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Rural Health Care Trends - School of Medicine · Medicare Enrollment – 2016 Percent of Population...
Transcript of Rural Health Care Trends - School of Medicine · Medicare Enrollment – 2016 Percent of Population...
Rural Health Care Trends and Policy Issues Facing Nevada Residents
John Packham, PhDDirector of Health Policy Research
Nevada State Office of Rural Health and Office of Statewide Initiatives
University of Nevada, Reno School of Medicine
April 11, 2017
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Data from the Nevada Rural and Frontier Health Data Book – 2017 Edition
• Biennial production of the Nevada State Office of Rural Health, UNR Med
• Most comprehensive source of county-level data on health, health care, and health determinants in Nevada
• Additional information www.unr.med.edu/osi
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A Snapshot of Rural and Frontier Nevada in Six Maps
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Distribution of Population by County and Region
Rural and Frontier Counties– 14 counties– 86.9% of land mass– 281,019 population– 9.7% of state population– 2.9 residents per square mile
• Urban Counties– 3 counties– 13.1% of land mass– 2.9 million population– 90.3% of state population– 182.7 residents per square mile
Source: Office of Statewide Initiatives (2017). Healthcare Resources in Nevada. Nevada Rural and Frontier Health Data Book 2017, p. 4, Map 1.
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Distribution of Nevada Population by RUCAs
• RUCAs: Rural-urban commuting areas• A more specific population
classification tool• Dense urban areas• Enormous rural, frontier, and
unpopulated areas• Urban counties have substantial
rural/frontier regions (i.e. Washoe, Clark)
• Rural/frontier counties have areas economically tied to urban areas (i.e. Lyon, Nye)
Source: Office of Statewide Initiatives (2017). Rural-Urban Commuting Area Codes. (2016). Nevada Rural and Frontier Health Data Book 2017, p. 5, Map 2.
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Unique Geography of Rural and Frontier Nevada
Average Distance from a Rural Hospital to:
• Nearest incorporated town: 46 miles
• Nearest hospital: 54 miles
• Nearest tertiary hospital: 108 miles
• Office of Rural Health & NRHP: 261 miles
Source: See Nevada Rural and Frontier Health Data Book 2017, p. 174 Map 6.1.
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Unique Terrain
• 150 mountain ranges• US Highway 50 –
“the loneliest highway in America”
• Travel time measured in hours not minutes
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Rural Health Care Challenges in Nevada
• Lack of access to essential health care services in many regions of rural and frontier Nevada, including mental and behavioral health
• High rates of uninsured and other cost barriers• Growing proportion of patients with public
health insurance coverage• High levels of chronic disease and associated
risk factors associated with chronic disease
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Rural Health Care Challenges in Nevada
• Persistent threats to the economic viability of rural hospitals, clinics, and other services
• Health workforce shortages – physicians, nurses, mental health professionals, other clinical and non-clinical staff
• Unique transportation challenges affecting the receipt of timely care
• Competition with urban areas (90.3% of the state’s population) for public resources
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Demography of Rural and Frontier Nevada
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Population Change in Nevada – 1990 to 2016
Region 1990 2016 Percent Change
Rural & Frontier 165,197 281,471 70.4 %
Urban 1,036,559 2,646,472 155.3 %
Nevada 1,201,756 2,927,943 143.6%
Source: Nevada State Demographer’s Office. (2016). See Nevada Instant Atlas, http://med.unr.edu/statewide/instant-atlas/county-data-map
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Population – 1990 to 2016Percent Change
-50
0
50
100
150
200
250
Perc
ent Nevada Average
Rural & Frontier Urban
Source: Nevada State Demographer’s Office. (2016). See Nevada Instant Atlas, http://med.unr.edu/statewide/instant-atlas/county-data-map
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Population Aged 65 and Over – 1990 to 2016Percent Change
0
100
200
300
400
500
Perc
ent
Nevada Average
Rural & Frontier Urban
Source: Nevada State Demographer’s Office. (2016). See Nevada Instant Atlas, http://med.unr.edu/statewide/instant-atlas/county-data-map
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Hispanic Population – 1990 to 2016 Percent Change
-100
100
300
500
700
Perc
ent
Nevada Average
Rural & Frontier Urban
Source: Nevada State Demographer’s Office. (2016). See Nevada Instant Atlas, http://med.unr.edu/statewide/instant-atlas/county-data-map.
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Veterans Population – 2016Percent of Total County Population
0
5
10
15
20
25
Perc
ent
Nevada Average
Rural & Frontier Urban
Source: U.S. Department of Veterans Affairs. (2016). See Nevada Rural and Frontier Health Data Book, p. 48, Table 1.24.
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Health Insurance Coverage in Rural and Frontier Nevada
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Health Insurance Coverage – 2014Population Aged 64 and Under - Uninsured
02468
10121416
Perc
ent U
nins
ured
Nevada Average
Rural & Frontier Urban
Source: U.S. Census Bureau. (2016). Nevada Rural and Frontier Health Data Book 2017, p.67, Table 3.1.
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Medicare Enrollment – 2016Percent of Population
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5
10
15
20
25
30
Perc
ent
Nevada Average
Rural & Frontier Urban
Source: Centers for Medicare and Medicaid Services (2016). Nevada Rural and Frontier Health Data Book 2017, p. 74, Table 3.8.
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Health Insurance Coverage – 2008 to 2014
Region 2008 2014Change – 2008 to 2014
Number Percent
Nye County 8,562 5,555 -3,007 -35.1%
Rural Counties 51,951 35,187 -16,764 -32.3%
Nevada 529,091 416,208 -112,883 -21.3%
Source: Office of Statewide Initiatives. 2017. Nevada Rural and Frontier Health Data Book – Eighth Edition. Reno NV: University of Nevada, Reno School of Medicine.
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Public Health Insurance Coverage – 2011 to 2016
Program 2011 2016Change – 2011 to 2016
Number Percent
Medicaid 33,492 50,961 17,469 52.2%
Medicare 50,804 60,343 9,539 18.8%
Medicare Rx 26,271 37,530 11,259 42.9%
Source: Office of Statewide Initiatives. 2017. Nevada Rural and Frontier Health Data Book – Eighth Edition. Reno NV: University of Nevada, Reno School of Medicine.
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Health Insurance Coverage – 2014
12.3 12.0
18.4
26.3
13.311.3
16.1
27.3
15.8
9.9
17.3
27.4
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5
10
15
20
25
30
Source: Office of Statewide Initiatives. 2017. Nevada Rural and Frontier Health Data Book – Eighth Edition. Reno NV: University of Nevada, Reno School of Medicine.
Total Population Under 19 Under 65 Under 65 & Below 138% FPL
Percent of Population Groups Who are Uninsured
Nye County Rural Counties Nevada
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Population Health Status in Rural and Frontier Nevada
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Obesity Prevalence – 2013Percent of Population
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5
10
15
20
25
30
35
Perc
ent
Nevada Average
Rural & Frontier Urban
Source: Centers for Disease Control (2016). Nevada Rural and Frontier Health Data Book 2017, p. 85, Table 4.2.
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Tobacco Use – 2014Percent of Population
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5
10
15
20
25
Perc
ent
Nevada Average
Rural & Frontier Urban
Source: Centers for Disease Control (2016). Nevada Rural and Frontier Health Data Book 2017, p. 87, Table 4.4.
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Behavioral Health Risk Factors – 2013/2014
12.5
31.529.7
18.415.6
9.0
24.6
21.3
17.0 17.6
7.2
28.726.1
15.116.6
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Diabetes Diagnosis Obesity Prevalence Physically Inactive Tobacco Use Excessive AlcoholConsumption
Percent of Adult Population
Nye County Nevada United States
Source: Office of Statewide Initiatives. 2017. Nevada Rural and Frontier Health Data Book – Eighth Edition. Reno NV: University of Nevada, Reno School of Medicine.
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All Cause Mortality Rate – 2014 Age-Adjusted Deaths per 100,000 Population
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200
400
600
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1,000
Nevada Average
Source: Office of Health Statistics and Surveillance. (2016). Nevada Rural and Frontier Health Data Book 2017, p.104, Table 4.21.
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Diseases of the Heart – 2014 Age-Adjusted Deaths per 100,000 Population
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50
100
150
200
250
300
Nevada Average
Source: Office of Health Statistics and Surveillance. (2016). Nevada Rural and Frontier Health Data Book 2017, p.105, Table 4.22.
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Malignant Neoplasm (Cancer) – 2014Age-Adjusted Deaths per 100,000 Population
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50
100
150
200
Nevada Average
Source: Office of Health Statistics and Surveillance. (2016). Nevada Rural and Frontier Health Data Book 2017, p.106, Table 4.23.
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Chronic Lower Respiratory Disease – 2014 Age-Adjusted Deaths per 100,000 Population
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50
100
150
200
N/A
Nevada Average
Source: Office of Health Statistics and Surveillance. (2016). Nevada Rural and Frontier Health Data Book 2017, p.107, Table 4.24.
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Lung, Trachea, and Bronchus Cancer – 2014 Age-Adjusted Deaths per 100,000 Population
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25
50
75
100
125
Nevada Average
Source: Office of Health Statistics and Surveillance. (2016). Nevada Rural and Frontier Health Data Book 2017, p.108, Table 4.25.
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Leading Causes of Death – 2014
285.9
176.9
88.0
63.8
40.6
191.3
161.9
52.1 45.332.8
167.0 161.2
40.5 42.1 36.5
0.0
50.0
100.0
150.0
200.0
250.0
300.0
Heart Disease Cancer COPD Lung Cancer Stroke
Number of Deaths per 100,000 Population
Nye County Nevada United States
Source: Office of Statewide Initiatives. 2017. Nevada Rural and Frontier Health Data Book – Eighth Edition. Reno NV: University of Nevada, Reno School of Medicine.
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Health Care Workforce in Rural and Frontier Nevada
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Primary Medical Care Health Professional Shortage Areas (HPSAs)
• Most regions of rural and frontier Nevada are federally-designated HPSAs
• 10 rural counties are single-county HPSAs
• Most rural and frontier census tracts of Clark and Washoe Counties are Primary Care HPSAs
Source: Bureau of Health Professions, Health Resources & Services Administration. (2017). Nevada Rural and Frontier Health Data Book 2017, p. 130, Map 5.1.
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Physician and Primary Care Workforce – 2016Number per 100,000 Population
Profession Rural &Frontier Urban Nevada
Allopathic Physicians (MD) 70.5 188.6 176.8
Adv Practitioners of Nursing (APN) 25.0 42.8 41.0
Osteopathic Physicians (DO) 15.9 24.2 23.4
Physician Assistants (PA) 23.6 25.6 28.6
Primary Care Physicians (MD & DO) 36.1 74.5 70.6
Source: See references for Tables 5.7 through 5.44 in Nevada Rural and Frontier Health Data Book 2017, p. 168, Table 5.45.
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Mental Health Professional Shortage Areas
• All 14 rural and frontier counties are mental health HPSAs
• With the closure of numerous rural mental health clinics, access to mental health services in rural areas is major public health issue
Source: Bureau of Health Professions, Health Resources & Services Administration. (2016). Nevada Rural and Frontier Health Data Book 2017, p. 148, Map 5.3.
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Mental and Behavioral Health Workforce – 2016Number per 100,000 Population
Profession Rural &Frontier Urban Nevada
Alcohol, Drug, & Gambling Counselors 48.8 41.5 42.1
Marriage & Family Therapists 16.4 26.3 25.2
Psychiatrists 0.1 7.1 6.8
Psychologists 4.2 14.5 13.4
Clinical Social Workers (LCSWs) 14.3 25.1 24.0
Source: See references for Tables 5.7 through 5.44 in Nevada Rural and Frontier Health Data Book 2017, p. 168, Table 5.45.
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Dental Health Professional Shortage Areas
• 8 of 14 rural and frontier counties are dental HPSAs
• Majority of census tracts in rural Clark County are also HPSAs
• Counties such as Churchill, Humboldt, and Lyon have historically been dental HPSAs
Source: Bureau of Health Professions, Health Resources & Services Administration. (2017). Nevada Rural and Frontier Health Data Book 2017, p. 140, Map 5.2.
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Oral Health Care Workforce – 2016Number per 100,000 Population
Profession Rural &Frontier Urban Nevada
Dentists 38.3 56.0 54.1
Dental Hygienists 35.5 36.0 35.9
Source: See references for Tables 5.7 through 5.44 in Nevada Rural and Frontier Health Data Book 2017, p. 168, Table 5.45.
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Health Care Resources• 14 hospitals with 2,249
employees and a payroll of $140.9 million, including 13 Critical Access Hospitals (CAHs)
• 40 federally designated Rural Health Clinics (RHCs) & Community Health Centers (CHCs)
• 13 tribal clinics and medical centers
Source: National Association of Community Health Centers. (2017). Centers for Medicare & Medicaid Services (2017). Nevada Rural and Frontier Health Data Book 2017, p. 4, Map 1.
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Major Rural Health Policy Issues
• Addressing the financial barriers to care, including high numbers of uninsured (and underinsured)
• Addressing geographic barriers, unique time and distance issues, e.g., telemedicine
• Ensuring the economic viability of low-volume, remote rural hospitals and clinics
• Aging physical plant and capital needs• Outmigration of patients from rural areas• Concerns about financing of long-term care an
other services for an aging population
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Major Rural Health Policy Issues
• Mental and behavioral health care needs and barriers• Integration of primary and mental/behavioral health
services, integration of medical care and public health • Chronic health workforce shortages and an aging
physician workforce • EMS workforce and resource deficits• Underdeveloped public health services and local
boards of health • State budget issues and historic underinvestment in
health care and public health
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Resources from the Office of Statewide Initiatives and UNR School of Medicine
Nevada Rural and Frontier Health Data Book – 2017 Edition
OSI Programs and Projects
• Nevada Office of Rural Health• Nevada Flex Program• Nevada SHIP Program• Project ECHO Nevada and rural
telemedicine • Nevada Area Health Education
Centers• Health Workforce Research and
Policy Program • Nevada AIDS Education and
Training Center
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Contact info
John Packham, PhDDirector of Health Policy ResearchOffice of Statewide Initiatives and
Nevada State Office of Rural HealthUniversity of Nevada, Reno School of Medicine
(775) 784-1235 / [email protected]://www.med.unr.edu/osi
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