Upper East Texas centers for health care services include Tyler in Smith County, Texarkana in Bowie County and Longview in Gregg County. Since the region is primarily rural, it faces a number of challenges in providing health care to its residents. Health care centers in urban areas, however, help provide necessary medical care throughout the region.
Hospitals and medical facilities are key factors in any health care infrastructure.
Health Care Infrastructure
Hospitals and medical facilities are key factors in any health care infrastructure. They provide a central point for advanced medical services; encourage the growth of affiliated medical services in surrounding areas; and often are major employers in some areas.
The Upper East Texas region has nine for-profit hospitals, 24 nonprofit hospitals and seven public hospitals (Exhibit 37).1 Of the 40 hospitals, eight are in Tyler; Texarkana has five; Longview has four; Palestine and Jacksonville each have two; and the remaining 19 are located in smaller communities.2
Tyler’s East Texas Medical Center has 464 beds and is the region’s largest hospital as well as one of the city’s 10 largest employers. Good Shepherd Medical Center in Longview and Wadley Regional Medical Center in Texarkana, with 412 and 402 beds, respectively, are the region’s second- and third-largest hospitals. Good Shepherd Medical Center, the Diagnostic Clinic of Longview and Longview Regional Medical Center are three of the city’s 10 largest employers.
The fourth-largest hospital in the region is Tyler’s Mother Frances Hospital, with 389 beds. It is another major employer in the city. Paris Regional Medical Center in Paris with 364 beds, and CHRISTUS St. Michael Health System in Texarkana with 278 beds, are the region’s fifth- and sixth-largest hospitals, respectively. Wadley Regional Medical Center, CHRISTUS St. Michael Health System, Collum and Carney Clinic and Jordan Home Care are among Texarkana’s 10 largest employers. In 2007, the region’s acute care hospitals had a total of 4,405 staffed beds.3
In recent years, many of the region’s hospitals have expanded facilities or instituted new programs. The Good Shepherd Medical Center has begun creating a new Institute for Healthy Living, an integrated wellness center that will combine rehabilitative services, education and a fitness facility complete with indoor track, indoor swimming pool, whirlpools and a fitness room.4 Exercise classes, swimming programs and even a full-service spa will be available for members.5
Hospital Districts Upper East Texas Region
|Hopkins County Hospital District|
|Marion County Hospital District|
|Titus County Memorial Hospital District|
|Wood County Central Hospital District|
Source: Texas Department of State Health Services.
The University of Texas Health Science Center at Tyler (UTHSC-Tyler) is one of six medical schools in the University of Texas System. It has a 125-bed hospital and a number of outpatient clinics overseen by more than 100 faculty members specializing in pulmonology, cardiology, oncology, primary care, occupational medicine and surgery.9
UTHSC-Tyler is opening a clinic in Gladewater that will handle more than 8,000 patients each year. It will help residents find care nearby, saving them a drive to Longview.10 And near Lake Palestine in southwest Smith County, Trinity Mother Frances Hospital is expanding an existing health clinic into a 30,000-square-foot center including mammography, physical therapy and a fitness center with a pool.11
The region also has four hospital districts (Exhibit 38), which have authority under Texas law to levy taxes in their jurisdictions for the support of health care and hospital services.12
Four of the region’s 23 counties – Delta, Marion, Morris and Rains – have no hospitals (Exhibit 39).
Upper East Texas Counties Without a Hospital and Primary Care Health Professional Shortage Areas, 2007
Health Professional Shortage Areas
The U.S. Department of Health and Human Services has designated seven of the region’s 23 counties as having a shortage of primary health care providers including primary care doctors, dentists and mental health professionals (Exhibit 39).
In addition, one county in the Upper East Texas region, Delta County, has no practicing physicians, according to the Texas Department of State Health Services.13
Some East Texas organizations are working to increase the region’s supply of medical professionals. The University of Texas at Tyler (UT-Tyler) is starting a new Ph.D. program for nurses in fall 2008. This online doctoral program is unique in Texas and has received more than 100 applications for 15 available slots. The program supplements UT-Tyler’s existing bachelor-level and master’s nursing programs. The doctoral program will train nurses for faculty positions and jobs in health care administration and research.14 UT-Tyler’s nursing graduates are critical in delivering the region’s health care; four out of every 10 practicing registered nurses in East Texas came from the university’s programs.15
Tyler Junior College and other organizations have joined together to create a school of nursing at East Texas Medical Center in Jacksonville. The East Texas Medical Center Regional Healthcare System, Trinity Mother Frances Health System and the Jacksonville Economic Development Corporation are united in the effort. The school will hold class on the grounds of East Texas Medical Center, using former hospital rooms. The first class will train licensed vocational nurses starting in August 2008, followed by an associate nursing degree program in October 2008.16
The University of Texas at Tyler (UT-Tyler) is starting a new Ph.D. program for nurses in fall 2008. This online doctoral program is unique in Texas and has received more than 100 applications for 15 available slots.
East Texas Medical Center Regional Healthcare System
Enlisted soldiers, veterans and their families in 18 East Texas counties can participate in the East Texas Resources for Iraq-Afghanistan Deployment (ETRIAD), which provides individual, group and family counseling at no charge.
Veterans’ Health Care
Upper East Texas does not have a Veterans Affairs (VA) hospital. The closest VA hospitals are in Dallas, Bonham, Temple and Waco. The region does have two VA Community Based Outpatient Clinics (CBOCs), however, in Tyler and Texarkana.18 The U.S. Veterans Health Administration (VHA) created the CBOCs in 1995 to augment the delivery of primary care to veterans.19 The program’s goals include better preventive care and early disease intervention for veterans.
The Andrews Center Regional Outpatient Clinic located in Tyler recently started a new counseling program for veterans. Enlisted soldiers, veterans and their families in 18 East Texas counties can participate in the East Texas Resources for Iraq-Afghanistan Deployment (ETRIAD), which provides individual, group and family counseling at no charge. Veterans and their families can seek help with problems involving readjustment to civilian life, financial difficulties, post-traumatic stress disorder and other mental health issues. The program is supported by a grant from the TRIAD Fund of the Dallas Foundation. Services are currently funded through March 2009, but the Andrews Center hopes to win continued funding.20
Rusk County Health Project
Volunteers in the Community
Determining the rate of uninsured persons in individual counties is difficult because surveys undertaken to do so often rely on small sample sizes at the county level. The U.S. Census Bureau, however, created county-level estimates for the uninsured in 2000. Based on these estimates, 20 percent or more of the residents of four counties in the region – Red River, Camp, Cherokee and Titus – were uninsured. The lowest uninsured rate was in Panola County, with an estimated 14.9 percent of its residents uninsured.21
So how do uninsured persons obtain medical care, especially in rural areas? Counties with hospital districts have statutory responsibility to provide for indigent care. Some counties also participate in the County Indigent Health Care Program, under which counties are responsible for providing basic health care services for people who are not eligible for Medicaid but whose income is less than 21 percent of the federal poverty limits, varying depending on family size.22 In 2007, only one Upper East Texas county, Lamar County, spent sufficient local funding on indigent health care in order to qualify for state reimbursement of some expenses.25
Uninsured people also rely on hospitals, especially ones with emergency rooms, for general medical care. Under federal law, hospitals must treat anyone who shows up in their emergency rooms, regardless of their ability to pay. Thus emergency rooms often must treat many patients with conditions that do not warrant this highly expensive care, interfering with their ability to serve those patients who truly need emergency care.
Health Care for the Uninsured
Heart Disease Four-year Average Age-Adjusted Mortality Rates for Upper East Texas Region by County 1999-2002
Cardiovascular disease is actually a set of heart and blood vessel diseases such as ischemic heart disease (narrowed or blocked blood vessels leading to the heart), stroke and congestive heart failure. These ailments account for two out of every five deaths in Texas. Heart disease and stroke are of particular concern in Upper East Texas, where mortality rates from heart disease are among the highest in the state (Exhibit 40).26
Heart disease and stroke are of particular concern in Upper East Texas, where mortality rates from heart disease are among the highest in the state.
The Texas Department of State Health Services estimates that its Health Services Region 4, which is the same as the Comptroller’s Upper East Texas region, has a 13.5 percent rate of cardiovascular disease, or more than an estimated 108,000 persons. Across the state, the estimated prevalence of cardiovascular disease is 8.5 percent, or more than 1.4 million persons affected.
Costs to the region’s hospitals due to heart disease totaled $436.5 million in 2005, while hospital costs due to congestive heart failure reached $142.8 million. Stroke accounted for another $112.1 million in hospital costs. Note that these numbers do not include other medical costs, including medicine, doctor visits and therapy, which are associated with treating cardiovascular disease.28
Texas hospital inpatient discharge data indicate that counties in the Upper East Texas region have a higher-than-average number of admissions for congestive heart failure per 100,000 residents (Exhibit 41). In 2005, Red River County had nearly four times the number of hospital admissions due to congestive heart failure; Camp County had nearly three times the state level of hospital admissions. Anderson, Bowie, Gregg, Henderson, Panola, Rusk, Upshur and Wood counties also had significantly higher admissions rates compared with the state average of 419 per 100,000 population, even after adjusting for risk factors to make the statistics comparable to Texas as a whole.29
Admissions for Congestive Heart Failure Upper East Texas Region and Texas by County, 2005
Texas hospital inpatient discharge data indicate that counties in the Upper East Texas region have a higher-than-average number of admissions for congestive heart failure per 100,000 residents.
In the Upper East Texas region, localities are joining the fight against cardiovascular disease. In Tyler, a no-smoking ordinance recently went into effect. Smoking is one of the risk factors for cardiovascular disease and a no-smoking ordinance is recommended as one way for communities to fight the disease.30 An estimated 24.2 percent of Upper East Texas residents smoke, according to the Texas Department of State Health Services.31 In Tyler, the ordinance prohibits smoking in public places and places of employment, including restaurants, bars and retail facilities. The ordinance went into effect June 1, 2008.32
- 1 Public hospitals are those owned and operated by cities or counties, while nonprofit hospitals are those meeting Internal Revenue Service standards for nonprofit organizations.
- 2 Texas Department of State Health Services, “Texas Acute and Psychiatric Hospitals 2007,” Austin, Texas, January 2008. (Spreadsheet.)
- 3 Texas Department of State Health Services, “Texas Acute and Psychiatric Hospitals 2007”; and information drawn from Texas Workforce Commission, Labor Market and Career Information, “LCMI Economic Profiles for Longview MSA, Texarkana MSA and Tyler MSA – July 2008,” http://www.tracer2.com/default.asp?PAGEID=94&SUBID=150. (Last visited June 30, 2008.)
- 4 Business Images of East Texas, “A Cure for What Ails You,” April 25, 2008, p. 1, http://imageseasttexas.com/index.php/site/articles/health/a_cure_for_what_ails_you. (Last visited September 24, 2008.)
- 5 Good Shepherd Medical Center, Institute for Healthy Living, “Institute Frequently Asked Questions,” http://www.gsmcinstitute.org/MessageCenterDetail.aspx?ContentID=67. (Last visited September 24, 2008).
- 6 E-mail communication from Ingrid Bowden, administrative manager, East Texas Area Health Education Center, July 11, 2008.
- 7 East Texas Medical Center Regional Healthcare System, “One with East Texas: Providing Care Across Our Region,” pp. 1-2,
- 8 “ETMC Announces New Method to Treat Tumors,” Tyler Morning Telegraph (October 12, 2006), http://www.tylerpaper.com/article/20061012/ARC/610120351. (Last visited September 24, 2008.)
- 9 The University of Texas Health Science Center at Tyler, “Fast Facts,” pp. 2-3, http://www.uthct.edu/about/fastfacts.asp. (Last visited September 24, 2008.)
- 10 CBS 19 TV, “New Gladewater Clinic,” June 20, 2008.
- 11 Adam Russell, “Trinity Mother Frances Breaks Ground On Lake Palestine-Area Expansion,” Tyler Morning Telegraph (June 21, 2008), http://www.tylerpaper.com/article/20080621/NEWS01/806210305. (Last visited September 24, 2008.)
- 12 Texas Department of State Health Services, “Texas Acute and Psychiatric Hospitals 2007.” Austin, Texas, January 2008. (Spreadsheet.)
- 13 Texas Department of State Health Services, “Direct Patient Care Physicians (DPC) by County of Practice - August 2007,” http://www.dshs.state.tx.us/CHS/hprc/tables/07DPC.shtm; (Last visited September 24, 2008.) and Texas Department of State Health Services, “Primary Care Physicians (PC) by County of Practice - August 2007,” http://www.dshs.state.tx.us/CHS/hprc/tables/07PC.shtm. (Last visited September 24, 2008.)
- 14 Images of Tyler, Texas, “New PhD Program Prepares Nurses for Research and Teaching,”April 29, 2008, http://images-tyler.com/index.php?/site/articles/health_care/new_phd_program_prepares_nurses_for_research_and_teaching. (Last visited September 24, 2008); and Betty Waters, “UT Tyler Announces Nursing Doctoral Program,” Tyler Morning Telegraph (November 15, 2007), http://www.tylerpaper.com/article/20071115/NEWS08/711150305. (Last visited September 24, 2008.)
- 15 University of Texas at Tyler, “Making an Impact on Health and Wellness,” http://www.uttyler.edu/perryman/health/html. (Last visited September 24, 2008.)
- 16 Megan Middleton, “East Texas Organizations Create Tyler Junior College Nursing School,” Tyler Morning Telegraph (May 17, 2008), http://www.tylerpaper.com/article/20080517/NEWS08/805160335. (Last visited September 24, 2008.)
- 17 Steve Bandy, “First at the Scene: First Responders Seeking New Members,” Marshall News Messenger, (June 9, 2008.)
- 18 Texas Veterans Commission, “VA Facilities in Texas,” pp. 2, 8, http://www.tvc.state.tx.us/HTML%20Pages%20for%20Frames/VAFacilities.html. (Last visited September 24, 2008.)
- 19 Ashley N. Hedeen, Patrick J. Heagerty, John C. Fortney, Steven J. Borowsky, Debby J. Walder, and Michael K. Chapko, “VA Community-Based Outpatient Clinics: Quality of Care Performance Measures,” Medical Care (July 2002), pp. 570-577.
- 20 Steve Bandy, “Counseling Available for Servicemen, Family,” Marshall News Messenger (July 12, 2008).
- 21 U.S. Bureau of the Census, “Model-Based Small Area Health Insurance Estimates for Counties and States,” http://www.census.gov/hhes/www/sahie/county.html. (Last visited June 18, 2008.) Custom query created of health insurance coverage estimates for Texas counties in 2000.
- 22 Texas Department of State Health Services, “County Indigent Health Care Program,” http://www.dshs.state.tx.us/cihcp/eligibility.shtm. (Last visited September 24, 2008.)
- 23 E-mail communication from Dr. Paul McGaha and Martha Light, Texas Department of State Health Services, July 17, 2008; and e-mail communication from Dr. Paul McGaha, July 21, 2008.
- 24 Bethesda Health Clinic, “Bethesda Health Clinic,” http://www.bethesdaclinic.org/index.html. (Last visited September 24, 2008.)
- 25 Texas Department of State Health Services, “County Indigent Health Care Program Year to Date Summary for FY 2007,” http://www.dshs.state.tx.us/cihcp/SpendingData/ihcsum07_2.pdf. (Last visited September 24, 2008.)
- 26 Texas Department of State Health Services, Texas Plan to Reduce Cardiovascular Disease and Stroke (Austin, Texas, May 2005), pp. 38-40, http://www.dshs.state.tx.us/wellness/PDF/update05.pdf. (Last visited September 24, 2008.)
- 27 Texas Comptroller of Public Accounts, “Comptroller Susan Combs Urges Texas Schools to Participate in Texas Fitness Now Program: $20 Million Available to Help Kids Get Fit,” http://www.window.state.tx.us/news2007/070724fitness.html. (Last visited September 24, 2008.)
- 28 Texas Department of State Health Services, “Cardiovascular Health Facts 2001-2005: Texas Health Services Region 4,” http://www.dshs.state.tx.us/wellness/PDF/FactSheetRg408.pdf. (Last visited September 24, 2008.), and Texas Department of State Health Services, “Texas Cardiovascular Health Facts 2001-2005,” http://www.dshs.state.tx.us/wellness/PDF/Fact%20SheetTexas08.pdf. (Last visited September 24, 2008.)
- 29 Texas Department of State Health Services, Preventable Hospitalizations, 2005 (Austin, Texas: December 2007), http://www.dshs.state.tx.us/THCIC/Publications/Hospitals/PQIReport2005/PreventableHospitalizations2005.shtm. (Last visited September 24, 2008.) See section on congestive heart failure.
- 30 Texas Department of State Health Services, Texas Plan to Reduce Cardiovascular Disease and Stroke, pp. 18-19.
- 31 Texas Department of State Health Services, “Cardiovascular Health Facts 2001-2005: Texas Health Services Region 4.”
- 32 City of Tyler, “Tyler Smoking Ordinance: Frequently Asked Questions,” http://www.cityoftyler.org/Portals/0/docs/departments/building/TylerSmokingOrdinance_Q&A.pdf. (Last visited September 24, 2008.)