The Healthcare System
For a community to reduce the risk of diabetes, the healthcare system needs to effectively screen for risk factors, communicate clear and consistent prevention guidance and ensure that services are accessible and affordable to even the most vulnerable. Currently, RGV residents face difficulty in accessing affordable, high- quality healthcare. In order to effectively prevent diabetes, individuals need to be linked to screening and testing services and be provided with clear and consistent education by providers on what steps they can take to improve their health and wellness. The residents also need a system that coordinates action among providers.
Access: All four counties in the RGV are partially or completely designated as medically underserved areas by the federal government due to the very low numbers of primary care physicians, mental health therapists, and nurses. Additionally, transportation and inconvenient appointment times were both reported to be significant barriers to accessing healthcare services.
Affordability: The RGV has among the highest rates of uninsured individuals in the country. Half of the population is uninsured, compared to 31 percent of Texans who lack insurance. This is partly due to the large number of undocumented immigrants in the region and the lack of employer-sponsored insurance. For the many uninsured individuals in the Valley, medical care is prohibitively expensive. Nearly one third of RGV adults double the national average reported that the primary reason for not accessing care is the inability to afford it. At the state level, Texas has declined to create its own healthcare exchange or expand Medicaid, meaning that at least one million Texans who would have been covered under healthcare reform, are without effective health insurance. Diabetes prevention services are also rarely reimbursed by Medicaid/Medicare which limits the ability of people to access the few services that do exist.
Quality of Care: Diabetes prevention is also hindered by lack of effective, culturally-competent communication between providers and patients. Primary care physicians who have limited time to speak with a patient may not adequately address the individual’s questions and concerns about their diabetes risk. Individuals may leave a doctor’s visit ill-prepared to make necessary lifestyle changes. Furthermore, uncoordinated care may lead to inconsistent or even conflicting information from different providers. For instance, if an individual’s electronic medical record is not shared between an individual’s primary care doctor, the hospital, emergency room or mental health therapist, a provide may not have the most recent clinical information to provide the most appropriate care and advice.
