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Health Care in New Orleans Before and After Hurricane KatrinaAdele Shartzer - PowerPoint PPT Presentation


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Figure 1. Health Care in New Orleans Before and After Hurricane Katrina Adele Shartzer, MPH Policy Analyst, Kaiser Commission on Medicaid and the Uninsured for kaiserEDU. Figure 2. Tutorial Overview. Pre-Katrina Louisiana Devastation after Hurricane Katrina

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Slide1 l.jpg

Figure 1

Health Care in New Orleans

Before and After Hurricane Katrina

Adele Shartzer, MPH

Policy Analyst,

Kaiser Commission on Medicaid and the Uninsured

for

kaiserEDU


Tutorial overview l.jpg

Figure 2

Tutorial Overview

  • Pre-Katrina Louisiana

  • Devastation after Hurricane Katrina

  • Impact on Health Care in New Orleans

  • Progress and Challenges


Key characteristics of pre katrina louisiana compared to the u s 2004 2005 l.jpg

Figure 3

Key Characteristics of Pre-Katrina Louisiana Compared to the U.S., 2004-2005

32%

26%

23%

21%

17%

12%

9%

7%

SOURCE: www.statehealthfacts.org. Data is from the Census Bureau’s March 2005 and 2006 Current Beneficiary Survey.


Health care access in pre katrina new orleans l.jpg

Figure 4

Health Care Access in Pre-Katrina New Orleans

  • High percentage uninsured

    • Low rates of employer sponsored insurance

    • Restricted Medicaid eligibility for adults

  • State and federal funding to support care to the uninsured concentrated in the LSU-operated safety-net hospital system

  • Care delivery characterized by a “two-tier” system based on insurance coverage

    • Uninsured: primarily served by safety-net hospitals (Medical Center of Louisiana at New Orleans/MCLNO); limited access to physicians’ offices and other community clinics

    • Insured: primarily used other hospitals; broader access to care in community

  • Specialty services offered to uninsured through MCLNO (aka Charity) as a teaching hospital


Devastation after katrina l.jpg

40.0

Figure 5

Devastation After Katrina

1,464

900,000

158,353 (~64%)

73,214

165,100 (~26%)

16,000

40

22 million tons

Lives lost

People displaced

Orleans household population

Occupied FEMA travel trailers

Jobs lost*

Businesses flooded

Schools destroyed

Debris generated

Data represents peak impact of Katrina.

SOURCE: Louisiana Recovery Authority, Hurricane Katrina Anniversary Data for Louisiana, August 2006, and Brookings/Greater New Orleans Community Data Center, “The New Orleans Index,” January 2008.


Slide6 l.jpg

Figure 6

New Orleans East

Gentilly

Lakeview

Lower 9th Ward

French Quarter

Lake Pontchartrain

Orleans Parish

Jefferson

Parish

Algiers

(Orleans)

St. Bernard Parish

Jefferson Parish

Plaquemines Parish


Health care for the poor in new orleans in the aftermath of katrina l.jpg

Figure 7

Health Care for the Poor in New Orleans in the Aftermath of Katrina

  • Closure of most acute care hospitals, including Charity Hospital (MCLNO)

    • Loss of Level 1 Trauma, mental health beds, other specialty care

    • Open hospitals operating at reduced capacity but almost full

  • Open safety-net clinics decreased from 90 to 19

  • Doctors and other health workforce relocated

  • Pharmacies closed, including Charity’s low-cost pharmacy

  • Half of nursing homes closed


Insights from survivors after the storm l.jpg

Figure 8

Insights from Survivors After the Storm

  • The stress of situation was exhausting, and for some basic needs like housing and food were not being met adequately

  • Many had unmet mental health needs

  • Many who had chronic conditions experienced gaps in their prescription drugs in the weeks and months following Katrina

  • They were disconnected from usual sources of care, and finding new providers was very difficult

  • When enrollment was successful, Medicaid coverage was helpful

  • It was hard to maintain healthy behaviors while living in hotels and trailers, particularly in very cramped conditions

SOURCE: Voices of the Storm: Health Experiences for Low-Income Katrina Survivors, KCMU publication #7538, August 2006


Profile of adults in the greater new orleans area and orleans parish one year after the storm l.jpg

Figure 9

Profile of Adults in the Greater New Orleans Area and Orleans Parish One Year After the Storm

54%

54%

53%

45%

43%

43%

35%

30%

16%

9%

Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area (conducted September 12 – November 13, 2006)


Slide10 l.jpg

Figure 10

Satisfaction With Quality of Life

In general, can you tell me how satisfied or dissatisfied you are with your overall quality of life? And what about before Hurricane Katrina?

Before Katrina

Percent “very satisfied” with overall quality of life:

One Year Later

65%

65%

63%

38%

34%

25%

Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area (conducted September 12 – November 13, 2006)


Slide11 l.jpg

Figure 11

Portrait of Problems Faced by Greater New Orleans Residents

Percent who reported having a problem in each of the following areas:

27% have no usual place of care; 25% of adults uninsured

Health care coverage and access problems

49%

Physical health challenges

43%

13% said job doesn’t pay enough to cover basic expenses

27%

No job or inadequate wages

Mental health challenges

18%

9% of those with children said their child didn’t get needed health care

Child in home troubled or not getting needed care

11%

PROBLEMS IN AT LEAST 1 AREA

77%

PROBLEMS IN 3 OR MORE AREAS

19%

Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area (conducted September 12 – November 13, 2006)


Usual source of care insured vs uninsured respondents l.jpg

Figure 12

Usual Source of Care, Insured vs. Uninsured Respondents

Insured Respondents

Uninsured Respondents

Other

Don’t Know/ Refused

2%

Don’t Know/ Refused

3%

13%

Doctor’s Office

Doctor’s Office

10%

No Usual Source of Care other than the ER

No Usual Source of Care other than the ER

55%

12%

Hospital Clinic

19%

54%

5%

Hospital Clinic

9%

18%

Neighborhood

Clinic

Neighborhood Clinic

Total Adults with No USOC other than the ER=27%

Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area(conducted September 12 – November 13, 2006)


Health care utilization in past 6 months uninsured vs insured adults in the new orleans area l.jpg

Figure 13

Health Care Utilization in Past 6 Months, Uninsured vs. Insured Adults in the New Orleans Area

55%

49%

46%

29%

25%

25%

23%

19%

15%

14%

14%

13%

Source: The Kaiser Post-Katrina Baseline Survey of the New Orleans Area(conducted September 12 – November 13, 2006)


Progress and challenges l.jpg

Figure 14

Progress and Challenges

  • University Hospital reopened November 2006, other hospitals also open

  • Plans to build a teaching hospital to replace VA and Charity, open in 2012

  • Restoring hospital capacity

  • Developing community clinics

  • Recruitment and retention of health professionals

  • Increasing mental health capacity to meet population needs

    • Capacity improved; however, considerable unmet need remains

  • Health coverage expansions

  • New clinics in response to need

  • $100 million federal grant to support access to primary care

  • Incentive grants to recruit physicians and other workforce

  • Medical education

  • Plan for reform developed; some elements stalled by negotiations between stakeholders and transition in administration

  • LaCHIP expansion for children


Additional resources l.jpg

Figure 15

Additional Resources

  • Kaiser Family Foundation http://www.kff.org/katrina

  • Greater New Orleans Community Data Center www.gnocdc.org

  • Louisiana Department of Health and Hospitals www.dhh.louisiana.gov

  • Louisiana Public Health Institute www.lphi.org

  • CMS Katrina Waivers http://www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/07_KatrinaWaivers.asp

  • HHS Hurricane Katrina Information http://www.hhs.gov/disasters/emergency/naturaldisasters/hurricanes/katrina/index.html


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