Various Fort Bend County entities conducted a series of community health studies and surveyed 800 individuals throughout 2022 to form the county’s 2022 Community Health Assessment report.
The CHA report released April 21 found that access to health care needed to be improved for many residents in the county; survey respondents said the two primary barriers to accessing health care were an inability to pay for care out of pocket and a lack of health insurance.
Areas north of Richmond, parts of Houston and the more rural areas in the county see uninsured population rates higher than 20%, said Kaila Williams, Fort Bend County’s director of health communications, equity and engagement.
Overall, 17% of adults and 11% of children were uninsured in the county in 2022, with the percentage of uninsured people reaching over 16% in the 77498 and 77489 Sugar Land and Missouri City ZIP Code Tabulation Areas in 2020. These ZCTAs—which are generalized representations of United States Postal Service ZIP code service areas—are located in the northeast part of the county near the city of Houston.
“Twenty-two percent of [CHA] respondents, they or a family member needed medical care in the past year but was unable to receive it,” she said. “The top reason was because they did not have health insurance.”
Williams also indicated 45% of respondents said free or low-cost medical services were the top missing services in their community. However, some local health clinics that provide low-cost services are undergoing expansions in areas with larger uninsured and low-income populations.
Identifying needs
Survey data and anecdotal accounts from health care officials that indicate household income and pandemic-era health trends point providers in the direction of the people who are most in need of support.
Fort Bend County overall has a lower percentage of uninsured people in its population than in the state, which has the highest population and percentage of uninsured residents in the nation, according to the Texas comptroller’s website. The ratio of providers to patients has improved over time in the county, but statewide trends—such as many essential labor employers not providing health care to workers—are also present in Fort Bend County.
In the CHA report, 25 “key informants” were consulted to represent different sectors and populations, such as primary health care providers, elected officials and hospitals.
These informants were asked to assess the health status of Fort Bend County residents. According to the report, the assessed individuals generally identified people with insurance and higher socioeconomic status as being relatively healthy, while people without insurance or with a low annual household income—or making less than $40,000—tended to have unmet health needs.
The observations made by informants were supported in the county’s health report. Only 29% of people with a low annual household income reported having “very good” health versus 41%-53% of people with middle and high annual household incomes.
Local nonprofit health care providers that cater to low income and uninsured populations, such as San Jose Clinic and AccessHealth, are expanding to better serve high-demand areas in the county.
San Jose Clinic aims to provide quality care and education to people with constraints keeping them from accessing health care. Kimberlyn Clarkson, chief advancement officer for San Jose Clinic, said chronic conditions were exacerbated over the course of the COVID-19 pandemic among patients. She said managing chronic conditions, such as diabetes and hypertension, is the current focus for the majority of San Jose Clinic patients.
“When a patient or person goes without consistent health care for a number of years, things like diabetes arise,” Clarkson said.
Meanwhile, AccessHealth, which has been based in Fort Bend and Waller counties for almost 50 years, provides health care for anyone that has no health insurance or no ability to pay.
Data from AccessHealth showed an increase in the number of mental health or substance abuse visits since the onset of the COVID-19 pandemic in 2020. According to the data, there were 8,681 of these visits in 2022, reflecting a 45.68% jump from 2020.
“These figures indicate an elevated demand for mental health services, potentially influenced by the ongoing effects of the pandemic and the current global landscape,” an emailed statement from AccessHealth reads.
Lara Hamilton, executive director of nonprofit health care provider Christ Clinic, said the Katy area is seeing high demand for affordable health care due to its rapid growth. Christ Clinic provides primary care to uninsured and underinsured people, or someone with insurance that may not sufficiently cover their medical needs.
“As communities grow ... the number of individuals that you need to run those businesses [increases], which are typically going to be part-time workers or hourly workers that are making less than a living wage,” Hamilton said. “[Massachusetts Institute of Technology] has a living wage calculator, and in the Katy area, it’s $32.20 per hour for one adult with one child. If you’re working retail or something like that, you’re not touching that.”
Barriers to care
The CHA report identified a variety of social barriers preventing residents from accessing quality care. Factors such as a lack of transportation and a lack of bilingual providers were key contributors, according to the CHA.
“With our patient population, the primary barrier, the reason that we are needed is socio-economic,” Hamilton said. “It’s income, employment. Most of our patients are employed, but as part-time workers or something like that, so their income is just not high enough or they’re not eligible for group benefits.”
Hamilton said the No. 1 reason for no-shows and cancellations at Christ Clinic is a lack of access to transportation. She pointed to an absence of public transportation or walkable infrastructure in Katy.
Palak Jalan, AccessHealth chief population health officer, referred to the factors preventing people from accessing care as “social determinants of health.” She also indicated a lack of adequate transportation as one of these factors while highlighting an inability to access healthy food, pay utility bills or generally find employment.
A lack of employment opportunities and low wages can cause many residents to deprioritize health care over housing and food, according to observations made in the CHA.
“[People] want to work, they want to take care of their families, they want to contribute to society—but they work in jobs that are not required to offer them benefits,” Clarkson said.
Meeting demand
Clarkson said San Jose is working to “bridge the trust gap” in areas around the Rosenberg community that it serves, especially people in more rural areas and people from marginalized communities.
San Jose Clinic is planning to open a pharmacy in Rosenberg over the summer. The pharmacy will help provide services to places in the county with the highest demand, Clarkson said. It will be located at 117 Lane Dr. in the Quadrangle Square.
Hamilton said Christ Clinic started the 2535 Initiative in late 2022 to better reach areas in Fort Bend County with high levels of poverty, such as the Fulshear and Simonton areas. The initiative involves partnerships with churches that will allow Christ Clinic to open satellite locations in the spaces.
Jalan said AccessHealth has plans to expand its presence in Missouri City and is also considering future expansions into west areas of the county and the Katy area.
Jalan said being medically underserved is a multidimensional problem affecting Fort Bend County communities. She said systems-based changes or changes to governing policy outside of clinics tend to be overlooked methods for taking on the challenge.
“Access to green spaces, sidewalks, ... things that we would [usually] associate with civic infrastructure, have a big impact on health and well-being,” Jalan said.
