1 The Challenge of Nebraska Health Peg Bottjen, MPA, MT(ASCP)SC Issues for Rural Health...
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Transcript of 1 The Challenge of Nebraska Health Peg Bottjen, MPA, MT(ASCP)SC Issues for Rural Health...
1
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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2828
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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
29
48
58
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?