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					                    Figure 1




    Health Care in New Orleans
 Before and After Hurricane Katrina

             Adele Shartzer, MPH
                Policy Analyst,
Kaiser Commission on Medicaid and the Uninsured

                      for

                  kaiserEDU


                                                  www.kaiseredu.org
                  Figure 2



         Tutorial Overview

• Pre-Katrina Louisiana

• Devastation after Hurricane Katrina

• Impact on Health Care in New Orleans

• Progress and Challenges




                                        www.kaiseredu.org
                                                        Figure 3


 Key Characteristics of Pre-Katrina Louisiana
      Compared to the U.S., 2004-2005

                                                                                       Louisiana
                                        32%

                                                                      26%              United States
         23%
                                                                               21%
                   17%
                                                 12%
                                                                                         9%
                                                                                                 7%




      Percent Living in              Percent African             Percent Nonelderly    Prevalence of
          Poverty                       American                  Adults Uninsured    Diabetes (Adults)


SOURCE: www.statehealthfacts.org.
Data is from the Census Bureau’s March 2005 and 2006 Current Beneficiary Survey.           www.kaiseredu.org
                                     Figure 4


                  Health Care Access in
                 Pre-Katrina New Orleans
•   High percentage uninsured
    – Low rates of employer sponsored insurance
    – Restricted Medicaid eligibility for adults
•   State and federal funding to support care to the uninsured
    concentrated in the LSU-operated safety-net hospital system
•   Care delivery characterized by a “two-tier” system based on insurance
    coverage
    1) Uninsured: primarily served by safety-net hospitals (Medical Center of
       Louisiana at New Orleans/MCLNO); limited access to physicians’ offices
       and other community clinics
    2) Insured: primarily used other hospitals; broader access to care in
       community
•   Specialty services offered to uninsured through MCLNO (aka Charity)
    as a teaching hospital


                                                                     www.kaiseredu.org
                                                        Figure 5


                            Devastation After Katrina
              Lives lost                                                      1,464

              People displaced                                                900,000

              Orleans household population                                    158,353 (~64%)

              Occupied FEMA travel trailers                                   73,214

              Jobs lost*                                                      165,100 (~26%)

              Businesses flooded                                              16,000

              Schools destroyed                                               40

              Debris generated                                                22 million tons
Data represents peak impact of Katrina.
SOURCE: Louisiana Recovery Authority, Hurricane Katrina Anniversary Data for Louisiana, August
2006, and Brookings/Greater New Orleans Community Data Center, “The New Orleans Index,”
January 2008.                                                                                    www.kaiseredu.org
                                             Figure 6



    Lake Pontchartrain
                                 New Orleans East

                   Gentilly
      Lakeview




Jefferson
                                      Lower 9th Ward
 Parish


                               Algiers
                 French       (Orleans)
                 Quarter



       Jefferson Parish

                                          Plaquemines
                                             Parish

                                                        www.kaiseredu.org
                            Figure 7



Health Care for the Poor in New Orleans in
         the Aftermath of Katrina
• Closure of most acute care hospitals, including Charity
  Hospital (MCLNO)
   – Loss of Level 1 Trauma, mental health beds, other
     specialty care
   – Open hospitals operating at reduced capacity but almost
     full
• Open safety-net clinics decreased from 90 to 19
• Doctors and other health workforce relocated
• Pharmacies closed, including Charity’s low-cost pharmacy
• Half of nursing homes closed

                                                       www.kaiseredu.org
                                                        Figure 8


         Insights from Survivors After the Storm

    • The stress of situation was exhausting, and for some basic needs like
      housing and food were not being met adequately

    • Many had unmet mental health needs

    • Many who had chronic conditions experienced gaps in their
      prescription drugs in the weeks and months following Katrina

    • They were disconnected from usual sources of care, and finding new
      providers was very difficult

    • When enrollment was successful, Medicaid coverage was helpful

    • It was hard to maintain healthy behaviors while living in hotels and
      trailers, particularly in very cramped conditions


SOURCE: Voices of the Storm: Health Experiences for Low-Income Katrina Survivors, KCMU
publication #7538, August 2006                                                           www.kaiseredu.org
                                                         Figure 9

   Profile of Adults in the Greater New Orleans Area
     and Orleans Parish One Year After the Storm
                         Greater New Orleans Area                              Orleans Parish

                                       53%            54% 54%

              43%                                                                 45%
                                                                            43%
      35%
                              30%


                                                                                                    16%
                                                                                              9%



    Economically                African            Employed Full-         Physical Health   Former Charity
   Disadvantaged               American             or Part-time            Challenge           Users


Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area
(conducted September 12 – November 13, 2006)                                                  www.kaiseredu.org
                                                        Figure 10

                         Satisfaction With Quality of Life
      In general, can you tell me how satisfied or dissatisfied you are with your overall
                  quality of life? And what about before Hurricane Katrina?

         Percent “very satisfied” with overall                              Before Katrina
         quality of life:                                                   One Year Later
            65%                                    65%                    63%



                                                                                    38%
                          34%
                                                                25%




         Greater New Orleans                       Orleans Parish         Jefferson Parish

Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area
(conducted September 12 – November 13, 2006)                                         www.kaiseredu.org
                                                        Figure 11

   Portrait of Problems Faced by Greater New Orleans Residents
          Percent who reported having a problem in each of the following areas:

Health care coverage and access                                                       27% have no usual place of
                                                           49%                        care; 25% of adults uninsured
problems

Physical health challenges                               43%


                                                                          13% said job doesn’t pay
No job or inadequate wages                          27%
                                                                          enough to cover basic expenses


Mental health challenges                          18%


Child in home troubled or not                                 9% of those with children said their child
                                                11%
getting needed care                                           didn’t get needed health care

PROBLEMS IN AT LEAST 1 AREA                                          77%


PROBLEMS IN 3 OR MORE AREAS                       19%

Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area
(conducted September 12 – November 13, 2006)                                                      www.kaiseredu.org
                                                         Figure 12

                           Usual Source of Care,
                    Insured vs. Uninsured Respondents
                   Insured Respondents                                     Uninsured Respondents
                                                                               Other

    Don’t Know/
     Refused                                                                            2%
                                                                                         Don’t Know/
                 3%                                                                       Refused
                                                                                           13% Doctor’s
                                      Doctor’s
                                                                                                     Office
            No Usual                   Office                              No Usual             10%
            Source of                                                      Source of
            Care other                  55%                                Care other
            than the ER                                                   than the ER
                                                                                               12% Hospital
                                                                                                       Clinic
              19%                                                             54%

                5%         Hospital
                            Clinic                                                                 9%
                             18%
    Neighborhood
        Clinic                                                                                        Neighborhood
                                                                                                          Clinic
                                Total Adults with No USOC other than the ER=27%


Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area
(conducted September 12 – November 13, 2006)                                                        www.kaiseredu.org
                                                         Figure 13

         Health Care Utilization in Past 6 Months,
   Uninsured vs. Insured Adults in the New Orleans Area

              Uninsured                               55%
                                                                                                      49%
              Insured                                                     46%



                                               29%
      23% 25%                                                                                  25%
                                 19%
                          13%                                      14%           14% 15%




     1+ ER Visit         Admitted               Visited            Received      Received     Take Rx on a
                       Overnight to a          Doctor's           Preventive    Mental Health Daily Basis
                         Hospital               Office              Health        Services
                                                                   Services

Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area
(conducted September 12 – November 13, 2006)                                                 www.kaiseredu.org
                                    Figure 14

                Progress and Challenges
• Restoring hospital capacity
   – University Hospital reopened November 2006, other hospitals also open
   – Plans to build a teaching hospital to replace VA and Charity, open in 2012
• Developing community clinics
   – New clinics in response to need
   – $100 million federal grant to support access to primary care
• Recruitment and retention of health professionals
   – Incentive grants to recruit physicians and other workforce
   – Medical education

• Increasing mental health capacity to meet population needs
   – Capacity improved; however, considerable unmet need remains
• Health coverage expansions
   – Plan for reform developed; some elements stalled by negotiations between
     stakeholders and transition in administration
   – LaCHIP expansion for children


                                                                     www.kaiseredu.org
                                Figure 15



                 Additional Resources

• Kaiser Family Foundation http://www.kff.org/katrina
• Greater New Orleans Community Data Center www.gnocdc.org
• Louisiana Department of Health and Hospitals www.dhh.louisiana.gov
• Louisiana Public Health Institute www.lphi.org
• CMS Katrina Waivers
  http://www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/07_KatrinaWa
  ivers.asp
• HHS Hurricane Katrina Information
  http://www.hhs.gov/disasters/emergency/naturaldisasters/hurricanes/k
  atrina/index.html



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