The Challenge of Nebraska Health
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1 The Challenge of Nebraska Health Peg Bottjen, MPA, MT(ASCP)SC Issues for Rural Health Practitioners
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The Challenge of Nebraska Health. Peg Bottjen, MPA, MT(ASCP)SC Issues for Rural Health Practitioners. Challenge of Nebraska Health. Definition of “rural” Who? What? Where? How? Why?. Definitions of Rural. Own? Census Bureau US Office of Management and Budget (OMB) DHHS Other. - PowerPoint PPT Presentation
Transcript of The Challenge of Nebraska Health
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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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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
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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?
