Why Parkland Hospital bears a disproportionate share of unpaid healthcare costs


Parkland Hospital & Health System, the only public hospital in Dallas County, provides much of the health care safety net for people who are uninsured and covered by Medicaid. This represents a potential customer base of over a million people, and Parkland sees approximately 300,000 individual patients per year, said Dr Fred Cerise, CEO of Parkland.

In 2019, more than 80 hospitals in Dallas-Fort Worth earned $ 3.14 billion, analyst says Allan Baumgarten, which publishes the Texas Health Market Review. Profits were nearly three times higher than a decade earlier during the Great Recession.

Margins vary widely, in part because the costs of treating uninsured people and lower-paying Medicaid plans fall more on certain providers. At Parkland, profit margins were 9.6% in 2019. On the other end of the spectrum, the two major hospitals of Medical City in Dallas and Plano recorded margins of 37% each – and both facilities gained 667 combined million dollars in 2019, the market reported.

“There is a fair amount of unpaid care in Dallas and the burden is not shared equally, not by any measure,” Baumgarten said.

Parkland had $ 670 million in unpaid care and unreimbursed costs for the fiscal year ended September 2020, according to Medicare hospital cost reports. That was six to ten times more than some of the area’s largest private hospitals, including Baylor University Medical Center, which had $ 113 million in unreimbursed costs; Medical City Dallas at $ 67 million and Texas Health Presbyterian in Dallas at $ 64 million, Baumgarten said.

The total reported by Parkland on the Medicare record does not include unreimbursed costs for the provision of medical services, on-the-go medications, and health care for the Dallas County prison system.

Healthcare is a powerful economic force here. More than 272,000 people work in health care and social assistance in the Dallas-Plano-Irving subway division. Since 2000, the segment has added jobs at nearly triple the rate of the rest of non-farm employment.

Since 2011, more than 23.5 million square feet of space has been built for hospitals, clinics, emergency care centers, and doctor’s offices. This is the most added healthcare space among all of Sun Belt’s major subways, according to the real estate services company Transouest, and that represents billions of dollars of investment.

In a Community Health Needs Assessment 2019 By Parkland and Dallas County, many of the disparities in health outcomes and death rates have been broken down by geography and socioeconomic factors. A handful of postal codes south of downtown – 75210, 75216, 75217 and 75241 – “have virtually all negative indicators,” according to the report.

The report included a map of the geographic distribution of hospitals in the Dallas areas, and 23 facilities were north of Interstate 30, compared with five to the south. This snapshot contained data from 2017, and the construction of healthcare in the northern regions has accelerated. A map in the Baumgarten review shows an even higher concentration of hospitals in the north.

These regions have faster population growth, higher family incomes, and more residents with commercial insurance. Prosper, for example, is the site of two new children’s hospitals under construction just 3 miles apart. And two other large children’s facilities are relatively close.

The call ? Prosper’s population has more than doubled in the past decade, and 96.5% of residents under 65 have health insurance, according to census data. The median household income in Prosper is almost three times that of Dallas.


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