Patient Flow Enewsletter
Volume 1, Issue 6
Thursday, July 15, 2004
Most Americans are familiar with Texas' rankings on insurance coverage issues: the highest number of uninsured residents; the biggest percentage of working adults without health coverage; the most children without insurance. But in San Antonio, such statistics can't dampen the enthusiasm of diverse community leaders working to find solutions.
Under the leadership of the Greater San Antonio Hospital Council, which represents more than 125 hospitals and health care organizations across south-central Texas, local elected officials are working alongside business and health leaders to assess the community's priorities and brainstorm solutions. The relationship between the Council and two-term Mayor Ed Garza is especially productive, with the mayor taking San Antonio's case directly to Congress and serving as a highly visible advocate for improving health care in this rapidly growing community.
Deep cuts in the state's Medicaid and CHIP programs, however, along with a growing physician shortage and large numbers of uninsured patients using hospital emergency rooms for primary care, are putting further strains on the web of local hospitals, clinics and health centers that provide care for San Antonio's poor or uninsured population. The University Health System's hospital provides the bulk of the care for safety net patients, although all hospitals throughout the metro area are affected.
With rapid population growth coupled with budget cuts, San Antonio is increasingly turning to its business community to help think through its health care challenges. Elected to office in 2001 with a reputation as a strong relationship-builder, Mayor Garza is a particularly strong champion of the need to engage business leaders in health care discussions and has strong views on how to engage new groups and motivate elected officials.
Interview: Ed Garza, Mayor of San Antonio, Texas
Q. Since you did not come to the mayoral office with a health care background, what got you interested in health care?
Like most of the residents of San Antonio, I had a certain awareness of the problems of the uninsured because I understood the socio-economic profile of our community. But putting faces to those theoretical problems and hearing personal stories makes it very, very real. It has become obvious to me and to most of the residents of San Antonio that health and health care go hand in hand with quality of life for any community. Making it a priority for the city and for our country is critical because a strong health care system supports the infrastructure of any community, either local or national.
Q. One of the first meetings you attended as mayor was a large health summit in the community. How has that meeting influenced you?Bexar County Judge Nelson Wolff, who is also a former mayor, took the leadership in calling for a health care summit throughout the region, and he asked that I attend. The summit brought together partners from both the city and county to talk about how we can make more of an impact in providing health services for people who need them in San Antonio. It was very interesting, because I had just entered office and ran on a theme of 'how we can grow as a city,' and I think the spirit of the summit really reflected that. Relationships were formed at that meeting between people who did not necessarily talk to each other or see eye to eye, but they became more willing to set aside their turf issues and talk about how we can work together as a community. For example, from the summit we learned that people were clearly duplicating efforts in some areas, and we've been working on that. We also learned that we need to share a lot more information on emergency and trauma care between the hospitals in order to reduce over-crowding and diversion and make all the hospitals more efficient, and progress has been made there as well.
I think these summits are incredibly important for a community. In this room full of people who spend all their time thinking about and working on these issues, there was a dawning realization that we first need to do a much better job communicating with each other about what we're all doing, and then discuss how these programs can better relate to each other. San Antonio is a big city located in a region that's growing very quickly, so it's not easy to keep everyone in the loop, but it's a necessary step.
Q. How do you meet the needs of your uninsured constituents in San Antonio?
We pull resources together from wherever we can to fill the gap, but it's a big gap, and we're all painfully aware of our shortcomings. In San Antonio, where there are so many people without health care, and safety net services are continuously used by so many people, there is always the need for improvement, and that is always a priority here. We recently issued bonds to help cover costs for a new community health clinic that will be built on the city's East side, which will be similar to a very popular clinic that serves uninsured patients on San Antonio's West side, so we're optimistic about that. But aside from better coordination and more money and programs, I think there needs to more action all across the nation where mayors and community leaders serve as vocal advocates for health care for all. The solution is not just in fixing our local safety nets - it's in more vigilant advocacy to appeal for state and federal changes.
Q. How have you gone about increasing awareness and advocacy for San Antonio's health care issues?I've spoken about this at length with other local officials and with our state and federal representatives. Through the American Hospital Association, I went to Washington and participated in a Capitol Hill briefing series and made a presentation to senior staff from both the Senate and the House about what is happening in San Antonio and how it affects the economy of our community as well as people's lives. I've also tried to get others in the community interested in the issue and speaking up about it.
Q. How have you gotten other leaders in San Antonio involved, particularly from the business community?
There are two ways to explain health care issues and most people can relate to both: through the business side and through the compassionate side. In San Antonio, health care is the single largest sector of our economy, so it is important for the economic vitality of our community. I try to communicate to business owners why access to health insurance is so vital to our vision of employment in the city - because it contributes to healthy, productive workers who enjoy their jobs and in turn grow our economy. If you're sick and can't get care, you have to skip work. If your child is sick and can't get care, then the child skips school and the parent skips work. For business owners, understanding this can affect the way they structure their own benefits programs. It can also affect their willingness to become more vocal advocates for health coverage reforms, and even affect their willingness to be philanthropists, which our community depends upon to keep many safety net organizations afloat. One of our Chambers of Commerce now has a standing committee on health issues, and the Chamber also oversees a long-term economic impact study of the effect of our health care situation. All of that helps engage the business community.
Q. What was the local reaction to the safety net assessment conducted by the Urgent Matters staff?
I think the assessment helped us gain perspective and expertise from people 'from the outside,' which can be very helpful. Any time we can get these topics in front of the public, it provides visibility for the issue of the safety net and practical tools for us to consider. One of the early meetings with Urgent Matters brought together more than 50 business owners, health care leaders and elected people - including my office - so that was very helpful. We're patient. We know it's not going to change overnight, but the more we keep this issue in front of the public, the more we can expect to see a dramatic improvement over time.
Q. What advice do you have for community health leaders who are trying to engage their municipal officials on health care issues?
They need to present their local elected officials with realistic goals. The health care dilemma is a big, dynamic issue where federal officials and budget allocations dominate, so people need to think long and hard about how to bring it down to local issues that are truly actionable. The other key is to illustrate this issue with specific examples from the community. A mayor is constantly trying to stay connected to the daily issues that affect his or her specific constituency. That's what local officials know best, and keeping the discussion on that level helps local officials feel more confident. So if the goals are realistic, and local leaders using local examples serve as partners, I think you'll begin to see results.
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Ed Garza
Mayor
San Antonio, TX
