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An estimated 1 million residents, or 30.2% of the population of Harris County, have no health insurance and an additional 500,000 residents are underinsured. Though a group of public and private agencies provide over $2 billion in health care for the uninsured/underinsured annually, the capacity of the safety net system is limited and meets less than one-third of the demand for its services. Demographic and economic trends, inadequate funding for indigent healthcare services and limited service coordination among providers are major problems that strain the safety net system. 

During 2004, two significant groups of healthcare and business leaders met in Houston to address two key challenges to the region’s healthcare delivery system – a high and growing uninsured population and increasing inappropriate use of area emergency departments.  These two groups – the Greater Houston Partnership’s Public Health Task Force and the Save Our ERs group – produced major reports in late 2004 that culminated in the formation of the Harris County Public Healthcare System Council and passage of Texas legislation providing financial support to area trauma centers.  The Harris County Public Healthcare System Council was appointed by Houston City Council and Harris County Commissioners’ Court as an advisory body to continue to develop and implement the recommendations of these two reports.  After functioning as an advisory body for 18 months, the Harris County Public Healthcare System Council recommended the formation of the non-profit Harris County Healthcare Alliance membership organization.  The Alliance was intended to serve as a coordinating vehicle for providers of indigent care, to facilitate efficient service delivery and to bring in additional resources to support indigent healthcare costs. Since its formation in 2006, the Alliance has grown to over 45 member organization working together to achieve results not possible individually.