The purpose of this essay is to discuss three patient and health-system related factors that influence health care disparities within the West Texas region and how they are inter-related.
The three patient related factors that influence healthcare disparities in West Texas are socioeconomic, health education, and health behavior. West Texas is home to 2.8 million people with 98 out of 108 counties being classified as rural (TTUHSC, n.d). Much of these 98 counties are populated by farmers and low-income people with Medicaid or Medicare. Access to healthcare is very limited and it is often to financially taxing to drive to one of the bigger cities for care. This leads to a disparity in health education. With 22 of the 98 counties being without
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a physician (West Texas Area Health Education Center, n.d.), patients are not receiving adequate health education on a frequent basis. Patients with illnesses, especially those with chronic conditions, suffer and rely on the internet or limited telemedicine interactions for their care. According to the Texas Health and Human Services, the top causes of death in the region are heart disease and cancer. (2013). The high mortality rates are caused by economic status and education, but also by patient behavior. Patients in West Texas may not be willing to get the care they need based on the limited healthcare options and the lack of education on preventative care and managing diseases. It is challenging to build a necessary relationship with providers when the health services are a hundred miles way. Patients are not the only ones to blame for health disparities in West Texas. Health-system related factors also play a big role in health disparity.
The three health-system related factors that influence healthcare disparities in West Texas are language, payment, and cultural competence.
In West Texas, Hispanics make up 35.9% of the population (2013). Much of this population is either bilingual or Spanish speaking only. The language barriers are a real challenge and will only increase as the Spanish speaking population increases. Clinics and hospitals across West Texas are not equipped with Spanish speaking providers. The addition of interpreters has helped relieve some of these barriers. As mentioned in the patient related factors, Medicare and Medicaid patients are wide-spread within the Texas panhandle. The reimbursement for treating these patients is insufficient (Fried & Fottler, 2015). In 2017, 26 million dollars was not reimbursed to the Texas Tech University Health Sciences Center School (TTUHSC) of Medicine in Lubbock (TTUHSC, 2017). While the payor mix consists of commercial and government payors, the demographics of West Texas leads to a large percentage with Medicare and Medicaid. Approximately 24.4% of patients are not even insured at all despite the efforts of the Affordable Care Act (2013). A final issue that creates additional health disparities is the lack of cultural competency amongst hospitals and clinics. For example, while the TTUHSC Lubbock employs faculty from a variety of backgrounds, the Hispanic faculty numbers are low. Considering West Texas has a substantial Hispanic population it would be
important for providers to undergo competency training specific to Hispanic healthcare. Patient and health-system factors do cause different kinds of health disparities, but they are inter-related.
Both patients and healthcare systems have a responsibility to decrease healthcare disparities in West Texas. Health systems must understand the challenges of their population and plan accordingly. An example of this is telemedicine. Telemedicine reaches the low-income and rural population to provide care and education to all patients. However, patients must be willing to utilize the services that are offered. A culturally competent healthcare system can further attract diverse patients by providing specific services and building trust and understanding amongst the population. The hope is that the increased patient volume will lead to more revenue which can be used to mitigate the patient health factors by providing additional services to the underserved community. Treating these patients with preventative care and additional education can also decrease health costs.
Patient and health-system related factors do influence health disparities in West Texas. The combination of cultural incompetence with a low-income population is a recipe for disaster. Health care systems must be the catalyst for change and patients must be willing to utilize resources that are given to them.
