators
  for their support and action
• HR 257 was passed unanimously by the House
  Committee on Public Health, remind your
  legislators
• Couple this language with current legislation in
  HB 1444

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CURRENT INITIATIVES

• LLB
• TALHO
• TAMHO

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Bob Galvanrgalvan245_at_charter.net