Four out of five patients are eligible for Medicare or Medicaid. It has a higher share of diabetes, obesity, heart disease, kidney disease, and kidney failure.
"There's a feeling here that coming to a hospital means the end of your life, which is a cultural thing," said Carlos Cardenas, MD, a McAllen gastroenterologist and chairman of the board of Doctors Hospital at Renaissance. That keeps many people from seeking healthcare earlier, before the disease process has marched too far along to be easily managed, he added.
"Many of our patients believe that if they were to go on insulin, it's something they don't want to do because they feel that people who go on insulin lose their eyesight, or lose their limbs," he said.
Bottom line, healthcare is expensive in McAllen not because doctors or hospitals are charging more, but because they are providing more of the most expensive kind of care, for patients whose health issues went ignored for decades, until they became acute.
All of that racks up the spending bill for healthcare.
"We have the sickest population in the United States," said E. Linda Villareal, MD., an internist in nearby Edinburgh. She said that for most physicians, the bulk of their practices consists of patients on Medicaid or Medicare.
And there's a shortage of physicians too, she added, saying the McAllen area has the lowest rate of physicians, 116 per 100,000 population, in the entire country and 43% fewer physicians than the U.S. average.
And that means the physicians that are there "see more and more patients in less and less time."
The physicians showed photographs of how many of their patients live, in meager buildings in the colonias where drinking water supplies can easily become contaminated with sewage, and where housing often lacks basic plumbing or air conditioning. Instead of bathrooms, residents use latrines.
Because of that, Stewart acknowledged, hospitals may keep patients in the hospital for a few days longer than they need to be there, because they know if they discharge them to a home that is not clean, their wounds will soon become infected and they may come right back into the hospital with hard-to-treat infections.