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The Challenge of Nebraska Health

Peg Bottjen, MPA, MT(ASCP)SC

Issues for Rural Health Practitioners

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Challenge of Nebraska Health Definition of “rural” Who? What? Where? How? Why?

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Definitions of Rural

Own? Census Bureau US Office of Management and

Budget (OMB) DHHS Other

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Census Bureau

UrbanUrbanized Area - Continuously built up area with a

population of 50,000 or moreUrban Place - Incorporated place outside a UA of 2,500

or moreCensus Designated Place – A densely settled

population center of at least 2,500 people with a name and community identity and is not incorporated

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Census Bureau

Rural – All other territories that are not urbanFarm – People living in rural areas of one acre of land

or more and where $1000 or more of agricultural products were sold in last year.

Non-farm – all other people

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US Office of Management and Budget

Metropolitan Area (MA) – by countiesOne city of 50,000 people or moreCB defined urbanized area of 50,000 and a total of

metropolitan area of 100,000Counties adjacent to MA if 50% of population is

included in MA or works there Non-metropolitan – all other counties

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US Dept. Health & Human Services

Frontier Counties – Six or fewer people per square mile.

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Other Federal Definitions of Rural

Housing and Urban DevelopmentOpen country, not part of a city

US Adm. On AgingUse modified census definition of rural

Why is this a problem?

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Many Definitions of Rural

ConsequencesFederal funds are being allocated based on rural

or urban statusDefinitions used to determine health personal

shortagesResearch becomes inconsistentHealth policy analysis and development is affected

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Who?

How many people live in Nebraska?

a. approx. 500,000

b. approx. 1 million

c. over 1.5 million

d. over 2 million

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1,758,787 Nebraskans in 200552.6% live in Dakota, Washington, Douglas, Sarpy, Cass,

and Lancaster counties

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Aging Population

1995 2025 % increase

0 – 64 years old

1,409,000 1,525,000 8.2

65

years old

228,000 405,000 77.6

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Race /Ethnic Origin 2004

White non-Hispanic 83.8%White Hispanic 6.9%Black 4.3%American Indian 0.9%Asian 1.5%Other or 2 or more 2.6%

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Projected Increase in Populationby Race/Ethnicity 1995 - 2025

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Economic Profile

Median Household Income 2004 (estimated)

NE avg. $48,409

Range $33,600 (Loup Co.)

$64,800 (Sarpy Co.)

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Poverty

Poverty is related to: Indicators of health statusHealth care access and useHealth related behaviors

Economic well-being greatly influences health and health care needs.

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Economic Profile Poverty 1998 - 2000

NE 10.6%

US 11.9%

Range 23.0% (Thurston Co) to 3.8% (Sarpy Co.)

Family Size Poverty Guideline

1 $8,590

2 $11,610

3 $14,630

4 $17,650

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What is the health status?

General Health Status

US 83.4% excellent or goodNE 87.6% excellent or good

Non-metropolitan 86%Metropolitan 91%

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Health Status

Leading cause of death in Nebraska in 20041. Heart disease 25.5%

2. Cancer 22.3%

3. Cerebrovascular disease

4. Accidents (leading cause for < 45 year olds)

5. Chronic lung disease

6. Alzheimer’s

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Rural vs Urban in U.S.

Rural Urban Heart Disease Pulmonary Disease (men) Accidents Smoking, adults & young No Mammograms (NE)

Health, United States, 2001 Urban and Rural Health Chartbook, HHS

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Rural vs Urban in U.S. (cont.)

RuralUrban

Alcohol consumption (men) Obesity (women) Total tooth loss No exercise Suicide Homicide

Health, United States, 2001 Urban and Rural Health Chartbook, HHS

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Rural vs Urban in U.S. (cont.)

RuralUrban

Adolescents giving birth Infant mortality Child/Young adult mortality Adult men mortality High AIDS risk (NE)

Health, United States, 2001 Urban and Rural Health Chartbook, HHS

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Health Status

Other health risks NE USSeatbelts 68.6% 76.6%Binge Drinking 17.6% 14.9%Current Smoker 20.2% 20.8%No Exercise 21.5% 22.8%BMI >30 23.2% 22.1%Cholesterol tested 69.0% 72.8%

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Where are the Health Resources? Health Professionals

Physicians Allied Health Nursing Mental Dental

Health Facilities CAH Health Systems Nursing Homes Rural Health Clinics

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Federally Designated MUAs, NE 2001

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Active Physicians to Population Ratio, NE

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Allied Health Shortages

Physician Assistant – Equal NumbersMetropolitan (.19/1,000) Non-metropolitan (.18/1,000)

Nursing Shortages 11-15% vacancy rate in NE Pharmacy Shortage 21% in US Dental Hygienists – 200 openings in NE

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N e e d f o r A l l i e d H e a l th P r o f e s s io n a l s I n N e b r a s k a

1

3

4

7

11

15

24

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1

8

3

45

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48

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0 10 20 30 40 50 60 70

Current Future 32

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Mental Health HPSAs, NE 2001

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Health Facilities

Critical Access Hospitals Mental Health Facilities Long Term Care Rural Health Clinics

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Hospitals in Nebraska

Non-critical access hospitals Critical Access hospitals

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Nursing Homes in Nebraska

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Long-term Care Beds to Population Age 65 and Over, NE 1990-2000

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State Designated Shortage Areas for Rural Health Clinics, NE 2005

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Insurance Status by Type, NE & US

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Why does rural health care need special consideration?

Cost

QualityAccess

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Access - Reasons why people were unable to obtain care.

Urban Rural Couldn’t afford 48% 52% No insurance 17% 15% Waiting Time 12% 9% Insurance 6% 4% Don’t know where to go 4% 4% Inconvenient 2% 4% Other 11% 13%

NCHS, 1994

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Quality

Right to expect local health care to meet certain basic standards.

3rd party payers want proof of quality. Medicare asks for formalized plan of Quality

Assurance.

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Summary

Definition of rural Who are we? What is health status? Where are health resources? How do we pay for health care? Why is this important?