The Challenge of Nebraska Health

1. The Challenge of Nebraska Health Peg Bottjen, MPA, MT(ASCP)SC Issues for Rural Health Practitioners

2. Challenge of Nebraska Health • Definition of “rural” • Who? • What? • Where? • How? • Why?

3. Definitions of Rural • Own? • Census Bureau • US Office of Management and Budget (OMB) • DHHS • Other

4. Census Bureau • Urban • Urbanized Area - Continuously built up area with a population of 50,000 or more • Urban Place - Incorporated place outside a UA of 2,500 or more • Census Designated Place – A densely settled population center of at least 2,500 people with a name and community identity and is not incorporated

5. Census Bureau • Rural – All other territories that are not urban • Farm – 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

6. US Office of Management and Budget • Metropolitan Area (MA) – by counties • One city of 50,000 people or more • CB defined urbanized area of 50,000 and a total of metropolitan area of 100,000 • Counties adjacent to MA if 50% of population is included in MA or works there • Non-metropolitan – all other counties

7. US Dept. Health & Human Services • Frontier Counties – Six or fewer people per square mile.

8. Other Federal Definitions of Rural • Housing and Urban Development • Open country, not part of a city • US Adm. On Aging • Use modified census definition of rural Why is this a problem?

9. Many Definitions of Rural • Consequences • Federal funds are being allocated based on rural or urban status • Definitions used to determine health personal shortages • Research becomes inconsistent • Health policy analysis and development is affected

10. Who? • How many people live in Nebraska? a. approx. 500,000 b. approx. 1 million c. over 1.5 million d. over 2 million

11. 1,758,787 Nebraskans in 2005 52.6% live in Dakota, Washington, Douglas, Sarpy, Cass, and Lancaster counties

12. Aging Population

14. 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%

15. Projected Increase in Populationby Race/Ethnicity 1995 - 2025

16. Economic Profile Median Household Income 2004 (estimated) NE avg. $48,409 Range $33,600 (Loup Co.) $64,800 (Sarpy Co.)

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18. Poverty • Poverty is related to: • Indicators of health status • Health care access and use • Health related behaviors • Economic well-being greatly influences health and health care needs.

19. Economic Profile • Poverty 1998 - 2000 NE 10.6% US 11.9% Range 23.0% (Thurston Co) to 3.8% (Sarpy Co.)

20. What is the health status? • General Health Status • US 83.4% excellent or good • NE 87.6% excellent or good • Non-metropolitan 86% • Metropolitan 91%

21. Health Status • Leading cause of death in Nebraska in 2004 • Heart disease 25.5% • Cancer 22.3% • Cerebrovascular disease • Accidents (leading cause for < 45 year olds) • Chronic lung disease • Alzheimer’s

22. 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

23. Rural vs Urban in U.S. (cont.) Rural Urban • Alcohol consumption (men)  • Obesity (women)  • Total tooth loss  • No exercise  • Suicide  • Homicide  Health, United States, 2001 Urban and Rural Health Chartbook, HHS

24. Rural vs Urban in U.S. (cont.) Rural Urban • 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

25. Health Status • Other health risks NE US • Seatbelts 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%

26. Health Professionals Physicians Allied Health Nursing Mental Dental Health Facilities CAH Health Systems Nursing Homes Rural Health Clinics Where are the Health Resources?

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29. Federally Designated MUAs, NE 2001 29

30. Active Physicians to Population Ratio, NE 30

31. Allied Health Shortages • Physician Assistant – Equal Numbers • Metropolitan (.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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34. Mental Health HPSAs, NE 2001 34

35. Health Facilities • Critical Access Hospitals • Mental Health Facilities • Long Term Care • Rural Health Clinics

36. Hospitals in Nebraska                    Non-critical access hospitals Critical Access hospitals

37. Nursing Homes in Nebraska

38. Long-term Care Beds to Population Age 65 and Over, NE 1990-2000

39. State Designated Shortage Areas for Rural Health Clinics, NE 2005

40. Insurance Status by Type, NE & US

41. Why does rural health care need special consideration? Cost Access Quality

43. 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

44. 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.

45. 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?