Two hospitals and several emergency clinics serve patients across Bastrop County, but they lack specialized services such as women’s and birthing care. Existing care also often fails to extend into more rural areas, according to local health care officials.

Bastrop also faces challenges related to inequity of care, with a high uninsured population and hospital visits often delayed until more serious health concerns arise, according to a 2023 St. David’s Foundation report.

“We have hotbeds of very vulnerable, high-risk populations in this county and with those pockets of residents, there is a true lack of access to health care,” said Donna Nichols, the Bastrop County Public Health Department interim executive director.

Two minute impact

Bastrop County’s lack of accessible care is not unique to regions of Texas experiencing growth, but it is an extreme case, said John Henderson, CEO of the Texas Organization of Rural and Community Hospitals.

The closure of nearby hospitals such as St. Mark’s Rural Hospital in La Grange in late 2023 put further strain on the county’s need for care.

Residents now travel to Smithville, Round Rock, Austin, College Station, Bryan or Kyle to receive care, making transportation a major barrier to health services within the county, according to nonprofit Bastrop County Cares.

Despite the challenges, local health care providers have made efforts to disperse care and address localized needs.

Ascension Seton opened a small-scale hospital in Bastrop in early 2020. The location has been strategic in offering needed localized care, said Jace Jones, chief administrative officer at Ascension Seton Bastrop Hospital.

Observing a need for simple surgeries and common fractures, Ascension Seton officials recruited a general and an orthopedic surgeon.

“I think what you have to offer at your hospital or [in] a rural community is what meets the needs of the community. What are they asking for?” Jones said. “We’re just trying to offer those services and be a pillar of the community—a place they can come to for care and not have to drive to Austin or Houston or San Antonio.”

A closer look

St. David’s Foundation designated the county as a health professional shortage area for primary, dental and mental health care. Due to population growth, the number of residents per primary care physician grew 12.1% from 2010 to 2018, according to a report by the nonprofit. The report found distance to receive affordable services has also contributed to barriers in residents receiving quality care.

In 2023, there was one primary care physician for every 4,250 people in Bastrop County, which is over three times the national average, according to data from County Health Rankings & Roadmaps.

Primary care is where patients can deal with chronic conditions and prescription needs to avoid emergency room visits, Henderson said.

“When you have a strain on that primary care ratio, that community is probably not going to have the health outcome they desire until they can figure out a way to recruit [and] retain more primary care providers,” Henderson said.

Zooming in

Aside from a lack of options, many locals also struggle to afford health care. In Bastrop County, 15% of children under age 19 and 26% of adults under age 65 did not have health insurance as of 2021, according to County Health Rankings & Roadmaps. Higher levels of uninsured individuals and a lack of transportation options often prevent those in Bastrop’s rural neighborhoods from seeking care sooner, said Norma Mercado, Bastrop County Cares executive director.

Disparities in care between Hispanic and Black residents in Bastrop County exist due to these challenges in accessing preventive care, Mercado said. Bastrop County’s population grew 31.3% from 2010-20, and Hispanic residents accounted for 75% of the total population growth during this time, contributing to a lack of culturally- and linguistically-appropriate care provided in the area, according to the St. David’s Foundation report.

Individuals who delay medical care due to affordability could lead to long-term variations in health outcomes and have lasting implications on individual and public health, according to the National Institutes of Health.

In 2017, the most recent year this data is available, approximately 16.5% of Bastrop County adult residents reported there being a time in the prior year when they needed care but could not afford it, according to the 2021-22 Community Health Needs Assessment.

Also of note

As young families move to the county, the area is seeing an increased need for pediatric and women’s care, according to the U.S. Census Bureau. Sixty percent of rural hospitals—including those in Bastrop—fail to provide labor and delivery services, according to the Texas Organization of Rural and Community Hospitals.

Many pregnant women travel to Austin for access to private doctors due to the county’s lack of nearby prenatal care, Dr. Linda Wilson, Smithville Hospital Authority board president previously told Community Impact .

“When you need health care, the further you are from it, the more variability you get in outcomes,” Henderson said.

Bastrop area fertility

Bastrop County has been designated as having low access to maternity care due to the availability of birthing facilities, maternity care providers and the percentage of uninsured women, according to the U.S. Census Bureau and nonprofit March of Dimes.
  • 7.8% of women in Bastrop between the ages of 15-50 gave birth in the past year, which is 1.4 times the Texas birth rate and 1.5 times the national birth rate
  • 895 average births per year in Bastrop County from 2014 to 2022
  • 30.5 miles is the average distance women in Bastrop County have to travel to reach a birthing hospital
  • 10% of babies are born preterm in Bastrop County
What’s next?

Despite the challenges, Bastrop County is moving toward expanding the county’s medical capabilities.

Bastrop County Care partners with mobile health organizations such as Smithville Rural Health as well as utilizes their own Care-A-Van, a mobile well-being and recreation unit, to help bring care to more isolated residents.

Last year, Ascension Seton Bastrop and Smithville began training emergency room physicians for pediatric readiness, with the help of Dell Children’s Medical Center. The hospital is also working on recruiting a pediatrician to the area. However, Jones said no expansion of the Ascension Seton Bastrop facility is planned at this time. Ascension Seton Bastrop officials plan to form an agreement with the Texas A&M School of Medicine, allowing medical students to take part in a two- to four-week elective rotation at the Bastrop location. The program would likely see up to two students at a time, Jones said.

“This would be an elective for [medical students] to choose to come to a rural area, spend time in the community and spend time with the physician,“ Jones said. “Our hope of doing that is that if they go on to do a residency, they will want to come back and practice in our area.”