Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out

Snohomish

VIEWS: 20 PAGES: 50

									 Access to Health Care in
   Snohomish County:
Highlights from the Snohomish
    County Access Report

   Gary Goldbaum, MD, MPH
       Health Officer & Director
      Snohomish Health District
       Acknowledgments
Presentation prepared with assistance
 from Health Statistics & Assessment:

 Colin Rehm, MPH – Epidemiologist
 Jane Ballard, PhD, MS – Manager/
  Epidemiologist
Access Report (2008)

           Highlights access to
            health care throughout
            the “life course”
           9 data sources
           Available online at:
            www.snohd.org/snoHealthStats/
              Key Points
 Many Snohomish County residents face
  multiple access challenges.
 Access to health care is not uniform in
  Snohomish County.
 OB supply in particular is declining
  relative to population growth.
 Access problems in Snohomish County
  are associated with substantial morbidity
  & mortality.
        What I’ll Cover
 Background
 Data sources for this presentation
 Access problems in Snohomish County
 Provider-supply issues
 Outcomes associated with access
  problems
 Next steps
  How do we measure access to
   health care for individuals?

 Not having insurance (including public
  insurance)
 Avoiding care (usually due to cost)
 Lacking personal health care provider
 Not visiting health care provider recently
 Combination of above
What are some consequences of
      access problems?
 Poor pregnancy/birth outcomes
 Under-utilization of recommended
  clinical preventive services
 Avoidable hospitalizations (due to
  infection, congestive heart failure,
  asthma, etc.)
 Mortality amenable to health care (due
  to heart disease, stroke, cancer, etc.)
  Data Sources for This Talk

 Behavioral Risk Factor Surveillance
  System (BRFSS)
 Comprehensive Hospital Abstract
  Reporting System (CHARS)
 Death Certificates
 Health Professional
  Shortage Areas (HPSA) Survey
   SES Proxy: Area Poverty
      Level (Within ZIP)

 Low: <10% of pop below 185% of
  Federal poverty level (FPL)
 Moderate: 10-19.9% of pop below 185%
  of FPL
 High: ≥20% of pop below 185% of FPL
Health Planning Areas (HPA)
Access Problems in
Snohomish County
      Trends in Key Access Indicators,
         Non-elderly Adults (18-64)
     24%

     20%

     16%             15%
                                                                   15%
               15%
     12%                                                         13%

       8%

       4%

       0%
           1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
           No insurance
           Avoid seeking medical care because of cost in past 12 months
Data source: 2005 BRFSS
   Who faces access challenges¶?
     Women (avoid care)
     Men (no provider/visit)
     Younger adults
     Low income (income<200% of poverty)
     Less than high school education
     Unmarried
     Unemployed* and self-employed
     Hispanic population
¶ No insurance, avoid seeking health care because of cost, no regular
provider, or no visit in 2 years
* Unemployed but seeking employment
            Percent with No Insurance
     25%         24%


     20%

                           16%
                                    15%                            Entire County
     15%                                       14%


                                                          10%
     10%
                                                                       8%


      5%



      0%
                Everett    East     North   Highway 99   South        View
                          County   County                Central     Corridor

Data source: 2005 BRFSS
                     Percent Avoiding Care
                          Due to Cost
     25%
                  22%

     20%

                           16%      16%
     15%                                                        Entire County
                                              12%
                                                       10%
     10%                                                            9%



       5%



       0%
                Everett    North   Highway    East    South       View
                          County      99     County   Central    Corridor
Data source: 2005 BRFSS
  Problems Not Limited to Uninsured

     70%
                                    Insured      Uninsured
                                                62%

     56%

                                                                      45%
                           43%
     42%


     28%
                                                             19%
                                         15%
     14%
                    9%


      0%
             Avoided care b/c of cost   No personal MD   2+ years since last MD
                                                                  visiti

Data source: 2005 BRFSS
Access Problems May Be Additive

 Combine 4 common access questions
  in single index:
  – No insurance
  – Avoided care
  – No regular provider
  – No routine visit in past 2 years
        Number of Access Problems
                               3+, 8%



                    Two, 11%




                                        None, 58%
               One, 22%




Data source: 2005-2006 BRFSS
     Most Likely to Have 3+ Access
              Challenges
       Men
       Younger adults
       Low income (income ≤ 200% of
        poverty)
       Unmarried
       Unemployed* & self-employed
       Native American population

* Unemployed but seeking employment
Provider-Supply Issues
                                      Population to Primary Care
                                           Provider Ratio
Population to primary care provider




                                      3500                3286
                                                                     Severe shortage
                                      3000
                                              2511
                                      2500                          Moderate shortage

                                      2000                              1844
               ratio




                                      1500
                                                                                  Ideal
                                      1000

                                      500

                                        0
                                             Overall   Low income     Medicare
                     Accepting New Patients
               All           Family Practice                Pediatrics   OB/GYN


           Insured

    Medicaid FFS


     Medicaid HO

   Medicare FFS


    Medicare MC

     Basic Health

                     0%            20%             40%            60%    80%      100%

                                 Percent Accepting New Patients
Data source: 2003 Snohomish County Primary Care Provider Survey
         Increasing Stress for OB Providers
               in Snohomish County
                                                                Snohomish County              Washington State
                                                     70
          Average number of births per OB provider




                                                     60



                                                     50



                                                     40



                                                     30
                                                          1997-1999   2000-02   2003          2004    2005       2006
                                                                                       Year
Data source: County Profiles: Birth and Unintended Pregnancy Statistics,
February 2008 (DRAFT), WA DSHS: Research and Data Analysis Section
       Population to Dental Care Provider
           Ratio: Overall Population
                                     4,500
                                                                        4,159
     Population to Provider Ratios




                                     4,000

                                     3,500

                                     3,000

                                     2,500
                                               1,903
                                     2,000

                                     1,500

                                     1,000

                                      500

                                        0
                                             Everyone                Low Income

                                                        Population
Data source: 2004 Snohomish County Dental Care Provider Survey
       Population to Dental Care Provider
         Ratio: Low-Income Population
                                     15,000     14,390
     Population to Provider Ratios




                                     12,500


                                     10,000


                                      7,500
                                                               6,372

                                                                                           5,127
                                                                             4,735
                                      5,000

                                                                                                         2,745      2,954
                                      2,500


                                         0
                                              East County   North County South Central View Corridor   Highway 99   Everett

                                                            Health Planning Areas
Data source: 2004 Snohomish County Dental Care Provider Survey
Outcomes Associated with
    Access Problems
    Cause & Effect:
Inadequate Prenatal Care

    Inadequate access
              
 Inadequate prenatal care
              
   – Low birth weight
   – Preterm delivery
         Inadequate Prenatal Care by Health
            Planning Area & Area Poverty
   25%

                                                                    21%
   20%        18%


   15%                   14%       13%                                     13%
                                            11%   11%      11%
   10%                                                                              9%


     5%



     0%
             Everett Highway North   South         East   View      High Moderate   Low
                        99   County Central       County Corridor
                                           HPA                         Area Poverty
Data source: 2003-2005 Birth Certificate
             Percent of Women Receiving
              Inadequate Prenatal Care




Data source: 2003-2005 Birth Certificate
             Consequences of Inadequate
                   Prenatal Care                                                                  Preterm Delivery
      8%                                                                         8%          8%
                                                                                                    (<37 weeks)


      7%
                             Low Birth Weight
                                (<2500g)
      6%
                                                                                                           5%
      5%
                   4%

      4%

      3%
                                  2%              2%
      2%

      1%

      0%
               Inadequate    Interm ediate     Adequate                     Inadequate   Interm ediate   Adequate


Data source: 2003-2005 Birth Certificate, analysis limited to singleton deliveries
           Cause & Effect:
Underutilization of Preventive Services

            Inadequate access
                      
  Underutilization of preventive services
                      
   – Avoidable hospitalizations
   – Mortality amenable to health care
   Use of Preventive Services (age 18-64)
                                       Insured          Uninsured
      84%                        80%
                  76%                                          76%

                                       67%
      67%
                                                57%
                        53%
                                                                     49%
      51%
                                                      43%


      34%
                                                                               23%

      17%                                                                            10%


       0%
                M am past 2    Pap test past 3 Colon/sigmoid   Chol past 5   Flu past 12 mo
                   years           years           ever          years
Data source: 2004/2006 BRFSS
     Use of Preventive Services (age ≥ 65)
                                Income <200% of FPL           Income >200% of FPL
     100%

                             82%
                                                       76%         78%
       80%
                                                                                  73%
                                            67%                            69%
                     67%

       60%                                                   56%



       40%



       20%


        0%
                 M am past 2 years Colon/sigmoid ever Chol past 5 years   Flu past 12 mo
Data source: 2004/2006 BRFSS (cholesterol 2005 only)
                     Visit to Dentist in Past Year for
                     Non-Elderly Adults (age 18-64)
     80%                  77%             76%                75%




     60%

               45%                                     46%
                                    39%
     40%




     20%




      0%
              <200% of   >200% of   No     Yes         Yes    No
                FPL        FPL
                                                       Avoided Health Care of
                 Poverty Status     Health Insurance
                                                               Cost
Data source: BRFSS (2004/2006)
                      Visit to Dentist in Past Year for
                          Elderly Adults (age≥65)
     90%



                                                                80%
     80%
                77%                      77%
                                 76%



     70%


                                                    61%
     60%




     50%
               Ov e rall         Male   Fe male   <2 00% of   >2 00% of
                                                     FP L        FP L
                                                   Poverty Status
Data source: BRFSS (2004/2006)
Avoidable Hospitalizations
      Avoidable Hospitalizations (age 18-64)
                                                  Incarcerated
                                 Other*, 228       hernia, 188

                   Volume depletion,                              Septicemia, 1083
                         312

                   COPD, 353


               Kidney/urinary
                Infection, 391


                                                                                 Bacterial
                                                                              pneumonia, 1061
                  Asthma, 445




                 Ketoacidosis/coma
                        576
                                                                 Congestive heart
                                       Cellulitis, 625             failure, 707

                                                                 * Other includes hypoglycemia, primary hypertension,
Data source: 2003-2005 CHARS                                          Grand Mal status, angina, and dental conditions.
          Avoidable Hospitalizations
       by Area Poverty Level (age 18-64)
                                               900
            Hospitalization Rate per 100,000
                                                     808
               Age-Adjusted Avoidable

                                               750
                                               600




                                                                   471
                                               450




                                                                                 329
                                               300
                                               150
                                               0




                                                     High        Moderate        Low
                                                            Area Poverty Level
Data source: 2003-2005 CHARS
                              Avoidable Hospitalizations
                           by Area Poverty Level (age 65-74)
                                        4,000
     Hospitalization Rate per 100,000




                                        3,500   3,368

                                                               3,021
                                        3,000


                                        2,500
                                                                             2,209


                                        2,000


                                        1,500
                                                High         Moderate        Low
                                                        Area Poverty Level
Data source: 2003-2005 CHARS
          Relationship between Insurance and
         Avoidable Hospitalizations (age 18-64)
                                           700
                                                                                   r 2 = 0.92
      Age-Adjusted Potentially Avoidable




                                           650
       Hospitalization Rate per 100,000




                                                                                                  Everett
                                           600

                                           550                       North

                                           500                     East
                                           450                                  Highway 99

                                           400

                                           350        View         South Central

                                           300
                                                 5%          10%          15%          20%        25%       30%
                                                                      Percent with No Insurance

Data source: 2005 BRFSS & 2003-2005 CHARS
Mortality Amenable to
     Health Care
 Deaths Amenable to Health Care (age 18-64)

                                      Septicemia, 24   Hypertensive heart
                        Diabetes mellitus                 disease, 22
                         (age 18-49), 27
                     Influenza &                                                Ischemic heart
                    pneumonia, 29                                                 disease, 199
                   Melanoma, 34



                 Leukemia, 42




                      Other*, 57


                                                                               Cerebrovascular
                                                                                 disease, 93
                            Breast cancer
                            (females), 74
                                                   Colorectal cancer,
                                                           82                * Other includes nephritis/nephrosis, cancer of corpus uteri and
                                                                            uterus, cervical cancer, acute rheumatic/chronic rheumatic fever,
                                                                                      peptic ulcer, pregnancy/childbirth, cholethit, hernia, and
Data source: 2003-2005 Death Certificate                                                                                    Hodgkin’s disease.
                                                 Mortality Amenable to Health Care
                                                 by Area Poverty Level (age 18-64)
                                                     100    94
     Age-Adjuste Mortality Amenable to Health Care




                                                      75
                   Rate per 100,000




                                                                          54
                                                      50
                                                                                       35

                                                      25



                                                       0
                                                           High        Moderate        Low

Data source: 2003-2005 Death Certificate
                                                                  Area Poverty Level
       Mortality Amenable to Health Care
                  (age 65-74)
                                        787
                                 800

                                 700

                                 600
       Deaths Rate per 100,000




                                                      520
                                 500

                                 400                               367


                                 300

                                 200

                                 100

                                   0
                                       High        Moderate        Low
                                              Area Poverty Level
Data source: 2003-2005 Death Certificate
              Relationship between Insurance and Mortality
                  Amenable to Health Care (age 18-64)
                                                  80
      Age-Adjusted Mortality Amenable to Health




                                                                                              r 2 = 0.94

                                                  70                                                       Everett
               Care Rate per 100,000




                                                                                  East
                                                  60
                                                                             North

                                                  50
                                                                                     Highway 99

                                                  40                     South Central
                                                            View
                                                  30
                                                       5%          10%               15%             20%       25%
                                                                         Percent with No Insurance

Data source: 2005 BRFSS & 2003-2005 Death Certificate
              Key Points
 Many Snohomish County residents face
  multiple access challenges.
 Access to health care is not uniform in
  Snohomish County.
 OB supply in particular is declining
  relative to population growth.
 Access problems in Snohomish County
  are associated with substantial morbidity
  & mortality.
Next Steps
Questions?
        Women Visiting Dentist During Pregnancy
           by Age, Poverty and Education
     80%
                                         71%

                                                        60%                      60%
     60%                         55%
                                                 48%                      50%
                      47%
             41%
     40%                                                          36%



     20%



      0%
              <20    20-24       25-34   35+     Les s Gr eater   <HS      HS   College
                                                 than   than              Gr ad
                       Maternal Age             185% 185%
                                                of FPL of FPL           Education
Data source: PRAMS (2000-2003)                 Poverty Status
  Women Visiting Dentist During Pregnancy
     70%
                                                               60%
              57%                                                         58%
     60%

                                                       48%                                 47%
     50%              45%        45%
                                       41%                                      42%
     40%

     30%

     20%

     10%

      0%
                 W


                         B




                                           A




                                                                           Pr


                                                                                     M
                                  N




                                                        <1


                                                                  >1




                                                                                              N
                           la




                                           sn




                                                                                      ed
                                   at




                                                                                                on
                  hi




                                                                             iv
                                                           8


                                                                     8
                              c




                                                             5%


                                                                     5%
                    te




                                                                                a
                                              /
                                      A




                                                                                       ic


                                                                                                   e
                             k




                                               Pa




                                                                                te
                                       m




                                                                                          aid
                                                  c
                                                  Is




                          Race                    Federal Poverty Level         Insurance
Data source: PRAMS (2000-2003)

								
To top