💡 What’s Happening?
What happens outside hospitals often determines what happens inside it. Communicable and endemic diseases such as influenza and sexually transmitted infections are recurring features of the public health landscape. Their predictability makes surveillance, prevention and preparedness possible – but their persistence also creates a baseline demand for public health infrastructure and health care resources.
Chronic disease presents a different challenge. Conditions such as diabetes, cardiovascular disease and hypertension can often be managed over years, but that management depends on sustained access to primary care, medications and other services. When that continuity breaks down, conditions that might otherwise remain manageable can become acute.
The common thread? Anything unaddressed shifts down the line. Hospitals become the place where an otherwise manageable or preventable condition finally demands attention, at a cost.
♻️ Defining Endemic
A predictable disease burden – or something endemic – means targeted investment in surveillance, testing, workforce capacity, education and other systems before demand escalates. But predictable does not mean inconsequential.
A disease that’s a routine part of a population’s health landscape still generates significant illness, complications and healthcare costs. When patients with communicable diseases ultimately require hospital care, the resources needed to respond – like diagnostic testing and specialized drugs or isolation capacity and staff time – are already waiting at the end of the pipeline.
“Most people get infected with RSV throughout their lives, and for most healthy adults, the virus causes a cold. But the virus can cause serious complications in children younger than 5 and adults older than 65. In a typical year, RSV causes at least 58,000 hospitalizations and between 100 and 300 deaths in children younger than 5, according to the U.S. Centers for Disease Control and Prevention. For people 65 and older, the virus causes at least 60,000 hospitalizations and 6,000 deaths each year.”
Fort Worth Star-Telegram: Longer than usual RSV season prompts Texas to extend vaccine availability
“Galveston was the focus of a recent study by the Centers for Disease Control and Prevention (CDC) on the resurgence of murine typhus, a flea-borne disease that can cause serious illness in humans. While the disease was nearly eradicated in the U.S. at one point, it had a resurgence in southeastern Texas and California, according to the study. More than 6,700 cases were reported statewide between 2008 and 2023, according to Texas Health and Human Services. Around 70% of the cases required hospitalization and 14 deaths were reported. The CDC study in particular looked at cases in Galveston between 2019 and 2023. Out of 149 cases, around 80% of people were hospitalized and 28% were admitted to the intensive care unit.”
Houston Public Media: Galveston at center of new CDC study on resurgence of flea-borne typhus
💳 A Regular Expense
Chronic disease creates a different kind of pressure, being a recurring expense instead of an episodic one. Effective management can keep many chronic conditions from progressing to more serious complications.
For instance, conditions such as diabetes, heart disease and hypertension often require years of medications, monitoring and routine care. When patients can access that care consistently, complications can sometimes be prevented or delayed. That includes preventive care, such as maternal and pre-natal programs, health education or mobile clinics. But gaps in insurance coverage, affordability, transportation, primary care access or medication access can interrupt that continuity.
A patient who cannot afford or access routine management may eventually seek care when symptoms become acute. By then, what could have been managed through an office visit, prescription or routine monitoring may require an emergency department visit, hospitalization or more intensive treatment. Now, the hospital isn’t the source of the problem – but it is where the accumulated consequences become visible and expensive. Healthcare costs are rising, in part, because people arrive at hospitals sicker, needing more intensive care.
“‘[Diabetes is] the seventh leading cause of death in this country. In San Antonio, Bexar County alone, 1 out of 6 individuals are walking around with diabetes, which makes it the fifth leading cause of death in this community,’ said White. White said they’ve seen an increase in hospitalizations due to diabetes as well as a greater prevalence in children.”
Spectrum News 1: Insulin program in San Antonio aims to help cover cost of medication
“Hospitals are not only paying more to provide care, they also are delivering more care to patients who are sicker and more medically complex. A recent AHA/Vizient analysis found that hospital case-mix index — a standard measure of how sick patients are — rose by about 5% between 2019 and 2024, indicating that a larger share of hospital care is devoted to higher-acuity patients with multiple conditions, greater clinical needs and longer stays. The continued rising prevalence of chronic diseases, such as heart disease, cancer and liver disease, continues to beset the system.”
AHA: Costs of Caring: Challenges Facing America’s Hospitals as They Care for Patients in 2026
💭 Consider This
Hospitals maintain capacity for both the expected and the exceptional. That readiness carries costs, but so does absorbing the consequences when gaps in public health, primary care or chronic disease management allow conditions to become acute. Hospitals may be the most expensive point of care, but they are often where costs generated earlier in the health care continuum ultimately converge.
If the goal is to reduce the overall cost of care, the most effective intervention may not occur inside the hospital at all. Investing upstream can reduce the number and severity of conditions that ultimately require high-cost hospital care.
“A program through the Texas A&M Rural and Community Health Institute is working with rural health care facilities across Texas to shift focus from treating illness to preventing it. The initiative, known as a value-based care model, helps rural health clinics keep patients healthy by assisting with scheduling wellness visits, managing chronic diseases and coordinating care after hospitalizations. ‘We focus on prevention, wellness, screenings, and really managing current disease states,’ said Reyann Davis, Director of the Value Based Care Program. ‘It has shown to improve cost of care by reducing emergency visits and avoidable hospitalizations.’ … So far, the program has worked with 36 rural organizations and has reached more than 5,000 rural patients to help schedule wellness visits.”
KBTX3: Texas A&M program targets rural health care through value-based care model
⭐ Hospitals do not benefit from having more sick patients; hospitals benefit when Texans are healthy, wherever in the health care system that health is achieved.
📖 Learn More
HMJ: A Healthy Texas Starts with Prevention
Texas Health Data: Chronic Disease and Hospitalization Rate by Year and by Selected County (2017-2023)
THA Testifies: The Aug. 20 hearing provided a clearer picture of how lawmakers are thinking about public health across several fronts – THA corrected the narrative on how hospitals are utilizing AI to improve operational efficiency and comply with government regulations.
