0-64 year olds 93% insured (Wisconsin & Eau Claire County)

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1 This priority looks at the importance of people getting the primary and preventive health care they need, such as medical, dental, mental health, and specialized services. Access to health services allows people to get regular health screenings, prevent illness and receive timely care for health problems. When people cannot get needed health services, they often have poorer health, develop serious health problems and have shorter lives. Many people face significant barriers to accessing health services, such as cost, transportation, language, race, culture and lack of available providers. Barriers are most pronounced for isolated residents in rural communities, people with low incomes, childless adults, and people with cultural differences. Reducing the proportion of the population that reports difficulties, delays, or the inability to receive ongoing primary and preventive health care (e.g., check-ups and management of acute and/or chronic illnesses) is a Wisconsin 2010 objective. Eau Claire County has a wealth of quality health care available, including hospitals, clinics, and pharmacies as well as a variety of alternative health care. In addition, many organizations, programs, and services are working to reduce barriers and increase access by providing financial assistance, reduced or waived fees, Hmong and Spanish interpreters, advocacy, community awareness and resources to create new initiatives. Information and data related to Access to Primary and Preventive Health Services are included below to assist in determining Eau Claire County s status and identifying areas for improvement. HEALTH CARE COVERAGE One of Wisconsin s 2010 objectives is to increase the proportion of the population with health insurance for the entire year to 92%. This objective has been met as shown below: 65 & older 99% insured (Wisconsin) 0-64 year olds 93% insured (Wisconsin & Eau Claire County) 0-17 year olds 94% insured (Wisconsin) Older adults (age 65 and older) are the highest portion of the population that has health insurance. Input from the Health Priority A (HP A) Community Planning Team indicates that although adults 65 and older are thought to be insured, many do not have the appropriate coverage. Children (ages 0-17) are mostly covered by employer-sponsored insurance (71%) and Medicaid programs (18%). 1 As of February 2008, all Wisconsin children have access to affordable health care coverage under BadgerCare Plus, regardless of family income. Over the last several years, the percent of individuals covered by employer-sponsored insurance decreased and the percentage covered by Medicaid increased. Eau Claire City/County Community Health Improvement Plan - July

2 Health Insurance by Coverage Type, Ages 0-64 Wisconsin ,2 80% 76% 74% 60% 40% Many people are covered by a combination of insurance types. Medicaid includes BadgerCare, BadgerCare Plus, Healthy Start, Medical Assistance, Supplemental Security Income (SSI). 20% 0% Employer- Sponsored 5% 4% 9% 10% 2% 2% Private Medicaid Other Other includes Health Insurance Risk Sharing Plan (HIRSP), military coverage such as VA and Tricare, etc Lack of health insurance is a distinct barrier to receiving preventive, diagnostic and treatment services. Approximately 7% of adults (5,064) do not have health insurance coverage in Eau Claire County. 3 Also of concern are the adults who have health insurance, but are underinsured (high deductibles, major medical coverage only, no health screening coverage, high co-pays, preexisting exclusions, etc.) and still do not have access to all health services needed. Only 27% of women ages in Eau Claire County needing publicly supported contraceptive services and supplies received them. 4 There are several programs available in Eau Claire County to assist low-income uninsured or underinsured individuals in obtaining limited medical services. However, input from the HP A Community Planning Team indicates that childless adults, especially males, and immigrants without citizenship do not meet eligibility criteria. Young adults ages in the US were almost three times more likely to be uninsured anytime in the past year than adolescents ages in The Chippewa Valley Free Clinic, a volunteer organization which provides medical services to low incomeindividuals without insurance, has served over 4,987 patients. These patients have made 21,000 visits since the clinic opened in July In 2007, the number of new patients and the number of patient visits both increased by about 18% over the previous year. It s estimated that 90% of patients are from Eau Claire County. 6 Another State 2010 objective is to increase provider screening for chronic diseases and other health risks, such as cervical cancer, mammograms, cholesterol, and colorectal cancer. Data for Wisconsin residents is available but 2010 targets have not been established to track progress. Also, county-level data is not currently compiled to measure this objective. There were 1,326 preventable hospitalizations in Eau Claire County during 2005 for conditions where timely and effective ambulatory care could have reduced the likelihood of hospitalization. 7 The cost averaged $11,743 per hospitalization, totalling $15,571,218. The percentage of the population in Eau Claire County reporting that they did not get needed health care (medical care or surgery) they felt they should have in the prior 12 months was 1.7% (approximately 1,639 individuals). 3 2 Eau Claire City-County Health Department

3 MENTAL HEALTH AND SUBSTANCE ABUSE CARE Mental health is closely linked to physical health and is basic to good health and human functioning. Mental health is indispensable to personal well being, family and interpersonal relationships, and meaningful contributions to community and society. Mental illness refers to all diagnosable mental disorders. Mental disorders are health conditions that are characterized by alterations in thinking, mood, behavior or some combination thereof. Mental disorders are associated with distress and impaired functioning and result in human problems that may include disability, pain, or death. Although mental disorders are treatable health conditions, many people with mental illness do not have access to diagnosis and treatment due to the cost and/or availability of needed services. This is true for people with substance abuse problems as well. Health care coverage for mental health and substance abuse disorders is more restrictive with lower dollar limits allowed and higher deductibles and copays required than coverage for other illnesses. Offering coverage equivalent to the coverage of all other illnesses is known as comprehensive insurance parity. With parity, health insurance would protect Wisconsin families from devastating financial loss when a member requires treatment. Over 34 states have enacted parity legislation, and fiscal analyses show that such a policy is cost effective in states that rely heavily on managed care, such as Wisconsin. 8 It is estimated that as much as 30 percent of the US population has a mental health or substance use disorder, however many go undiagnosed. 9 Almost half of adults who were diagnosed with both mental health and substance use problems in 2006 did not receive treatment. 10 There are an estimated 403,000 adults and 40,300 adolescents in Wisconsin who are in need of substance use treatment while only 21% receive it. 11 It is also estimated that nearly 15% or 2,252 of our year olds in Eau Claire County have a serious alcohol problem and 84% of these young people (1,895) do not receive treatment. 12 Most mental health problems diagnosed in adulthood begin during adolescence. The National Institute of Mental Health estimates that one in 10 children or adolescents have a serious emotional disturbance. Further estimates indicate that two-thirds of these children will not receive appropriate care for their condition. The most common mental health disorders among youth include depression, anxiety disorders and attention-deficit/hyperactivity disorder and substance use disorder. 13 Input from the HP A Community Planning Team indicated that families report having difficulty getting their children in to see a psychiatrist, possibly due to a limited number of providers or not being aware that referrals could be provided by their pediatrician. There is inequity in coverage for medically necessary treatment of all mental health and substance abuse disorders in Wisconsin. The average age reported by Eau Claire County youth for first use of any tobacco is age 13 alcohol is age 13 marijuana is age By age 14, 50% of lifetime mental health disorders begin and 75% start by age Over 7% of the high school youth in Eau Claire County report thinking about committing suicide often or a lot. The majority of these students also report using alcohol, a known depressant. 14 Although suicide or suicidal thought is not a mental health disorder, it is more common among adolescents with certain mental health Eau Claire City/County Community Health Improvement Plan - July

4 problems. The risk of suicide is increased with depression as well as the presence of other mental health problems, such as anxiety, eating, or conduct disorders. 13 Suicide is the 2nd highest cause of death Tobacco is a highly addictive drug. The rate of tobacco use in the US has among year olds decreased to about 20 percent among the general population. However, in Eau Claire County. among people suffering from mental illness and substance abuse, 50-80% It is the top cause smoke cigarettes. Smoking increases the likelihood of substance abuse of death among relapse during recovery and often makes a mental illness worse. 16 Increased year olds. 15 access to effective quitting methods is needed among this population. Two hospitals in Eau Claire County implemented a tobacco-free policy in their behavioral health units in 2007, acknowledging the need to expand mental illness and substance abuse treatment to include tobacco cessation. Many of the youth and adults with mental or substance use disorders go undiagnosed. For those who are diagnosed, many do not receive treatment. DENTAL CARE Oral health is essential to general health and well-being. Regular dental visits provide an opportunity for the early diagnosis, prevention, and treatment of dental problems and oral diseases for people of all ages and to assess self-care practices. Adults who do not receive regular dental care can develop oral diseases that eventually require complex treatment and may lead to tooth loss and health problems. Most adults in the US show signs of gum disease. Severe gum disease affects about 14 percent of adults aged 45 to 54 years. Five percent of adults, 40 to 59 years, are missing all their natural teeth. Almost 20% 17, 18 of Wisconsin s 65+ population have lost all of their teeth. Over 40% of poor adults, 20 years and older, in the US, have at least one untreated decayed tooth compared to 16 percent of non-poor adults. 17 Toothaches are the most common mouth or face pain reported by adults, and it can interfere with eating, swallowing, and talking. Tooth decay is one of the most common diseases among US children - five times more common than asthma and seven times more common than hay Dental care is the fever. By age 11, about half of children have experienced decay. By the age of most common 19, tooth decay in permanent teeth affects two-thirds of adolescents. Dental unmet treatment care is the most common unmet treatment need in US children. Lower-income need in children have twice as much untreated decay as more affluent children. 19 This US children. 19 can result in problems that greatly reduce a child s capacity to succeed in school. Dental diseases are also associated with systemic health conditions. In 2007, 34% (85) of the 251 second-grade children screened in the Eau Claire Dental Sealant Project needed further treatment for decay. 20 By age 19 Tooth decay in permanent teeth affects 2/3 of adolescents & older 40% of poor adults have untreated decay compared to 16% of non-poor year olds Most in United States have signs of gum disease & older 20% in Wisconsin have lost all of their teeth Eau Claire City-County Health Department

5 For every adult 19 years or older in the U.S. without medical insurance, there are three without dental insurance. Most employers do not offer dental insurance. Lack of insurance is a barrier to receiving preventive, diagnostic, and treatment services for dental health. Children from families without dental insurance are three times more likely to have unmet dental needs than insured children. One of the State Health Plan s 2010 objectives is to increase the percentage of Wisconsin s Medicaid and BadgerCare recipients receiving dental care in the past year to 33% or more. Wisconsin has made some progress with 24.9% receiving dental care in 2006 compared to 22.5% in Clearly further progress is needed. Dental care reimbursement for Medicaid patients remains very low and only one local dentist accepts Medicaid patients. The Chippewa Valley Technical College Dental Clinic was established in From October 2004 through June 2007, 17,433 patient visits were made by low-income individuals. Medical Assistance covered 76% of the patient visits and 24% were private pay. From July 2006 through June 2007, 4,941 patient visits were made, an increase of 6.6% from the previous year. Sixty-three percent (63%) of patients are from Eau Claire County. There is a waiting list of up to a year or more for non-emergency services , % of the Eau Claire County population reports that they did not see a dentist in the prior year. 3 SPECIAL HEALTH CARE NEEDS Children and adults with chronic disease or disability, non-english speaking residents and special cultural groups as well as others may have special needs in accessing primary and preventive health services. About 1 in 6 adolescents (ages 12-17) in the U.S. have special health care needs and almost 20% of these adolescents had a past-year unmet need for health care. Almost 5% of young adults ages have a disabling chronic condition. Young adults with disabilities have a higher rate of unmet needs than their peers without disabling conditions. 5 Genetic Services (such as counseling, testing, treatment and education) are an important component of overall preventive health care. Genetics can refer to changes in genes, disorders that are passed on in families, birth defects and their causes, as well as involvement in common disorders, such as asthma, diabetes, heart disease, mental illness and cancer. Understanding the influence genetics can have at any point in the life cycle allows for great strides in prevention and early diagnosis/treatment. 23 However, in Eau Claire County, genetic services are only offered on a limited, outreach basis. Specialized Nutrition Services are an essential component of preventive health care for children with disabilities to minimize the effects of disease and disability and enhance lifelong potential. The last Eau Claire County nutrition needs assessment done in 1997 identified that no one in the community is taking responsibility for the nutrition needs of children with special health care needs, 24 and it remains an unmet need. Families must travel long distances to major medical centers to access needed pediatric nutrition specialty services. Nutrition services for children requiring special health care remains an unmet need in Eau Claire County. Eau Claire City/County Community Health Improvement Plan - July

6 Language/Culturally Sensitive Materials are needed. Input from the HP A Community Planning Team indicated that Spanish interpreters and culturally sensitive materials are needed for preventive health education and services. It was also indicated that Mennonite and Amish communities are interested in preventive screenings and services but face barriers accessing health information. About 1 in 5 youth with special health care needs has problems accessing health care and goes without needed services. 5 COMMUNITY RESOURCES Aging & Disability Resource Center of Eau Claire County AIDS Resource Center of Wisconsin All Family Dental American Cancer Society APPLE Pregnancy Care Bolton Refuge House Catholic Charities Children s Mental Health Alliance Chippewa Valley Children s Service Society of Wisconsin Chippewa Valley Free Clinic Chippewa Valley Technical College Dental Clinic Clear Vision Eau Claire Community Health Partnership, Inc. Community Volunteers Eau Claire City-County Health Department Adult Health Program Prenatal Care Coordination Birth to Three Early Intervention Program Reproductive Health Program/ Children/Youth with Special Health Care Needs Family Planning Clinic/STI Health Benefits Advocacy School Health Program Immunization Clinic Women, Infants and Children (WIC) Nutrition Program Maternal and Child Health Program Wisconsin Well Woman Program Oral Health Program Eau Claire Coalition for Youth - Health & Safety Committee Eau Claire County Department of Human Services BadgerCare and BadgerCare Plus Crisis Mental Health Intervention BadgerCare Prenatal Extension Family Planning Waiver Program Birth to Three Early Invention Program Medical Assistance Program Community Support Program Mental Health Medication Program Coordinated Services Teams TB Medical Assistance Eau Claire Metro Treatment Center 6 Eau Claire City-County Health Department

7 Epilepsy Foundation of Western Wisconsin Great Rivers Information, Referral & Crisis Line Healthy Communities of Eau Claire County Dental Health Promotion Action Team Health Care Access Action Team Lutheran Social Services Luther Midelfort Financial Assistance Program Marshfield Clinic - Chippewa Dental Center Marshfield Clinic Community Care Program MATCh (Mental Health Assistance for Teens & Children) Program Omne Clinic Partnership for Prescription Assistance Planned Parenthood of Wisconsin, Inc. Sacred Heart Hospital Community Care Program Sexual Assault Nurse Examiner (SANE) Program Tobacco Free Partnership Task Force on Treating Tobacco Dependence Tender Care Transport, Inc. United Cerebral Palsy of West Central Wisconsin UW Eau Clare Center for Communication Disorders UW Health Family Medicine Clinic Residency Program UW Stout Clinical Services Center Western Dairyland Headstart Oral Health Initiative Wisconsin Tobacco Quit Line Eau Claire City/County Community Health Improvement Plan - July

8 GOALS AND OBJECTIVES FOR EAU CLAIRE COUNTY Goal: Improve access to primary and preventive health services in Eau Claire County by 2013 in the areas of medical, dental, mental health, substance abuse, and specialized health care. To improve access, the Health Priority A Community Planning Team recommends accomplishment of the following objectives in each of the following areas over the next 5 years: MEDICAL AND DENTAL CARE 1. Community organizations will build capacity to develop and use an operational community health information system to track, analyze, and report utilization rates of preventive health screening services on a countywide basis by December Community organizations will assess the need for an educational campaign to inform the population of the recommended schedule of preventive health screenings, targeting the needs of various age groups between 0 and 24, in a culturally appropriate manner by December SPECIAL HEALTH CARE NEEDS 1. Community organizations will work together to select, order and implement use of Hmong and Spanish translated and culturally appropriate education materials regarding family health such as family planning, nutrition, child growth and development, etc. 2. Community organizations employing interpreters will partner to form an interpreter network, focused on enhancing access to preventive health information, referral and outreach services for members of the local Hmong and Hispanic communities. 3. Community organizations will form partnerships focused on improving local access to needed specialized health services such as pediatric nutrition, community-based genetics counseling and Hmong mental health services. MENTAL HEALTH AND SUBSTANCE ABUSE CARE 1. Community organizations will encourage local employers to provide employee assistance programs, while working together to achieve insurance parity for individuals needing care for mental health and substance abuse problems. 2. Community organizations and individuals with expertise in mental health and substance abuse care will work together to reduce the need for specialized crisis care and expand the skills of primary and mid-level providers by: a) developing and disseminating assessment tools to assist in recognizing actual and potential problems; and b) identifying appropriate early intervention strategies and referral sources. 3. A community-wide network of entities will work to reframe substance abuse and mental illness as health issues rather than a criminal problem by promoting prevention programs, early intervention strategies, and community education. 8 Eau Claire City-County Health Department

9 REFERENCES 1 Bureau of Health Information and Policy, Division of Public Health, Wisconsin Department of Health Services. Wisconsin Health Insurance Coverage, November Bureau of Health Information and Policy, Division of Public Health, Wisconsin Department of Health Services. Wisconsin Health Insurance Coverage, September Athens JK, Taylor KW, Booske BC, Kempf AM, Remington PL. Wisconsin County Health Rankings Report, University of Wisconsin Population Health Institute The Alan Guttmacher Institute. Contraceptive Needs and Services, , Tables 1-3, Wisconsin National Adolescent Health Information Center. Fact Sheet on Health Care Access & Utilization: Adolescents & Young Adults University of California, San Francisco. 6 Chippewa Valley Free Clinic statistics, provided by Susan Strom, Clinic Manager 7 Bureau of Health Information and Policy, Division of Public Health, Wisconsin Department of Health Services Profile for Eau Claire County. 8 Office of the Lieutenant Governor. Report of the Task force on Women and Depression. May State of Wisconsin. 9 Center for Mental Health Services. Substance Abuse and Mental Health Services Administration. Mental Health, United States, US Department of Health and Human Services Office of Applied Studies. Substance Abuse and Mental Health Services Administration. Results from the 2006 National Survey on Drug Use and Health (NSDUH): National Findings. US Department of Health and Human Services National Survey on Drug Use and Health. State Estimates of Persons Needing But Not Receiving Substance Abuse Treatment, Office of Applied Studies, Substance Abuse and Mental Health Services Administration. US Department of Health and Human Services Estimates generated by The Alcohol Cost Calculator for Kids based on the National Survey on Drug Use and Health (HSDUH) and the National Comorbidity Survey (NCS) Knopf D, Park MJ, and Paul Mulye T. The Mental Health of Adolescents: A National Profile, National Adolescent Health Information Center. University of California, San Francisco PRIDE (Parent s Resource Institute for Drug Education) Questionnaire results. Report for Eau Claire County Schools, 2007/2008. Eau Claire City-County Health Department. 15 Bureau of Health Information and Policy, Division of Public Health, Wisconsin Department of Health Services. Eau Claire County Deaths by Age Group, Heiligenstein, E and Stevens S. Smoking and Mental Health Problems in Treatment Seeking University Students. Nicotine and Tobacco Research, 2006; 8: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Department of Health and Human Services. Oral Health for Adults - Fact Sheet National Oral Health Surveillance System. Wisconsin - Oral Health Profile. Eau Claire City/County Community Health Improvement Plan - July

10 19 Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Department of Health and Human Services. Children's Oral Health Fact Sheet. October Oral Health Program. Total Dental Sealants for 2007, Eau Claire City-County Health Department Annual Report Bureau of Health Information and Policy, Division of Public Health, Wisconsin Department of Health and Family Services. Dental visit in past year, Medicaid/BadgerCare recipients. Prepared for Tracking the State Health Plan, State-Level Data. July Chippewa Valley Technical College statistics, provided by Ellen Kirking and Connie Supri. 23 Genetic Services Plan for Wisconsin, 24 Splett & Associates. Needs Analysis: Defining Public Health Nutrition Opportunities for Eau Claire City/County Health Department. August Eau Claire City-County Health Department