UTMB's History of Care for the Indigent



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Today, 24.1 percent of Texas inhabitants have no health insurance, by choice or happenstance; medical inflation is approximately 6 percent annually; and federal support for indigent health care is eroding in the face of a war in the Middle East. With the 2008 race for the presidency of the United States in full swing, however, candidates increasingly are focusing on providing some kind of health care coverage for the 15.6 percent of U.S. citizens who live––and die––without it. Thus, with this national focus, one can see that the crisis of finding ways to pay for treating unsponsored patients is not unique to Texas nor to UTMB. \r\nNor is this issue new to the contemporary era. Even before Texas voters in 1881 selected Galveston as the location for the Medical Department of the University of Texas, the island city was the home of the Texas Medical College and Hospital, founded with the notion that serving paupers was part of its mission. When the medical department opened ten years later, that mission transferred to the new institution, known today as the University of Texas Medical Branch at Galveston (UTMB). Ever since, it has been considered the charity care provider for the state, as the home of the John Sealy Hospital, the only full-service hospital owned by the State of Texas. The state, however, viewed care of paupers (including maintaining their health) as a local prerogative, and delegated that responsibility to the counties without providing an enforcement mechanism, nor requiring any financial allocation toward that end. \r\nThis paper will review the history of UTMB vis a vis its mission of providing health care for indigents and uninsured; examine the role of the State Legislature in helping or hindering UTMB in caring for patients who cannot pay for their treatment; discuss measures enacted by other states that are models for pilot programs the state hopes will recover or reduce uncompensated health care costs; and propose some solutions currently being undertaken or that UTMB may consider to address the problems.\r\n



unsponsored, uninsured, uncompensated care, indigent health care, health policy, health care access