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C'mon Texas, Let's Fix This Mess

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Editorial posted in the Dallas Morning News with regard to the age old argument of how Dallas County is taking it in the shorts from the surrounding counties for healthcare expenses incurred by non-Dallas County residents.  The latest is complaining about how Collin County dumps their indigents there (Collin County does have an indigent program but not a county hospital).  Regardless of the spewing back and forth between Parkland, Dallas, and Collin Counties (Hey, Parkland.  If you didn't have the indigent care you wouldn't be receiving the federal subsidies that you are that are helping to cover the cost of that shiny new Lego building of yours).  What I've always failed to fully grasp is how Collin County residents end up at Parkland in Dallas County and based upon EMTALA criteria don't get turned away?  If it were a "transfer" of care then this should play out based on acceptance of transfer from facility to facility.  If the following scenario were in play then the incurred costs wouldn't matter since you would be reimbursed based on the suggestion as listed.

Any who, someone feel happy to shoot holes in this recommendation.  Instead of county-based taxes for indigent care through respective counties, how about the state of Texas divide up the state into health regions such as it does with Texas DSHS, and prorate the total indigent care costs over the respective region with a weighting of taxation based on population census for each respective county within the region?  You can determine the taxable amount to be incurred to Collin County residents based on their percentage of the region's population and add it to each respective county tax bill.  Done, 'nuff said.  One caveat, you have to include one major medical center within each region so for west/southwest Texas as an example you'd have to lump them into El Paso, Lubbock, Corpus Christi, and/or San Antonio.

The final part of this equation that I haven't fully comprehended is why all these folks end up at Parkland when the last time I checked the tertiary facility for tertiary facilities was UTMB-Galveston?  Back in the stone-age we'd have folks show up at all times of the day and night from all over the state on our doorsteps.



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