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MEDICAL YEAR
IN REVIEW

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ico or Central America looking for work. Social Services and Methodist Healthcare The Border Health Caucus in trying
There has been a major shift in that demo- Ministries, who have established pro- to assist with increasing the number of
graphic. Now, the people crossing into the grams for food, shelter and assistance. physicians in the border areas by:
US are mostly women and children, either • Continuing to work bi-nationally on • Advocating for 1.1 Graduate Medical Ed-
as families, women alone or as unaccompa- common solutions to all health care is- ucation slots per graduating medical stu-
nied children. The influx is no longer pri- sues, with special emphasis on those of dent from Texas-based medical schools
marily from Mexican origin; now it is a mix the persons coming across the border. entering the first year of residency.
of people from Mexico, Central America, • Advocating for increases in direct med-
Venezuela, other parts of South America, The Border Health Caucus - ical education and incentivize primary
Africa (including the Congo), Syria, China, Improving Access to Care care training at teaching hospitals.
and Cuba. Following tort reform in 2003, as in the • Addressing the significant imbalance in
The respective health departments on rest of Texas, the number of border physi- the Medicare GME funding base rate for
both sides of the US border are tasked with cians increased. More recently, medical not only Texas, but for many other states.
ensuring no potentially communicable or schools have opened along the border that • Facilitating the development of new
high consequence infectious diseases are are training physicians that will, if appropri- teaching hospitals by allowing hospitals
present in these migrant people. Hector ately developed and integrated with resi- in underserved communities to have
Gonzalez, MD, MPH from the Laredo dency programs, help alleviate the border’s more flexibility in the Medicare GME
Health Department, has an excellent rela- physician shortage. Other healthcare prac- cap-setting schedule.
tionship with his counterpart, Dr. Oscar titioner training programs are also being de- • Advocating for evaluation of Texas
Gerardo Gonzalez Arrambide, in Nuevo veloped to complement the physician Medicaid’s physician payment rates com-
Laredo. Together they stressed the regional workforce, including nurses and therapists pared with commercial payers.
binational network for disease surveillance of all types, as well as community health- • Continuing to work in an effort to rein-
and detection. Webb County, for example, care workers or “promotoras” that are state the 20% deduction on the
has a rate of tuberculosis three times higher being successfully used in multiple counties Medicare/Medicaid payment system. All
than the state of Texas and up to five times of the border region. Part B services require the patient to pay
higher than the US national rate.
An important area that is stressed is the
need for all healthcare providers, from physi-
cians to first responders to school nurses, to
report infectious diseases. Some of this re-
porting is already mandated by law, but needs
to be significantly improved. Only by this
prompt reporting can detection and preven-
tion of the spread of disease be stopped as
early as possible. Suggestions for improve-
ment in reporting include:
• Establishing a program through the State
Health Department to re-educate all who
are involved in health care as to reporting
requirements. Only through enhanced,
real-time, around-the-clock reporting can
we stop a disease from moving beyond
an outbreak.
• Working individually and as groups with
Border Health Caucus physicians aim to improve access to care for their patients and raise
community programs such as Catholic awareness of health care disparities along the binational border.

12 San Antonio Medicine • December 2019