While Texas continues to provide a model Medical Liability Environment and has made great improvements in Disaster Preparedness, it still struggles with significant threats to Public Health and Injury Prevention, as well as severe financial barriers in Access to Emergency Care.
Texas continues to be among the nation's leaders with its exemplary Medical Liability Environment. The state has the third lowest average malpractice award payments, and medical liability insurance premiums have continued to decline, especially for specialists whose premiums are on average $11,000 less than in the previous Report Card. Texas placed a $250,000 medical liability cap on non-economic damages, enacted additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act, and passed apology inadmissibility legislation.
Texas has made substantial improvements in Disaster Preparedness since 2009. The state has instituted state or regional strike teams or medical assistance teams and has begun enrolling health care professionals in the Emergency System for Advance Registration of Volunteer Health Professionals. The state has the second highest rate of registered nurses who have received training in emergency preparedness (51.8%) and requires training in disaster management for all emergency medical services (EMS) and hospital personnelóone of only five states to do so. Texas also has strong liability protections in place to protect volunteer health care workers responding to a disaster.
Texas continues to struggle with numerous factors in Access to Emergency Care, including severe financial barriers to care. The state has some of the worst rates of health insurance for adults and children (26.9% and 15.4% uninsured, respectively), for which it ranks last and second to last in the nation. Additionally, Medicaid fee levels for office visits are only 77.3% of the national average, having declined 4.9% since 2007. While hospital capacity is about average on many indicators, the state saw two hospital closures in 2011, which has likely contributed to the overall reduction in staffed inpatient beds from 319.8 to 292.7 per 100,000 people. Additionally, while Texas has been successful in attracting large numbers of emergency physicians and specialists over the past decade, performance on these indicators is overshadowed by the state's large and growing population and has resulted in very low per capita rates of many types of specialists, emergency physicians, and registered nurses. The Texas legislature recently increased graduate medical education funding, which should provide opportunity for increases in future workforce numbers.
Texas' grade in the Quality and Patient Safety Environment has declined, partially due to the inclusion of new indicators, but also due to a lack of funding for quality improvement of the EMS system and not having implemented important statewide policies. A multitude of EMS is necessary to cover this large state; as a result, the state has taken a regionalized approach to various EMS protocols. Nevertheless, Texas could investigate implementation of statewide practices and policies to set a standard of safe and effective care for emergency response, such as field trauma triage protocols; destination policies for stroke, ST-elevation myocardial infarction, or trauma patients; or a system for providing pre-arrival instructions.
Texans suffer from a number of health risk factors and high rates of motor vehicle-related fatalities in the Public Health and Injury Prevention category. Texas has extremely high rates of obesity among adults and children (30.4% and 19.1%, respectively) and the highest cardiovascular disease disparity ratio in the nation: Non-Hispanic American Indians are 4.6 times more likely to have cardiovascular disease than the racial or ethnic group with the lowest likelihood. Texas also has high rates of bicyclist and pedestrian fatalities and the third highest rate of traffic fatalities related to alcohol (46.0%).
Texas must work to improve Access to Emergency Care for its population. Of great importance is lessening the state's severe financial barriers to care by improving access to adequate health insurance for both adults and children. Texas must also act to increase Medicaid fee levels so that they are at least on par with the national average. In addition, Texas must continue to support a strong Medical Liability Environment and attract additional emergency care providers, specialists, and Medicare providers to meet the needs of its growing and aging population.
Texas must address racial and ethnic health disparities in cardiovascular disease rates by improving access to primary health care services. Hospitals have taken an excellent first step in addressing health disparities by collecting data on patients' race and ethnicity and taking steps to implement diversity strategies or plans, but the state must do more to encourage healthy habits and reduce cardiovascular disease risk factors among populations at highest risk. Implementing evidence-based practices to reduce adult and child obesity rates and improving traffic safety may be important first steps in improving state scores.