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McAllen, Texas Docs Defend Region's Healthcare Spending

Cheryl Clark, for HealthLeaders Media, June 24, 2009

Four out of five patients are eligible for Medicare or Medicaid. It has a higher share of diabetes, obesity, heart disease, kidney disease, and kidney failure.

"There's a feeling here that coming to a hospital means the end of your life, which is a cultural thing," said Carlos Cardenas, MD, a McAllen gastroenterologist and chairman of the board of Doctors Hospital at Renaissance. That keeps many people from seeking healthcare earlier, before the disease process has marched too far along to be easily managed, he added.

"Many of our patients believe that if they were to go on insulin, it's something they don't want to do because they feel that people who go on insulin lose their eyesight, or lose their limbs," he said.

Bottom line, healthcare is expensive in McAllen not because doctors or hospitals are charging more, but because they are providing more of the most expensive kind of care, for patients whose health issues went ignored for decades, until they became acute.

All of that racks up the spending bill for healthcare.

"We have the sickest population in the United States," said E. Linda Villareal, MD., an internist in nearby Edinburgh. She said that for most physicians, the bulk of their practices consists of patients on Medicaid or Medicare.

And there's a shortage of physicians too, she added, saying the McAllen area has the lowest rate of physicians, 116 per 100,000 population, in the entire country and 43% fewer physicians than the U.S. average.

And that means the physicians that are there "see more and more patients in less and less time."

The physicians showed photographs of how many of their patients live, in meager buildings in the colonias where drinking water supplies can easily become contaminated with sewage, and where housing often lacks basic plumbing or air conditioning. Instead of bathrooms, residents use latrines.

Because of that, Stewart acknowledged, hospitals may keep patients in the hospital for a few days longer than they need to be there, because they know if they discharge them to a home that is not clean, their wounds will soon become infected and they may come right back into the hospital with hard-to-treat infections.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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2 comments on "McAllen, Texas Docs Defend Region's Healthcare Spending"


Sony (10/7/2012 at 9:00 AM)
I Know from first hand experience that Atul Gawade is absolutely right. I recently had an abscess and went to a doctor for that. I was immediately send to doctors hospital at renaissance, and instead of a simple I& D , had to spent 4 days(!) in the hospital. I was simply shuttled from one doctor to other ( while in the hospital I was seen by another doctor that the original doctor has recommended, had I&dperformed by a surgeon from another group (McAllen physicians) and for a simple work excuse ( the doctor who 'saw' me at the hospital 'ld have given it to me) was referred back to the original doctor ( of course! I need to make an appointment for that too!!) and was told to make an appointment in a week with another surgeon ( not the surgeon who performed the actual procedure)!! . The absolute apathy they show to the patient is very very evident and they just treat people like an ATM machine. If I ever had to see a doctor or needs to be admitted in a hospital, it is never going to be in Rio grande valley-So help me God.

William Pastor (12/18/2010 at 6:54 PM)
Atul Gawande preempted this argument in his article, correctly pointing out that El Paso county is demographically similar to Hidalgo county (where McAllen is) and has per capita Medicare expenditures literally half those of Hidalgo. There are lots of poor places in America and lots of sick people, Hidalgo County just has a bad medical culture. And it's no surprise that the doctors there would rather deny the existence of the problem than improve the situation.