his document summarizes selected data about Nebraska health care delivery, cost, and quality. The figures are excerpts from the second annual report of the Nebraska Health Information Project: 1996 Databook. The Databook was compiled for the Nebraska Department of Health by the Nebraska Center for Rural Health Research.
T T T T
he purpose of the 1996 Databook is to provide a comprehensive source of recent Nebraska health information to meet the diverse needs of health professionals including policymakers, administrators, executives, analysts, advocates, educators and researchers. Databook chapters focus on specific topic areas related to the availability, cost, and quality of health care in Nebraska. he data presented in this Executive Summary represent only a small portion of the information in the comprehensive report. In many cases, data are available for different years, and for substate and county levels. he 1996 Databook has over 100 tables and graphics providing users quick access to recent information about key health, demographic, and economic factors in the Nebraska health care environment. Copies of the complete 1996 Databook can be purchased from the Nebraska Center for Rural Health Research at the University of Nebraska Medical Center. An order form is enclosed.
Demographics
Population Distribution 1980, 1990 and 1994
Population by Year
Nebraska’s population is becoming increasingly metropolitan.* The residence of the population has shifted between 1980 and 1994 (see map below). The majority of Nebraskans now live in metropolitan counties whereas in 1980, the greatest proportion of the population were living in non-metropolitan counties. Most likely to shift residence were Nebraskans aged 25 through 44. Between 1980 and 1994, a large portion of this age group moved from non-metropolitan to metropolitan counties.
1980 Nebraska 1,569,825 100.0% 98,244 6.3% 114,631 7.3% 215,690 13.7% 221,725 14.1% 385,127 24.5% 534,408 34.0% 841,510 53.6% 728,315 46.4%
1990 1,578,385 100.0% 91,049 5.8% 102,920 6.5% 208,846 13.2% 209,873 13.3% 395,563 25.1% 570,134 36.1% 791,050 50.1% 787,335 49.9%
1994 1,623,283 100.0% 91,430 5.6% 105,325 6.5% 212,544 13.1% 213,234 13.1% 409,225 25.2% 591,525 36.4% 800,287 49.3% 822,996 50.7%
Panhandle West Central Central Northern Southeast Midlands
Nonmetropolitan Metropolitan
Percentages may not sum to 100% due to rounding.
Percent Change in Population Distribution Nebraska and Health Planning Areas 1980-1994
Area I. Panhandle -6.9%
Area IV. Northern -3.8% Area VI. Midlands +10.7%
Area III. Central -1.5%
Area II. West Central -8.1%
Area V. Southeast +6.3%
Nebraska +3.4%
Data Sources: U.S. Census, 1980; U.S. Census, 1990; Population Distribution Branch, U.S. Bureau of the Census, 1994. *Metropolitan area boundaries and names are those defined by the Federal Office of Management and Budget on June 30, 1993. In Nebraska, metropolitan boundaries correspond with county boundaries. Metropolitan counties include Cass, Dakota, Douglas, Lancaster, Sarpy and Washington. This report uses the most recent definitions of metropolitan county status. Non-metropolitan counties are defined as all other counties not otherwise defined as metropolitan. Users should note that Washington County was added as a metropolitan area in January of 1983, and that Cass county was added in January of 1993.
2 -- Executive Summary: 1996 Databook
Health Professionals
Health Professionals, Nebraska and Substate Areas, Selected Years
Physicians per 1,000 Population
Between 1990 and 1994, the number of active physicians practicing medicine full-time in Nebraska increased 22.5%. The number of active full-time physicians increased 10.3% in non-metropolitan counties and 27% in metropolitan counties during this time. The figure at the left shows physicians per 1,000 population in Nebraska Health Planning Areas for 1990 and 1994.
Area I. Panhandle 1990: 1.3 1994: 1.3
Area IV. Northern 1990: 0.6 1994: 0.8
Area II. West Central 1990: 0.8 1994: 0.9
Area VI. Midlands 1990: 3.2 1994: 4.0 Area III. Central 1990: 1.2 1994: 1.3 Area V. Southeast 1990: 1.3 1994: 1.3
Nebraska 1990: 1.8 1994: 2.2
Health Professional Shortage Areas
Fifty-four percent (n=50) of Nebraska’s 93 counties, partially or fully, contained Primary Care Health Professional Shortage Areas (HPSAs) as of June 1996. According to the U.S. Department of Health and Human Services, Mental Health Professional Shortage Areas were identified in 67 Nebraska counties. Dental Health Professional Shortage Areas were identified in 13 counties.
Non-metropoltian
II. West Central
Nebraska Total
Midlevel and Nursing Professionals Physician Assistants, 1996 Registered Nurses, 1995 Licensed Practical Nurses, 1995 Advanced Registered Nurse Practitioners, 1996 Certified Nurse Midwives, 1996 Mental Health Professionals Psychiatrists, 1994 Psychologists, 1996 Master Social Workers, 1996 Mental Health Practitioners, 1996 Certified Professional Counselors, 1996 Certified Marriage & Family Therapists, 1996 Dentists, 1993 186 304 1418 710 591 80 1026 5 5 50 37 16 2 43 1 5 50 39 10 3 46 16 21 160 105 46 12 117 4 14 77 38 29 1 93 25 136 385 183 137 39 301 135 123 696 308 353 23 426 27 66 408 258 472 55 390 159 238 1010 452 119 25 636 1366 14501 6414 77 4 79 638 564 5 0 83 560 527 2 0 170 1795 1131 11 1 131 1205 1060 6 0 341 3391 1700 17 2 562 6912 1432 36 1 579 5374 4174 30 1 787 9127 2240 47 3
Sources: Nebraska Department of Health Nebraska Health Manpower Report, 1994; U.S. Census, 1990; Population Distribution Branch, U.S. Bureau of the Census, 1994. Consistent with data released in PE-47, PE-48, PPL-49 and PPL-50, 8/20/96. See http://www.census.gov/population/estimates/county/casrh/9094ne.txt. Professional and Occupational Licensure Division, Nebraska Department of Health, 1996.
Nebraska Health Information Project -- 3
Metropolitan
IV. Northern
I. Panhandle
V. Midlands
III. Central
Nebraska Health Professionals, Selected Years.
IV. Southeast
Health Resources
Health Facilities Capacity and Utilization, 1990, 1995
Acute Care Hospitals
1990 Acute Care Hospitals-Nebraska Acute Care Hospital Discharges Total Acute Average Stay in Days Acute Bed Capacity-Licensed Beds Acute Beds per 1,000 Population Acute Bed Utilization-Occupancy Rate Acute Plus Swing Beds-Occupancy Rate Surgery Visits - Non-federal Acute Care Hospitals Percent Inpatient Percent Outpatient 92 169,156 5.5 6,923 4.4 36.9% 40.1% 162,895 43.8% 56.2% 1995 91 159,165 4.4 6,191 3.8 30.9% 34.9% 166,919 38.2% 61.8%
In 1995, 104 hospitals were operating in Nebraska. Three of these were federal hospitals, 91 were licensed to provide acute care, 68 were licensed to provide long-term care, 18 were licensed for psychiatric care, and 5 were licensed for rehabilitation care. Available inpatient acute care beds have decreased about 5%, and occupancy rates have declined about 3% between 1990 and 1995. Outpatient surgeries have increased 8% between 1990 and 1995. During the same time period, inpatient surgeries have decreased 10%.
Long-term Care Facilities
Long-term care facilities are defined as nursing homes or hospitals licensed to provide long-term care with beds specifically licensed for that purpose. There were 242 facilities in Nebraska providing long-term care in 1995. Data from the U.S. Census Bureau show that there was an estimated 8.5% increase in the number of Nebraskans 65 years and over between 1980 and 1990 - the age group most likely to need long-term care. Since 1990, the number of Nebraskans aged 65 and over Long-term Care Population and Beds, 1995 increased approximately 2%. In 1995, nearly 80% of Nebraska’s long-term care facilities were located in counties defined as non-metropolitan, providing care to about 70% of all Nebraska longterm care facility residents. As shown in the table to the right, the Southeast and Midlands Health Planning Areas served as home to the greatest proportion of the state’s 65 and over population. Statewide, there were approximately 85 beds per 1,000 Nebraska residents aged 65 and over in 1995. The comparable bed to population rate in the United States was slightly more than 53 beds per 1,000 persons 65 and over.
Area Nebraska Panhandle West Central Central Northern Southeast Midlands Estimated Population 229,647 15,380 18,709 36,098 36,215 60,282 62,963 Age 65 and Over Beds Available per 1,000 84.8 87.5 76.1 101.0 113.9 82.3 63.1
Non-metropolitan Metropolitan
142,894 86,753
94.8 68.3
Sources: U.S. Census, 1990; Population Distribution Branch, U.S. Bureau of the Census, 1994 and 1995; Data Collection Section, Nebraska Department of Health, 1996. American Association of Retired Persons, Public Policy Institute, Profiles of Long-term Care Systems, 1994.
4 -- Executive Summary: 1996 Databook
Health Insurance
Insurance and HMOs
Percent of Population (1995) Covered by:
Any Private Plan
Nebraska U.S. Nebraska U.S. Nebraska U.S. Nebraska U.S. Nebraska U.S. Nebraska U.S. 13.5% 13.1% 8.1% 12.1% 6.2% 3.5% 9.0% 15.4% 62.6% 61.1% 78.4% 70.3%
Insurance Status
The U.S. Census Bureau estimates from the 1996 Current Population Survey (U.S. Census) suggest that 9% of Nebraskans were uninsured for some or all of 1995. Nationwide, approximately 15% of persons of all ages were uninsured at some time during 1995. Survey data collected between 1988 and 1996 show that the percent of Nebraskans who were uninsured at any time during the previous year averaged 9.7% annually, reaching a high of 11.9% in 1993 and a low of 8.2% in 1991.
*Military health insurance includes military and veteran’s health care. These include, CHAMPUS (Comprehensive Health and Medical Plan for Uniformed Services), and CHAMPVA (Civilian Health and Medical Program of the Department of Veteran’s Affairs). Note: The percentages by type of coverage are not mutually exclusive, therefore persons can be covered by more than one type of health coverage during the year.
Employment Based
Medicare
Medicaid
Military*
No Insurance
Health Maintenance Organizations
Data from the Nebraska Department of Insurance show that 14.4% of the state population was enrolled in a Health Maintenance Organization as of June 1996. There was a 21.5% increase in the number of Nebraskans enrolled in HMOs between December 1995 and June 1996.
Enrollment as of December 1995 20,289 43,025 25,505 32,235 64,405 16,341 185,459 1,637,112 11.3% March 1996 20,386 49,140 27,677 36,256 93,956 9,380 227,415 June 1996 19,902 51,222 28,610 36,459 100,062 8,955 236,255 Percent Change in Enrollment -1.9% 16.0% 10.9% 11.6% 35.6% -82.5% 21.5%
Health Maintenance Organization Plan Name Mutual of Omaha Health Plans of Lincoln, Inc. United Health Care of the Midlands, Inc. HMO Nebraska, Inc. Principal Health Care of Nebraska, Inc. Exclusive Healthcare, Inc. Care Choices - Iowa (Operates in S.Sioux City, NE) Total Enrollment in Nebraska HMOs Nebraska Estimated Population, July 1, 1995 Percent of Nebraska Population Enrolled in HMOs
13.9%
14.4%
Sources: March 1996, U.S. Bureau of the Census Current Population Survey; Population Distribution Branch, U.S. Bureau of the Census, 1995; Nebraska Department of Insurance, 1996.
Nebraska Health Information Project -- 5
Health Expenditures (Continued)
Medicare and Medicaid
Medicare
Over 15% of the Nebraska population was enrolled in Medicare during 1994; more than half of those enrollees were identified as rural residents. Nationwide, just over 13% of the total population was enrolled in Medicare. In managed care programs for Medicare beneficiaries, payment to the provider is based on Adjusted Average Per Capita Cost (AAPCC) of care. The reimbursement to the provider is determined by the previous year’s expenditures for Medicare beneficiaries in a county and their demographic characteristics. AAPCC rates may vary significantly within and between states. Combined, Part A and Part B monthly Medicare beneficiary reimbursement rates for Nebraska in 1997 are expected to average $292.05. The expected average per capita monthly reimbursement rate for all U.S. counties is $394.91 in 1997. The monthly payment per U.S. beneficiary per month in 1997 is expected to be $466.95.
Adjusted Average Per Capita Cost (AAPCC) Mean Medicare Reimbursement Rates Nebraska and Substate Areas, 1997
Area I. Panhandle $282.08
Area IV. Northern $297.18 Area III. Central $285.52 Area II. West Central $296.24 Area V. Southeast $276.60 Area VI. Midlands $372.37
1997 AAPCC Rates: All Nebraska counties expected average rate All U.S. counties expected average rate: Expected U.S. monthly payment per beneficiary
$292.05 $394.91 $466.95
Lowest and Highest County AAPCC Rates (Combined Part A and Part B), U.S. 1997
Rank Lowest 2 3 4 5 6 7 8 9 10 Ten Lowest Reimbursement Rates State County NE NE OH MN TX NE NM SD NE NE Arthur Banner Holmes Chippewa Presidio Saline Harding Fall River Gage Seward Rate* $220.92 $221.31 $225.01 $227.30 $229.70 $231.10 $231.67 $233.06 $234.71 $235.02 Rank Highest 2 3 4 5 6 7 8 9 10 Ten Highest Reimbursement Rates State County NY FL NY LA LA NY NY PA FL TX Richmond Dade Bronx Plaquemines St. Bernard New York Kings Philadelphia Okeechobee Liberty Rate* $767.35 $748.23 $728.24 $727.72 $719.84 $713.12 $705.37 $704.25 $692.82 $677.79
Medicaid
Medicaid is a joint federal/state program that provides medical assistance for certain individuals with low incomes and limited assets. According to the Nebraska Department of Social Services, one out of eleven Nebraskans were eligible for Medicaid benefits in fiscal year 1995. Nebraska Medicaid expenditures comprised 15% of the total budget in 1995 and was higher in the U.S., about 19.2% of the total budget. Medicaid payments per Medicaid Beneficiaries and Expenditures, 1995 Nebraska beneficiary averaged $3,609; in the U.S., payments per beneficiary averaged $3,311.
Recipients 13.7% 46.7% 20.3% 19.3% Expenditures 7.2% 22.0% 36.2% 34.6%
In 1995 the greatest proportion, about 47%, of persons who received Medicaid benefits were children (see table at right). In terms of expenditures, the blind and disabled, and the aged, received the greatest proportion of total Medicaid benefits paid in fiscal year 1995.
ADC Adults Children Blind and Disabled Aged
Sources: Health Care Financing Administration, 1997. Nebraska Department of Social Services, Annual Report, 1990 and 1995.
6 -- Executive Summary: 1996 Databook
Health Status
Quality of Life and Health Status, Selected Years
General Health Status
Recent survey data show that 88% of Nebraskans consider their health to be either “excellent” or “good”.* The comparable statistic for the U.S. is 86%.
*Standard error +/- 1.2%.
Leading Cause of Death
In 1995, the leading cause of death in Nebraska was heart disease (see table below). By modifying lifestyle, the risk of developing heart disease can be decreased. Risk factors which can be modified include high blood pressure, high blood cholesterol and tobacco use. Data for the year 1993 from the Center for Disease Control show that about 23% of Nebraska adults reported having been informed by a health professional that they had high blood pressure. Sixty-two percent reported having had their blood cholesterol level tested in the last five years and, of those, 18% were told they had high blood cholesterol levels. In 1995, the data show that about 22% of Nebraska adults smoke cigarettes. Among every-day smokers, 41% said they had quit smoking for one or more days in the previous year.
Percent Rank and Cause 1. Heart Disease 2. Cancer 3. Cerebrovascular 4. Pneumonia 5. Accidents 6. Chronic Lung Disease 7. Diabetes Mellitis 8. Atherosclerosis 9. Alzheimer's Disease 10. Suicide Other All Deaths (N=15,216) of Deaths 33.5% 22.1% 7.6% 4.2% 3.7% 3.6% 1.9% 1.5% 1.2% 1.2% 19.5% 100.0%
Cancer
According to the National Cancer Institute, the average male has about a 45% risk of being diagnosed with cancer, and a 33.4% risk of dying of cancer. In her lifetime, an American woman has about a 39% risk of being diagnosed with cancer and a 20.4% risk of dying from cancer. Nebraska Vital Statistics data show that cancer, of any type, was the second leading cause of death in 1995. Lung and breast cancer were the most frequent causes of cancer related deaths among Nebraska women in 1995. Lung and prostate cancer were the most frequent causes of cancer related deaths among Nebraska men in 1995. The tables below show the types of cancer newly diagnosed among Nebraskans in 1994.
The Nebraska Cancer Registry
Newly Diagnosed Cancer, 1994 All Nebraskans % Digestive 18.9% Breast 15.9% Prostate 15.1% Respiratory 13.2% Female Genital 10.2% Urinary Tract 6.8% All Other Sites 19.9% Total 100.0% Women Breast Female Genital Digestive Respiratory Other Total Men Prostate Digestive Respiratory Urinary Tract Other Total % 30.8% 19.9% 17.1% 9.9% 22.3% 100.0% % 31.0% 20.8% 16.6% 9.1% 22.5% 100.0% N 1,505 1,265 1,201 1,048 814 537 1,584 7,954 N 1,259 814 700 404 908 4,085 N 1,201 805 644 351 868 3,869
HIV and AIDS
The Nebraska Department of Health began collecting data about Human Immunodeficiency Virus (HIV) in 1995. Since then, 232 cases of HIV have been reported to state health officials through June of 1996. Data about Acquired Immunodeficiency Syndrome (AIDS) have been collected by the state since 1990. Through June of 1996, a total of 745 cases of AIDS have been diagnosed and reported to the Nebraska Department of Health.
Sources: Nebraska Vital Statistics Annual Report, 1995 Nebraska Department of Health, 1996. Communicable Disease Section, Nebraska Department of Health, 1996 HIV/AIDS Morbidity/Mortality Report, June 1996. Vol 2, No. 2. Nebraska Cancer Registry, Data Collection Section, Nebraska Department of Health, 1996. Ries LAG, Miller BA, Hankey BF, Kosary CL, Harras A, Edwards BK (eds). SEER Cancer Statistics Review, 1973-1991: Tables and Graphs, National Institutes of Health, National Cancer Institute. NIH Pub. No. 942789. Bethesda MD, 1994.
Nebraska Health Information Project -- 7
Hospitalization Characteristics
Acute Hospital Care Discharges
Discharge Characteristics
During the 12 month period of October 1, 1994 through September 30, 1995, there were over 165,000 discharges reported to the Nebraska Association of Hospitals and Health Systems data archive, representing about 85% of total Nebraska Hospital Discharges. Of these, 152,342 were Nebraska resident discharges.
Acute Hospital Discharges Per 1,000 Population Nebraska 92.6 I. Panhandle II. West Central III. Central IV. Northern V. Southeast VI. Midlands 101.4 113.0 102.5 93.1 85.0 89.1 1. 2. 3. 4. 5. Five Most Frequent Acute Hospital Discharges Number of Rank & Diagnosis Discharges Normal Newborn Vaginal Delivery Psychoses Major Joint & Limb Reattachment Hip & Femur Procedures 14,812 13,086 4,559 4,274 4,086
Ambulatory Care Sensitive Condition Discharges (Preventable Hospitalizations)
A condition or illness leading to a potentially preventable hospitalization is an “ambulatory care sensitive condition (ACSC)”. Utilizing data from the Nebraska Association of Hospitals and Health Systems (NAHHS), the Nebraska Health Information Project evaluated hospital discharge records from the 12 month period of October 1, 1994 through September 30, 1995. Of the 152,342 Nebraska resident discharge records examined*, 21,706 -- or approximately 13.4% of all discharges -- were identified as potentially preventable. Nearly two-thirds of ACSC discharges occurred among patients 65 and over. Statewide, the most frequently occurring ACSC hospitalizations were for diagnoses related to bacterial pneumonia, congestive heart failure, cellulitis, chronic obstructive pulmonary disease and asthma.
All Ages Percent Rate** All ACSC Conditions Ranked by Frequency of ACSC diagnosis Bacterial pneumonia Congestive heart failure Cellulitis Chronic Obstructive Pulmonary Disease Asthma Angina Kidney/Urinary Tract Infections Dehydration Gastroenteritis Convulsions Diabetes Mellitus w/Ketoacidosis Diabetes w/Other Manifestations Ear, Nose, Throat (ENT) Diabetes Without Other Complications Hypertension Grand mal status Dental Hypoglycemia Immunizable & Preventable 100.0% 13.4
64 and Under Percent Rate** 100.0% 5.9
65 and Over Percent Rate** 100.0% 58.7
25.0% 19.1% 9.9% 8.6% 6.2% 5.5% 5.4% 5.1% 4.3% 2.5% 1.7% 1.7% 1.4% 1.2% 1.0% 0.9% 0.3% 0.1% 0.1%
3.3 2.5 1.3 1.2 0.8 0.7 0.7 0.7 0.6 0.3 0.2 0.2 0.2 0.2 0.1 0.1 0.0 0.0 0.0
20.8% 6.6% 13.6% 6.1% 11.4% 4.0% 5.1% 6.0% 7.2% 4.5% 3.6% 2.1% 3.0% 1.9% 1.3% 1.9% 0.6% 0.1% 0.2%
1.2 0.4 0.8 0.4 0.7 0.2 0.3 0.4 0.4 0.3 0.2 0.1 0.2 0.1 0.1 0.1 0.0 0.0 0.0
27.5% 26.7% 7.6% 10.2% 3.0% 6.4% 5.7% 4.6% 2.5% 1.3% 0.6% 1.4% 0.3% 0.7% 0.9% 0.4% 0.1% 0.1% 0.0%
16.2 15.6 4.4 6.0 1.8 3.8 3.3 2.7 1.5 0.8 0.4 0.8 0.2 0.4 0.5 0.2 0.1 0.0 0.0
Source: Data collected by the Nebraska Association of Hospitals and Health Systems. ACSC analyses conducted by the Nebraska Health Information Project, 1996. Population estimates used in rates from the Population Distribution Branch, U.S. Bureau of the Census. *Based on an approximate 85% representation of total Nebraska hospital discharges for the reporting year. **Rates per 1,000 population.
8 -- Executive Summary: 1996 Databook
Hospitalization Characteristics
Acute Care Hospitalizations: Charges and Payers
Discharge forms allow hospitals to record a) total charges incurred for that hospitalization and b) a primary and secondary payer responsible for those charges.
Five Highest Average Charges by Diagnosis Acute Care Hospital Discharges Rank & Diagnosis 1. 2. 3. 4. 5. Coronary Bypass w/Cardiac Catherization Major Small & Large Bowel Procedures Cardiovascular (Percutaneous) Procedures Major Joint & Limb Reattachment Lower Extremities Hip & Femur Procedures Statewide Average Charge $44,419 $22,810 $18,367 $16,531 $12,032
Among all acute discharges, responsible primary payers were identified as follows:
Medicare Commercial Insurers Medicaid Workman’s Comp/CHAMPUS Patient (Self-Pay) Total 41.7% 41.2% 13.3% 1.3% 2.5% 100.0%
The highest average charge by diagnosis included a coronary bypass with catherization, followed consecutively by major procedures involving the small and large bowel, cardiovascular procedures, and major joint and limb procedures.
Charge data show that average charges for typical hospitalizations vary between geographic areas (see exhibit below). For example, the average statewide charge for the hospitalization of a normal newborn was $664 during the 1994-1995 discharge year. Comparatively, a similar hospitalization in the Panhandle Health Planning Area averaged $845. In the Southeast Health Planning Area, the average charge was $618.
Nebraska Average Charges for the Five Most Frequent Statewide Discharges
1. Normal Newborn 2. Vaginal Delivery 3. Psychoses 4. Major Joint/Limb Reattachment 5. Heart Failure & Shock $ 664 $ 2,237 $ 7,020 $ 16,531 $ 6,500 Area IV. Northern
1. Normal Newborn: 2. Vaginal Delivery: 3. Psychoses: 4. Major Joint/Limb Reattachment: 5. Heart Failure & Shock: $ 633 $ 1,781 $ 1,967 $ 12,746 $ 3,868
Area I. Panhandle
1. Normal Newborn: 2. Vaginal Delivery: 3. Psychoses: 4. Major Joint/Limb Reattachment: 5. Heart Failure & Shock: $ 846 $ 2,279 $ $ -
I
IV VI II III V
Area VI. Midlands
1. Normal Newborn: 2. Vaginal Delivery: 3. Psychoses: 4. Major Joint/Limb Reattachment: 5. Heart Failure & Shock: $ $ $ 664 2,614 8,596
$ 18,746 $ 9,139
$ 5,079
Area II. West Central
1. Normal Newborn: 2. Vaginal Delivery: 3. Psychoses: 4. Major Joint/Limb Reattachment: 5. Heart Failure & Shock: $ 692 $ 1,692 $ $ 16,394 $ 3,882
Area III. Central
1. Normal Newborn: 2. Vaginal Delivery: 3. Psychoses: 4. Major Joint/Limb Reattachment: 5. Heart Failure & Shock: $ $ $ 684 2,029 5,844
Area V. Southeast
1. Normal Newborn: 2. Vaginal Delivery: 3. Psychoses: 4. Major Joint/Limb Reattachment: 5. Heart Failure & Shock: $ $ $ 618 1,959 5,813
$ 16,252 $ 5,509
$ 14,009 $ 5,842
Source: Data collected by the Nebraska Association of Hospitals and Health Systems. *Based on an approximate 85% representation of total Nebraska hospital discharges for the reporting year. -Insufficient data to report at this geographic level.
Nebraska Health Information Project -- 9
Nebraska Counties, Health Planning Areas, and Metropolitan Counties, 1996
IV. Northern I. Panhandle III. Central
Health Planning Area I Panhandle II West Central III Central IV Northern V Southeast VI Midlands
VI. Midlands
II. West Central V. Southeast Metropolitan Counties
Source: Nebraska Department of Health; Population Distribution Branch, U.S. Census, 1994. Note: Metropolitan area boundaries and names are those defined by the Federal Office of Management and Budget on June 30, 1993. This report uses the most recent definitions of metropolitan county status. Users should note that Washington County was added as a metropolitan area in January of 1983, and that Cass county was added in January of 1993.
Department of Preventive & Societal Medicine Center for Rural Health Research P.O. Box 984350 Omaha, NE 68198-4350
Nebraska’s Health Science Center
University of Nebraska Medical Center