Hospital and health service districts [1] are units of local government created to generate tax revenue to provide health care services to indigent county residents. Hospital districts are the only local health care jurisdiction that is able to impose voter-approved taxes, though not all hospital districts levy taxes. The legislature creates these districts under the authority of the Texas Constitution Article IX, Sections 4 – 11 and are either governed by an elected board or by the county commissioners court. Hospital districts can issue revenue and tax-supported bonds and can also, with voter approval, issue up to a 2 percent sales tax for property tax relief or, in counties with under 75,000 residents, for general purposes. Several chapters in Title 4 of the Health and Safety Code outline role and function of these Districts.

Health services districts are described in Chapter 287 of the Health and Safety Code and can be formed in one or more counties and one or more hospital districts to provide indigent health care on a sliding scale to county residents. The county judge of the county initiating the district appoints a board of directors, the number of which is dependent on the population of the county. Counties and hospital districts fund health services districts through contractual agreements. Health services districts may issue revenue bonds but not general obligation bonds.

[1] This map produced in 2005, and includes a number of entities in addition to Health Service Districts.