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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.

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the challenge of nebraska health

The Challenge of Nebraska Health

Peg Bottjen, MPA, MT(ASCP)SC

Issues for Rural Health Practitioners

challenge of nebraska health
Challenge of Nebraska Health
  • Definition of “rural”
  • Who?
  • What?
  • Where?
  • How?
  • Why?
definitions of rural
Definitions of Rural
  • Own?
  • Census Bureau
  • US Office of Management and

Budget (OMB)

  • DHHS
  • Other
census bureau
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
census bureau1
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
us office of management and budget
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
us dept health human services
US Dept. Health & Human Services
  • Frontier Counties – Six or fewer people per square mile.
other federal definitions of rural
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?

many definitions of rural
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
slide10
Who?
  • How many people live in Nebraska?

a. approx. 500,000

b. approx. 1 million

c. over 1.5 million

d. over 2 million

slide11

1,758,787 Nebraskans in 2005

52.6% live in Dakota, Washington, Douglas, Sarpy, Cass,

and Lancaster counties

slide14
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%

economic profile
Economic Profile

Median Household Income 2004 (estimated)

NE avg. $48,409

Range $33,600 (Loup Co.)

$64,800 (Sarpy Co.)

poverty
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.
economic profile1
Economic Profile
  • Poverty 1998 - 2000

NE 10.6%

US 11.9%

Range 23.0% (Thurston Co) to 3.8% (Sarpy Co.)

what is the health status
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%
health status
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
rural vs urban in u s
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

rural vs urban in u s cont
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

rural vs urban in u s cont1
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

health status1
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%
where are the health resources
Health Professionals

Physicians

Allied Health

Nursing

Mental

Dental

Health Facilities

CAH

Health Systems

Nursing Homes

Rural Health Clinics

Where are the Health Resources?
allied health shortages
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
health facilities
Health Facilities
  • Critical Access Hospitals
  • Mental Health Facilities
  • Long Term Care
  • Rural Health Clinics
hospitals in nebraska
Hospitals in Nebraska

 Non-critical access hospitals

Critical Access hospitals

access reasons why people were unable to obtain care
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

quality
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.
summary
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?