The Region IV The Region IV Healthcare Marketplace Healthcare - - PowerPoint PPT Presentation

1 Health Informatics Center of Acadiana

The Region IV The Region IV Healthcare Marketplace Healthcare Marketplace

Presented to the Presented to the

Region IV Healthcare Consortium Region IV Healthcare Consortium

• L. Philip Caillouet, Ph.D.
• L. Philip Caillouet, Ph.D.

Health Informatics Center of Acadiana Health Informatics Center of Acadiana The University of Louisiana at Lafayette The University of Louisiana at Lafayette December 8, 2004 December 8, 2004

2 Health Informatics Center of Acadiana

I. I. What is “Region IV”? What is “Region IV”? II. II. What is the Region IV “Healthcare Marketplace”? What is the Region IV “Healthcare Marketplace”?

• Healthcare Providers

Healthcare Providers

• Healthcare Consumers

Healthcare Consumers III. III. Louisiana HABITS Louisiana HABITS – – Quantifying Access Barriers Quantifying Access Barriers

IV. IV.

Where do patients go for care? Where do patients go for care?

V. V.

Concluding Observations Concluding Observations

The Region IV The Region IV Marketplace Healthcare Marketplace Healthcare

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• I. What is “Region IV”?
• I. What is “Region IV”?

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Louisiana DHH Regions Louisiana DHH Regions

• The

The Louisiana Department of Health and Hospitals Louisiana Department of Health and Hospitals (DHH) (DHH) has organized the state into nine administrative regions. has organized the state into nine administrative regions.

• DHH Region IV

DHH Region IV

consists of: consists of: Acadia Parish Acadia Parish Evangeline Parish Evangeline Parish Iberia Parish Iberia Parish Lafayette Parish Lafayette Parish

• St. Landry Parish
• St. Landry Parish
• St. Martin Parish
• St. Martin Parish

Vermilion Parish Vermilion Parish Region IV

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• II. What is the “Region IV
• II. What is the “Region IV

Healthcare Marketplace”? Healthcare Marketplace”?

• - Healthcare Providers

Healthcare Providers

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Region IV Healthcare Marketplace: Region IV Healthcare Marketplace: Healthcare Providers Healthcare Providers

• 1,019 licensed physicians

1,019 licensed physicians (source: LSBME)

(source: LSBME) and directed staff

and directed staff

– – General Practice Physicians, Specialists, and Surgeons General Practice Physicians, Specialists, and Surgeons – – Nurse Practitioners and Physician Assistants Nurse Practitioners and Physician Assistants

• 26 Hospitals

26 Hospitals (source: LHA)

(source: LHA)

– – 15 general acute care (2,419 licensed beds) [including UMC] 15 general acute care (2,419 licensed beds) [including UMC] – – 1 specialty (Women’s & Children’s) acute care (93 licensed bed 1 specialty (Women’s & Children’s) acute care (93 licensed beds) s) – – 1 critical access hospital acute care (25 licensed beds) 1 critical access hospital acute care (25 licensed beds) – – 4 long 4 long-

• term acute care (121 licensed beds)

term acute care (121 licensed beds) – – 3 rehabilitation (34 licensed beds) 3 rehabilitation (34 licensed beds) – – 2 psychiatric (80 licensed beds) [including UMC] 2 psychiatric (80 licensed beds) [including UMC]

• Many other important professional and institutional healthcare

Many other important professional and institutional healthcare providers including dentists, mental health professionals, nursi providers including dentists, mental health professionals, nursing ng homes, home health agencies, pharmacies, … homes, home health agencies, pharmacies, …

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Physicians and Acute Care Beds Physicians and Acute Care Beds Are Not Well Are Not Well-

• Distributed in Region IV

Distributed in Region IV

46 2,537 538 1,019 548,154 Total 37 201 1,454 37 53,807 Vermillion 5 25 3,239 15 48,583

• St. Martin

50 436 593 148 87,700

• St. Landry

58 1,100 309 617 190,503 Lafayette 32 237 672 109 73,266 Iberia 91 321 805 44 35,434 Evangeline 37 217 1,201 49 58,861 Acadia

Acute Care Beds per 10,000 Population Total Acute Care Beds Available 9 Persons Served per Physician Total Physicians Available 8 2000 Population 1 UMC Catchment Parish

persons served per physician = persons served per physician = 538 538 acute hospital beds per 10,000 persons = acute hospital beds per 10,000 persons = 46 46

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Health Professional(s) Shortage Area: Health Professional(s) Shortage Area:

any of the following which HHS determines has a shortage of heal any of the following which HHS determines has a shortage of health professional(s): th professional(s): (1) An urban or rural area (which need not conform to the geogra (1) An urban or rural area (which need not conform to the geographic boundaries of a phic boundaries of a political subdivision and which is a rational area for the political subdivision and which is a rational area for the delivery of health services); delivery of health services); (2) a population group; or (2) a population group; or (3) a public or nonprofit private medical facility. (3) a public or nonprofit private medical facility.

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• Veterans Affairs Out

Veterans Affairs Out-

• Patient Clinic in Lafayette

Patient Clinic in Lafayette

• 3 Federally Qualified Health Centers (FQHCs)

3 Federally Qualified Health Centers (FQHCs)

– – New Iberia New Iberia – – Gueydan Gueydan – – Opelousas Opelousas

• 1 federally designated Critical Access Hospital

1 federally designated Critical Access Hospital

Federally Federally-

• Sponsored Providers in

Sponsored Providers in Region IV Region IV

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State State-

• Sponsored Providers

Sponsored Providers in Region IV in Region IV

• University Medical Center,

University Medical Center,

• perated by LSUHSC
• perated by LSUHSC-
• NO HCSD

NO HCSD

– – 208 licensed beds, including 20 psychiatric beds 208 licensed beds, including 20 psychiatric beds at Joseph Henry Tyler Jr. Mental Health Center at Joseph Henry Tyler Jr. Mental Health Center – – Emergency Department & multiple outpatient clinics Emergency Department & multiple outpatient clinics – – 75 faculty 75 faculty (46 FTE salaried faculty physicians) (46 FTE salaried faculty physicians) – – 65 interns and Graduate Medical Education residents 65 interns and Graduate Medical Education residents (~6.5 FTE physicians in advanced training) (~6.5 FTE physicians in advanced training)

• 9 Parish Health Units, operated by Louisiana OPH

9 Parish Health Units, operated by Louisiana OPH

– – 3 in St. Landry (Opelousas, Eunice, and Melville) 3 in St. Landry (Opelousas, Eunice, and Melville) – – 1 each in Acadia, Evangeline, Iberia, Lafayette, 1 each in Acadia, Evangeline, Iberia, Lafayette,

• St. Martin, & Vermilion
• St. Martin, & Vermilion

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• II. What is the “Region IV
• II. What is the “Region IV

Healthcare Marketplace”? Healthcare Marketplace”?

• - Healthcare Consumers

Healthcare Consumers

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Region IV Healthcare Marketplace: Region IV Healthcare Marketplace: Healthcare Consumers Healthcare Consumers

• All persons in Region IV are

All persons in Region IV are either active or eventual consumers either active or eventual consumers

• f healthcare services,
• f healthcare services,

but not all can afford to purchase care, but not all can afford to purchase care, personally or through insurance plans. personally or through insurance plans.

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Population Statistics Population Statistics

• Region IV has a population of

Region IV has a population of 548,154 persons 548,154 persons: :

– – Estimated Estimated 111,982 “uninsured” (20.4%) 111,982 “uninsured” (20.4%): :

» » Est. 79,283 “uninsured and at or below 200% FPL (14.5%)

• Est. 79,283 “uninsured and at or below 200% FPL (14.5%)

» » Est. 32,699 “uninsured and above 200% FPL (5.9%)

• Est. 32,699 “uninsured and above 200% FPL (5.9%)

– – Countable Countable 193,638 “under 193,638 “under-

• insured” (35.3%)

insured” (35.3%): :

» » 126,288 Medicaid enrollees (23.0%) [ 126,288 Medicaid enrollees (23.0%) [due to poor reimbursement

due to poor reimbursement]

] » » 67,350 Medicare enrollees (12.3%) [ 67,350 Medicare enrollees (12.3%) [have lacked R

have lacked Rx benefit benefit]

]

– – Estimated Estimated 242,534 242,534 “well “well-

• insured” (44.2%)

insured” (44.2%) 548,154 548,154

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at or below 200% FPL = at or below 200% FPL = 43.2% 43.2%

Low Income Households Low Income Households

enrolled in Medicaid = enrolled in Medicaid = 23.0% 23.0% “ “the working poor” = the working poor” = 20.2% 20.2%

20.2% 110,699 23.0% 126,288 43.2% 236,987 548,154 Total 23.3% 12,520 20.3% 10,947 43.6% 23,467 53,807 Vermillion 20.2% 9,818 24.4% 11,862 44.6% 21,680 48,583

• St. Martin

22.9% 20,042 30.3% 26,596 53.2% 46,638 87,700

• St. Landry

17.7% 33,716 16.7% 31,724 34.4% 65,440 190,503 Lafayette 19.7% 14,446 25.0% 18,304 44.7% 32,750 73,266 Iberia 20.0% 7,088 32.8% 11,628 52.8% 18,716 35,434 Evangeline 22.2% 13,069 25.9% 15,227 48.1% 28,296 58,861 Acadia

% Target Population (at

• r < 200% FPL

and not covered by Medicaid) % Medicaid Enrollees ("Eligibles") % Population at or < 200% FPL 2000 Population 1 Region IV (UMC Catchment Parishes)

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• Medicaid is a state

Medicaid is a state-

• run, federally subsidized medical insurance

run, federally subsidized medical insurance program that provides coverage for program that provides coverage for some some of the medically

• f the medically

indigent. indigent. – – Eligible for Medicaid: Eligible for Medicaid:

» » Low Income Pregnant Women Low Income Pregnant Women

• Low income defined as <200% FPL

Low income defined as <200% FPL ($3,067/month for a family of 4 in 2003) ($3,067/month for a family of 4 in 2003) » » Low Income Children (LaCHIP) Low Income Children (LaCHIP) » » Very Poor Parents Very Poor Parents

• Less than 16% of FPL

Less than 16% of FPL ($245/month for a family of 4) ($245/month for a family of 4)

» » Persons with certain disabilities Persons with certain disabilities – – Ineligible for Medicaid: Ineligible for Medicaid:

» » Parents Parents --

• - greater than 16% of FPL

greater than 16% of FPL » » Childless Adults Childless Adults --

• - ineligible at any income

ineligible at any income

Medicaid Medicaid

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Source: Source: Louisiana HABITS Louisiana HABITS, , a direct consumer survey approach a direct consumer survey approach developed by HICA at UL Lafayette. developed by HICA at UL Lafayette.

UMC Catchment Parish 2000 Population 1 Households 5 Average Persons per Household 5 UL Lafayette HICA Est. Uninsured 6 % 6

Acadia 58,861 21,142 2.78 16,648 28.3% Evangeline 35,434 12,736 2.78 10,335 29.2% Iberia 73,266 25,381 2.89 15,810 21.6% Lafayette 190,503 72,372 2.63 25,797 13.5%

• St. Landry

87,700 32,328 2.71 19,848 22.6%

• St. Martin

48,583 17,164 2.83 12,889 26.5% Vermillion 53,807 19,382 2.78 10,655 19.8% Total 548,154 200,505 2.73 111,982 20.4%

Of the 110,699 Of the 110,699 “working poor” “working poor” in Region IV, in Region IV, some who are some who are working working full full-

• time

time may be insured may be insured through through an employer. an employer. Many are not Many are not working full working full-

• time

time

• r can’t afford their
• r can’t afford their

share of the share of the premiums. premiums.

The Uninsured The Uninsured

uninsured uninsured = = 20.4% 20.4%

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• Medicaid enrollees

Medicaid enrollees may be considered may be considered “under “under-

• insured”

insured” because their coverage because their coverage pays far below “usual and pays far below “usual and customary” customary” medical fees. medical fees.

– – 126,288 (23.0% of the population of Region IV) 126,288 (23.0% of the population of Region IV) qualifying qualifying indigent persons are covered by Medicaid. indigent persons are covered by Medicaid.

• Medicare enrollees

Medicare enrollees may be considered may be considered “under “under-

• insured”

insured” because because prescription medications are not yet covered prescription medications are not yet covered. .

– – 67,350 (12.3% of the population of Region IV) 67,350 (12.3% of the population of Region IV) qualifying elderly qualifying elderly

• r disabled persons covered by Medicare.
• r disabled persons covered by Medicare.

Who Are the Who Are the “ “Under Under-

• insured

insured” ” in Region IV? in Region IV?

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• Subtracting the uninsured and under

Subtracting the uninsured and under-

• insured populations

insured populations from the total leaves from the total leaves 242,534 (44.2%) 242,534 (44.2%) – – fewer than half fewer than half – – who might be said to be “well insured” against the risks of who might be said to be “well insured” against the risks of unexpected health unexpected health-

• related expenses, and therefore able to

related expenses, and therefore able to fully participate in the healthcare marketplace. fully participate in the healthcare marketplace.

When fewer than half of the residents of a When fewer than half of the residents of a region are able to fully participate in a region are able to fully participate in a healthcare marketplace, that marketplace is healthcare marketplace, that marketplace is bound to show the effects of economic stress! bound to show the effects of economic stress!

Who Are the Who Are the “ “Well Well-

• Insured

Insured” ” in Region IV? in Region IV?

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• “

“Medically Indigent Medically Indigent” ” : : A person who is too impoverished to meet A person who is too impoverished to meet medical expenses. medical expenses. The term currently refers to persons whose income is

The term currently refers to persons whose income is too low for them to afford routine medical care, although they a too low for them to afford routine medical care, although they are able to re able to pay for their basic living costs, or to persons with generally a pay for their basic living costs, or to persons with generally adequate dequate income who suddenly face catastrophic medical bills. income who suddenly face catastrophic medical bills.

[The Aspen Dictionary of Health Care Administration, 1989.] [The Aspen Dictionary of Health Care Administration, 1989.]

• “

“Medically Needy Medically Needy” ”: : A term in the Medicaid program for persons A term in the Medicaid program for persons who have enough income and resources to pay their basic living who have enough income and resources to pay their basic living expenses (and so not need public assistance) but not enough to p expenses (and so not need public assistance) but not enough to pay ay for medical care. for medical care. Medicaid law requires that the standard for income

Medicaid law requires that the standard for income used by a state to determine if someone is medically needy canno used by a state to determine if someone is medically needy cannot exceed t exceed 133% of the maximum amount paid to a family of similar size unde 133% of the maximum amount paid to a family of similar size under the r the Aid to Families with Dependent Children (AFDC) program [now call Aid to Families with Dependent Children (AFDC) program [now called ed “Temporary Aid to Needy Families (TANF)”]. “Temporary Aid to Needy Families (TANF)”].

[Ibid.] [Ibid.]

The Medically Indigent or Needy The Medically Indigent or Needy in Federal & State Law in Federal & State Law

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The Medically Indigent or Needy The Medically Indigent or Needy & Louisiana’s Charity Hospitals & Louisiana’s Charity Hospitals

• “

“Any Any bona fide bona fide resident of the state of Louisiana who is resident of the state of Louisiana who is medically medically indigent indigent or

• r medically needy

medically needy shall be eligible for any form of treatment shall be eligible for any form of treatment by any general hospital owned and operated by the State of by any general hospital owned and operated by the State of Louisiana.” Louisiana.”

[LRS 46:6, Section 6. Act 62 of 1926] [LRS 46:6, Section 6. Act 62 of 1926]

• The [state

The [state-

• owned “charity”] hospitals
• wned “charity”] hospitals …

… shall be operated primarily shall be operated primarily for the medical care of the for the medical care of the uninsured uninsured and and medically indigent medically indigent residents residents

• f the state and others in need of medical care and as teaching
• f the state and others in need of medical care and as teaching

institutions. institutions.

[LRS 17:1519.1.A.(1)] [LRS 17:1519.1.A.(1)]

• University Medical Center in Lafayette

University Medical Center in Lafayette, part of the 8 , part of the 8-

• hospital charity

hospital charity hospital system currently administered by LSUHSC hospital system currently administered by LSUHSC-

• NO HCSD, has

NO HCSD, has as its mandate the care of Louisiana residents who are as its mandate the care of Louisiana residents who are medically medically indigent, those in households earning at or below 200% of FPL indigent, those in households earning at or below 200% of FPL (Federal Poverty Level). (Federal Poverty Level).

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• III. Louisiana HABITS
• III. Louisiana HABITS –

– Quantifying Access Barriers Quantifying Access Barriers

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• Louisiana HABITS

Louisiana HABITS – – “Healthcare Access Barriers In The State” “Healthcare Access Barriers In The State”

• Developed by HICA in conjunction with LRHAP, SWLAHEC,

Developed by HICA in conjunction with LRHAP, SWLAHEC, CLAHEC, and the Rapides Foundation CLAHEC, and the Rapides Foundation

• Built on questions from widely used surveys:

Built on questions from widely used surveys:

1. 1. CDC’s Behavioral Risk Factor Surveillance System (BRFSS) CDC’s Behavioral Risk Factor Surveillance System (BRFSS) 2. 2. Medical Expenditure Panel Survey (MEPS) Medical Expenditure Panel Survey (MEPS) 3. 3. North Carolina Health Profile Survey (NCHP), and other studies North Carolina Health Profile Survey (NCHP), and other studies

• Survey methodology to better address

Survey methodology to better address locally locally significant barriers significant barriers through sufficiently dense sampling through sufficiently dense sampling

• Administered in two phases or “rounds”:

Administered in two phases or “rounds”:

1. 1. Random telephone survey to measure general population, and Random telephone survey to measure general population, and 2. 2. In In-

• person interviews to profile vulnerable populations

person interviews to profile vulnerable populations

• No personally identifiable data collected retained

No personally identifiable data collected retained

• Tailored for use with “healthy communities” initiatives

Tailored for use with “healthy communities” initiatives

Results Inform Local Leadership, not Washington! Results Inform Local Leadership, not Washington!

Resources & Methods: Resources & Methods:

What Is Louisiana HABITS? What Is Louisiana HABITS?

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Resources & Methods: Resources & Methods:

Why Two “Rounds”? Why Two “Rounds”?

• The telephone survey approach

The telephone survey approach fails to sample households fails to sample households without telephones! without telephones!

– – Some 4.9% of households in Some 4.9% of households in Region IV are without Region IV are without telephones telephones --

• - varying by parish.

varying by parish. (Census 2000) (Census 2000)

• Households without

Households without telephones are very likely to telephones are very likely to also experience “access to also experience “access to healthcare” barriers! healthcare” barriers!

– – This is why we also conducted This is why we also conducted an in an in-

• person round of interviews

person round of interviews with persons in vulnerable with persons in vulnerable populations. populations.

4.9% 9,772 200,955 Total 5.2% 1,023 19,832

Vermilion

6.4% 1,090 17,164

• St. Martin

6.9% 2,224 32,328

• St. Landry

2.4% 1,751 72,372

Lafayette

5.1% 1,301 25,381

Iberia

8.7% 1,105 12,736

Evangeline

6.0% 1,278 21,142

Acadia

% without telephone service # without telephone service Occupied Housing Units

Census 2000

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• First round based on at least 96 random

First round based on at least 96 random-

• digit

digit-

• dialed

dialed (RDD) telephone interviews of households (RDD) telephone interviews of households

• Second round based on at least 96 interviews of

Second round based on at least 96 interviews of households with “barriers” households with “barriers”

• Response was entirely voluntary; each respondent could

Response was entirely voluntary; each respondent could terminate the interview at any time or could refuse to terminate the interview at any time or could refuse to answer any given question; only completed interviews answer any given question; only completed interviews were used in the analysis were used in the analysis

• Statistics that follow are based on 96 (if everyone

Statistics that follow are based on 96 (if everyone answered) or on a smaller number (if fewer answered) answered) or on a smaller number (if fewer answered)

• The statistics shown have error rate of

The statistics shown have error rate of ± ±10 10% % ( 95% confidence)

( 95% confidence)

Resources & Methods: Resources & Methods: Sampling Methodology Sampling Methodology

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• Collected parish baseline data by telephone survey

Collected parish baseline data by telephone survey

• Developed in

Developed in-

• person interview schedule with the Office

person interview schedule with the Office

• f Family Support and Office of Public Health
• f Family Support and Office of Public Health
• Conducted in

Conducted in-

• person interviews at the Office of Family

person interviews at the Office of Family Support and at the Parish Health Unit Support and at the Parish Health Unit

• Built database of findings

Built database of findings

• Analyzed data to form conclusions on barriers to access

Analyzed data to form conclusions on barriers to access

• Presented findings/conclusions/recommendations to

Presented findings/conclusions/recommendations to LRHAP and to parish planning group LRHAP and to parish planning group

Resources & Methods: Resources & Methods:

Workplan and Timeline Workplan and Timeline

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• For the purposes of this study, a household is said to

For the purposes of this study, a household is said to experience a “barrier to access to healthcare services” if experience a “barrier to access to healthcare services” if any one or more of the following three situations exist: any one or more of the following three situations exist: One or more household members had some problem in One or more household members had some problem in the last 12 months … the last 12 months …

1.

• 1. Problem obtaining healthcare services

Problem obtaining healthcare services, including , including

a) a) Difficulty Difficulty in obtaining care in obtaining care b) b) Delay Delayed ed seeking care seeking care c) c) Did not receive Did not receive the care they thought they should have the care they thought they should have

2.

• 2. Problem obtaining prescribed medications

Problem obtaining prescribed medications

• r
• r

One or more household members currently … One or more household members currently …

3.

• 3. Lack of health insurance coverage

Lack of health insurance coverage or a “medical card”.

• r a “medical card”.

Findings: Findings:

Access Barriers Access Barriers --

• - Defined

Defined

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Findings: Findings: C Comparison of Region IV Parishes

• mparison of Region IV Parishes

Green => “better” than Region IV population-weighted average Red => “worse” than Region IV population-weighted average

(adjusted for no-phone populations)

43.2% 43.2% 31.9% 31.9% 9.3% 9.3% 16.5% 16.5%

Acadia Acadia Parish Parish (2003) (2003)

52.0% 52.0% 35.5% 35.5% 18.3% 18.3% 31.3% 31.3%

Evangeline Evangeline Parish Parish (2002) (2002)

36.6% 36.6% 25.0% 25.0% 12.9% 12.9% 19.3% 19.3%

Iberia Iberia Parish Parish (2002) (2002)

39.9% 39.9% 15.3% 15.3% 8.0% 8.0% 26.2% 26.2%

Lafayette Lafayette Parish Parish (2002) (2002)

39.4% 39.4% 26.2% 26.2% 15.4% 15.4% 20.6% 20.6%

• St. Landry
• St. Landry

Parish Parish (2002) (2002)

49.3% 49.3% 33.5% 33.5% 16.7% 16.7% 20.3% 20.3%

• St. Martin
• St. Martin

Parish Parish (2001) (2001)

38.5% 38.5% 24.7% 24.7% 12.5% 12.5% 15.4% 15.4%

Vermilion Vermilion Parish Parish (2001) (2001)

OVERALL OVERALL Insurance Insurance Medications Medications DDD DDD

Barrier Barrier 41.2% 41.2% 23.9% 23.9% 11.8% 11.8% 22.1% 22.1%

Region Region IV IV Weighted Weighted Average Average

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Lafayette Parish Lafayette Parish Findings: Findings:

Source of Care Source of Care

M44: Place that family members go most often for healthcare

13.4% 11.5% 1.0% 60.4% 18.6% 14.4% 2.1% 33.0% 1.0% 17.5% 7.3% 11.5% 5.2% 3.1% 0% 10% 20% 30% 40% 50% 60% 70%

no place reported do not know or not sure walk-in clinic or urgent care center emergency room at hospital clinic or health center clinic at a hospital doctors office

Barrier Population (n=97) General Population (n=96)

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Evangeline Parish Evangeline Parish Findings: Findings:

Source of Care Source of Care

M44: Place that family members go most often for healthcare

1.0% 5.2% 9.4% 57.3% 21.9% 5.2% 54.2% 20.8% 6.3% 1.0% 5.2% 1.0% 11.5%

0% 10% 20% 30% 40% 50% 60% 70%

no place reported refused do not know or not sure clinic at a hospital emergency room at hospital clinic or health center doctors office

Barrier Population (n=96) General Population (n=96)

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Lafayette Parish Lafayette Parish Findings: Findings:

Source of Care Source of Care (continued)

(continued) M45: Do you have one person you think of as your household's MAIN personal doctor or healthcare provider?

24.7% 37.1% 37.1% 1.0% 18.8% 18.8% 61.5% 1.0% 0% 10% 20% 30% 40% 50% 60% 70% do not know or not sure more than one place no yes

Barrier Population (n=97) General Population (n=96)

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Evangeline Parish Evangeline Parish Findings: Findings:

Source of Care Source of Care (continued)

(continued)

M45: Do you have one person you think of as your household's MAIN personal doctor or healthcare provider?

14.6% 24.0% 61.5% 13.5% 16.7% 69.8%

0% 10% 20% 30% 40% 50% 60% 70% 80% more than one place no yes

Barrier Population (n=96) General Population (n=96)

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Lafayette Parish Lafayette Parish Findings: Findings:

Insurance Coverage Insurance Coverage

Ins 1-Ins 8: Percentage of "General Population" households having at least one person with listed health coverages

3.1% 9.4% 11.5% 13.5% 14.6% 18.8% 18.8% 20.8% 64.6% 0.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Indian Health service Champus, TriCare or VA LaChip Medicaid NO INSURANCE Medicare Supplement Medicare Part B Medicare Purchased/Self Employed Employer Sponsored 96 Households with 169 coverages (i.e., each household has 1.76 coverages on the average)

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Evangeline Parish Evangeline Parish Findings: Findings:

Insurance Coverage Insurance Coverage

Ins 1-Ins 8: Percentage of "General Population" households having at least one person with listed health coverages 7.3% 10.4% 18.8% 19.8% 19.8% 28.1% 35.4% 41.7% 1.0% 29.2% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100 % Indian Health service Champus, TriCare or VA Purchased/Self Employed Medicare Supplement LaChip Medicaid Medicare Part B NO HEALTH INSURANCE Medicare Employer Sponsored 96 Households with 203 coverages (i.e., each household has 2.11 coverages on the average)

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• IV. Where Do Patients
• IV. Where Do Patients

Go for Care? Go for Care?

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UMC UMC – – Lafayette Admissions Lafayette Admissions

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UMC UMC – – Lafayette Outpatient Visits Lafayette Outpatient Visits

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Where do the Uninsured go for care? Where do the Uninsured go for care?

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Where do Medicaid enrollees go for care? Where do Medicaid enrollees go for care?

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Where do Medicare enrollees go for care? Where do Medicare enrollees go for care?

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Where do employer Where do employer-

• insureds go for care?

insureds go for care?

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• Access to healthcare is not uniform across Region IV.

Access to healthcare is not uniform across Region IV.

• The proportion of persons who have a regular source of care

The proportion of persons who have a regular source of care varies by parish, but seems unexpectedly higher in rural areas varies by parish, but seems unexpectedly higher in rural areas among persons in “barrier populations.” among persons in “barrier populations.”

• Lafayette Parish has an abundance of providers and facilities,

Lafayette Parish has an abundance of providers and facilities, yet more than ¼ of its population reports having difficulty yet more than ¼ of its population reports having difficulty

• btaining care, delaying care for various reasons, and not
• btaining care, delaying care for various reasons, and not

getting the care it feels it needs. getting the care it feels it needs.

• Rural Region IV parishes have provider shortages, causing

Rural Region IV parishes have provider shortages, causing flight of healthcare dollars toward Lafayette flight of healthcare dollars toward Lafayette – – dollars spent by dollars spent by insured persons who also have access to transportation. insured persons who also have access to transportation.

• Careful review of available regional data should inform the

Careful review of available regional data should inform the policy decisions of the Region IV Healthcare Consortium. policy decisions of the Region IV Healthcare Consortium.

• Gathering of additional Region

Gathering of additional Region-

• specific data may prove useful

specific data may prove useful where only statewide statistics are now available. where only statewide statistics are now available.

• V. Concluding Observations
• V. Concluding Observations

43 Health Informatics Center of Acadiana

a commitment to education, research, and a commitment to education, research, and community service in health informatics! community service in health informatics! Region IV Region IV Louisiana HABITS Louisiana HABITS reports and reports and

• ther regional data tools
• ther regional data tools

can be downloaded from can be downloaded from http://hica.louisiana.edu http://hica.louisiana.edu <caillouet@louisiana.edu> <caillouet@louisiana.edu>

prepared at the prepared at the

Health Informatics Center of Acadiana Health Informatics Center of Acadiana