Rural Health Care Trends and Policy Issues Facing Nevada Residents

Transcription

1 Rural Health Care Trends and Policy Issues Facing Nevada Residents John Packham, PhD Director of Health Policy Research Nevada State Office of Rural Health and Office of Statewide Initiatives University of Nevada, Reno School of Medicine April 11, 2017

2 Data from the Nevada Rural and Frontier Health Data Book 2017 Edition Biennial production of the Nevada State Office of Rural Health, UNR Med Most comprehensive source of county-level data on health, health care, and health determinants in Nevada Additional information

3 A Snapshot of Rural and Frontier Nevada in Six Maps

4 Distribution of Population by County and Region Rural and Frontier Counties 14 counties 86.9% of land mass 281,019 population 9.7% of state population 2.9 residents per square mile Urban Counties 3 counties 13.1% of land mass 2.9 million population 90.3% of state population residents per square mile Source: Office of Statewide Initiatives (2017). Healthcare Resources in Nevada. Nevada Rural and Frontier Health Data Book 2017, p. 4, Map 1.

5 Distribution of Nevada Population by RUCAs RUCAs: Rural-urban commuting areas A more specific population classification tool Dense urban areas Enormous rural, frontier, and unpopulated areas Urban counties have substantial rural/frontier regions (i.e. Washoe, Clark) Rural/frontier counties have areas economically tied to urban areas (i.e. Lyon, Nye) Source: Office of Statewide Initiatives (2017). Rural-Urban Commuting Area Codes. (2016). Nevada Rural and Frontier Health Data Book 2017, p. 5, Map 2.

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7 Unique Geography of Rural and Frontier Nevada Average Distance from a Rural Hospital to: Nearest incorporated town: 46 miles Nearest hospital: 54 miles Nearest tertiary hospital: 108 miles Office of Rural Health & NRHP: 261 miles Source: See Nevada Rural and Frontier Health Data Book 2017, p. 174 Map 6.1.

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9 Unique Terrain 150 mountain ranges US Highway 50 the loneliest highway in America Travel time measured in hours not minutes

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12 Rural Health Care Challenges in Nevada Lack of access to essential health care services in many regions of rural and frontier Nevada, including mental and behavioral health High rates of uninsured and other cost barriers Growing proportion of patients with public health insurance coverage High levels of chronic disease and associated risk factors associated with chronic disease

13 Rural Health Care Challenges in Nevada Persistent threats to the economic viability of rural hospitals, clinics, and other services Health workforce shortages physicians, nurses, mental health professionals, other clinical and non-clinical staff Unique transportation challenges affecting the receipt of timely care Competition with urban areas (90.3% of the state s population) for public resources

14 Demography of Rural and Frontier Nevada

15 Population Change in Nevada 1990 to 2016 Region Percent Change Rural & Frontier 165, , % Urban 1,036,559 2,646, % Nevada 1,201,756 2,927, % Source: Nevada State Demographer s Office. (2016). See Nevada Instant Atlas,

16 250 Population 1990 to 2016 Percent Change 200 Percent Nevada Average Rural & Frontier Urban Source: Nevada State Demographer s Office. (2016). See Nevada Instant Atlas,

17 Population Aged 65 and Over 1990 to 2016 Percent Change Percent Nevada Average Rural & Frontier Urban Source: Nevada State Demographer s Office. (2016). See Nevada Instant Atlas,

18 Hispanic Population 1990 to 2016 Percent Change 700 Nevada Average Percent Rural & Frontier Urban Source: Nevada State Demographer s Office. (2016). See Nevada Instant Atlas,

19 25 Veterans Population 2016 Percent of Total County Population Percent Nevada Average Rural & Frontier Urban Source: U.S. Department of Veterans Affairs. (2016). See Nevada Rural and Frontier Health Data Book, p. 48, Table 1.24.

20 Health Insurance Coverage in Rural and Frontier Nevada

21 Health Insurance Coverage 2014 Population Aged 64 and Under - Uninsured Percent Uninsured Nevada Average Rural & Frontier Urban Source: U.S. Census Bureau. (2016). Nevada Rural and Frontier Health Data Book 2017, p.67, Table 3.1.

22 Medicare Enrollment 2016 Percent of Population Nevada Average Percent Rural & Frontier Urban Source: Centers for Medicare and Medicaid Services (2016). Nevada Rural and Frontier Health Data Book 2017, p. 74, Table 3.8.

23 Health Insurance Coverage 2008 to 2014 Region Change 2008 to 2014 Number Percent Nye County 8,562 5,555-3, % Rural Counties 51,951 35,187-16, % Nevada 529, , , % Source: Office of Statewide Initiatives Nevada Rural and Frontier Health Data Book Eighth Edition. Reno NV: University of Nevada, Reno School of Medicine.

24 Public Health Insurance Coverage 2011 to 2016 Program Change 2011 to 2016 Number Percent Medicaid 33,492 50,961 17, % Medicare 50,804 60,343 9, % Medicare Rx 26,271 37,530 11, % Source: Office of Statewide Initiatives Nevada Rural and Frontier Health Data Book Eighth Edition. Reno NV: University of Nevada, Reno School of Medicine.

25 Health Insurance Coverage 2014 Percent of Population Groups Who are Uninsured Total Population Under 19 Under 65 Under 65 & Below 138% FPL Nye County Rural Counties Nevada Source: Office of Statewide Initiatives Nevada Rural and Frontier Health Data Book Eighth Edition. Reno NV: University of Nevada, Reno School of Medicine.

26 Population Health Status in Rural and Frontier Nevada

27 Percent Obesity Prevalence 2013 Percent of Population Nevada Average Rural & Frontier Urban Source: Centers for Disease Control (2016). Nevada Rural and Frontier Health Data Book 2017, p. 85, Table 4.2.

28 Tobacco Use 2014 Percent of Population Percent Nevada Average Rural & Frontier Urban Source: Centers for Disease Control (2016). Nevada Rural and Frontier Health Data Book 2017, p. 87, Table 4.4.

29 Behavioral Health Risk Factors 2013/2014 Percent of Adult Population Diabetes Diagnosis Obesity Prevalence Physically Inactive Tobacco Use Excessive Alcohol Consumption Nye County Nevada United States Source: Office of Statewide Initiatives Nevada Rural and Frontier Health Data Book Eighth Edition. Reno NV: University of Nevada, Reno School of Medicine.

30 All Cause Mortality Rate 2014 Age-Adjusted Deaths per 100,000 Population 1, Nevada Average Source: Office of Health Statistics and Surveillance. (2016). Nevada Rural and Frontier Health Data Book 2017, p.104, Table 4.21.

31 Diseases of the Heart 2014 Age-Adjusted Deaths per 100,000 Population Nevada Average Source: Office of Health Statistics and Surveillance. (2016). Nevada Rural and Frontier Health Data Book 2017, p.105, Table 4.22.

32 Malignant Neoplasm (Cancer) 2014 Age-Adjusted Deaths per 100,000 Population Nevada Average Source: Office of Health Statistics and Surveillance. (2016). Nevada Rural and Frontier Health Data Book 2017, p.106, Table 4.23.

33 Chronic Lower Respiratory Disease 2014 Age-Adjusted Deaths per 100,000 Population Nevada Average 0 N/A Source: Office of Health Statistics and Surveillance. (2016). Nevada Rural and Frontier Health Data Book 2017, p.107, Table 4.24.

34 Lung, Trachea, and Bronchus Cancer 2014 Age-Adjusted Deaths per 100,000 Population Nevada Average 25 0 Source: Office of Health Statistics and Surveillance. (2016). Nevada Rural and Frontier Health Data Book 2017, p.108, Table 4.25.

35 Leading Causes of Death 2014 Number of Deaths per 100,000 Population Heart Disease Cancer COPD Lung Cancer Stroke Nye County Nevada United States Source: Office of Statewide Initiatives Nevada Rural and Frontier Health Data Book Eighth Edition. Reno NV: University of Nevada, Reno School of Medicine.

36 Health Care Workforce in Rural and Frontier Nevada

37 Primary Medical Care Health Professional Shortage Areas (HPSAs) Most regions of rural and frontier Nevada are federally-designated HPSAs 10 rural counties are single-county HPSAs Most rural and frontier census tracts of Clark and Washoe Counties are Primary Care HPSAs Source: Bureau of Health Professions, Health Resources & Services Administration. (2017). Nevada Rural and Frontier Health Data Book 2017, p. 130, Map 5.1.

38 Physician and Primary Care Workforce 2016 Number per 100,000 Population Profession Rural & Frontier Urban Nevada Allopathic Physicians (MD) Adv Practitioners of Nursing (APN) Osteopathic Physicians (DO) Physician Assistants (PA) Primary Care Physicians (MD & DO) Source: See references for Tables 5.7 through 5.44 in Nevada Rural and Frontier Health Data Book 2017, p. 168, Table 5.45.

39 Mental Health Professional Shortage Areas All 14 rural and frontier counties are mental health HPSAs With the closure of numerous rural mental health clinics, access to mental health services in rural areas is major public health issue Source: Bureau of Health Professions, Health Resources & Services Administration. (2016). Nevada Rural and Frontier Health Data Book 2017, p. 148, Map 5.3.

40 Mental and Behavioral Health Workforce 2016 Number per 100,000 Population Profession Rural & Frontier Urban Nevada Alcohol, Drug, & Gambling Counselors Marriage & Family Therapists Psychiatrists Psychologists Clinical Social Workers (LCSWs) Source: See references for Tables 5.7 through 5.44 in Nevada Rural and Frontier Health Data Book 2017, p. 168, Table 5.45.

41 Dental Health Professional Shortage Areas 8 of 14 rural and frontier counties are dental HPSAs Majority of census tracts in rural Clark County are also HPSAs Counties such as Churchill, Humboldt, and Lyon have historically been dental HPSAs Source: Bureau of Health Professions, Health Resources & Services Administration. (2017). Nevada Rural and Frontier Health Data Book 2017, p. 140, Map 5.2.

42 Oral Health Care Workforce 2016 Number per 100,000 Population Profession Rural & Frontier Urban Nevada Dentists Dental Hygienists Source: See references for Tables 5.7 through 5.44 in Nevada Rural and Frontier Health Data Book 2017, p. 168, Table 5.45.

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44 Health Care Resources 14 hospitals with 2,249 employees and a payroll of $140.9 million, including 13 Critical Access Hospitals (CAHs) 40 federally designated Rural Health Clinics (RHCs) & Community Health Centers (CHCs) 13 tribal clinics and medical centers Source: National Association of Community Health Centers. (2017). Centers for Medicare & Medicaid Services (2017). Nevada Rural and Frontier Health Data Book 2017, p. 4, Map 1.

45 Major Rural Health Policy Issues Addressing the financial barriers to care, including high numbers of uninsured (and underinsured) Addressing geographic barriers, unique time and distance issues, e.g., telemedicine Ensuring the economic viability of low-volume, remote rural hospitals and clinics Aging physical plant and capital needs Outmigration of patients from rural areas Concerns about financing of long-term care an other services for an aging population

46 Major Rural Health Policy Issues Mental and behavioral health care needs and barriers Integration of primary and mental/behavioral health services, integration of medical care and public health Chronic health workforce shortages and an aging physician workforce EMS workforce and resource deficits Underdeveloped public health services and local boards of health State budget issues and historic underinvestment in health care and public health

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48 Resources from the Office of Statewide Initiatives and UNR School of Medicine Nevada Rural and Frontier Health Data Book 2017 Edition OSI Programs and Projects Nevada Office of Rural Health Nevada Flex Program Nevada SHIP Program Project ECHO Nevada and rural telemedicine Nevada Area Health Education Centers Health Workforce Research and Policy Program Nevada AIDS Education and Training Center

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50 Contact info John Packham, PhD Director of Health Policy Research Office of Statewide Initiatives and Nevada State Office of Rural Health University of Nevada, Reno School of Medicine (775) / jpackham@med.unr.edu