The findings and final work product [abridged] of my Applied Learning Experience Presentation (ALE), the thesis requirement for my Masters of Public Health degree. The National Economic and Social Rights Initiative (NESRI) served as the host organization for my project.
Madridge Journal of AIDS (ISSN: 2638-1958); This commentary will address how prosecutors can use existing legislation, innovative court-related programs, and smart prosecution techniques to fulfill their duty to protect public safety as it relates to persons with HIV in the criminal justice system.
Cook County Department of Public Health 2016 WePLAN 2020 Forces of Change Ass...Jim Bloyd
The Forces of Change Assessment identified several factors affecting public health in Cook County, Illinois, based on focus groups with knowledgeable individuals. The Affordable Care Act was seen as both an opportunity and threat by increasing access but also having limitations. State budget cuts limited resources. Climate change and marriage equality presented threats and opportunities. Incarceration and lack of economic opportunity disproportionately affected minorities and women. Large corporations were seen as prioritizing profits over communities. Focus group members felt average citizens had less power than wealthy individuals and corporations to influence policies impacting health.
The document is a letter from the National Council for Community Behavioral Healthcare responding to CMS's proposed rule on the Electronic Health Record Incentive Program. It discusses challenges community behavioral health organizations face in adopting electronic health records, including a significant digital divide compared to primary care. It recommends that CMS simplify requirements around reassigning EHR incentive payments from eligible professionals to their employing organizations to help more community behavioral health providers participate. The letter emphasizes the importance of behavioral health in overall healthcare and urges CMS to ensure the proposed rule does not further isolate behavioral health providers.
The National Council for Community Behavioral Healthcare submitted a response to the Department of Health and Human Services' strategic framework for individuals with multiple chronic conditions. The National Council represents over 1,700 community mental health and addiction treatment organizations. They stressed that mental illness and substance use disorders often co-occur with physical health conditions, worsening health outcomes. They supported several of the strategic framework's goals, including identifying best practices and tools for treating individuals with multiple chronic conditions, enhancing health professionals' training, and facilitating self-care management programs which have been effective for other chronic conditions like mental illnesses and substance use disorders. Community behavioral health organizations are well positioned to coordinate care for those with multiple chronic conditions.
The document proposes the creation of "BAND" (Behavioral-health and Addiction-training in North Dakota), a collaborative unit between the University of North Dakota and state/local partners. It would address North Dakota's behavioral health crisis by expanding training/workforce development, improving access to evidence-based services, and analyzing/disseminating data. The proposed unit would focus on issues like rapid population growth, substance use in rural areas, and expanding tele-behavioral health. It would include various specialists and have an annual budget of around $918,500. The goal is to leverage university resources and expertise to develop community-centered solutions for the state's mental health and addiction problems.
The Enrollment Opportunity for Criminal Justice PopulationsEnroll America
Slides from a webinar Enroll America co-hosted (April 9, 2014) with The California Endowment and Californians for Safety and Justice to discuss the work currently being done to ensure that criminal justice populations are connecting to the new coverage options available as a result of the Affordable Care Act. Watch the recording above — and check out the slides and related resources below — to learn about successful partnerships between criminal justice and health care systems in three states, best practices for setting up a health care enrollment program for people in the justice system, and resources for taking this work to the next level.
Colorectal cancer screening rates in West Virginia remain below national averages, with only 63.5% of residents over 50 receiving appropriate screening. West Virginia faces numerous challenges to increasing these rates, including a largely rural population with limited access to healthcare, high rates of poverty, smoking, and other cancer risk factors. However, numerous organizations are working together through the Mountains of Hope Cancer Coalition and other initiatives to help West Virginia achieve the national goal of 80% colorectal cancer screening rates by 2018 by implementing widespread screening programs, raising awareness, and improving access to care.
This document discusses plans to integrate primary care and behavioral health care in Eastern Tennessee through strategic guidance, performance improvement solutions, and addressing compatibility issues between clinical documentation systems. It provides demographics on Eastern Tennessee, which has a population of over 2 million people. Top community health needs identified include nutrition/obesity/fitness, after hours access to care, substance abuse, mental illness, diabetes, cancer, tobacco use, and cardiovascular disease. Barriers to healthcare access like lack of insurance, transportation, and provider shortages are also examined.
Madridge Journal of AIDS (ISSN: 2638-1958); This commentary will address how prosecutors can use existing legislation, innovative court-related programs, and smart prosecution techniques to fulfill their duty to protect public safety as it relates to persons with HIV in the criminal justice system.
Cook County Department of Public Health 2016 WePLAN 2020 Forces of Change Ass...Jim Bloyd
The Forces of Change Assessment identified several factors affecting public health in Cook County, Illinois, based on focus groups with knowledgeable individuals. The Affordable Care Act was seen as both an opportunity and threat by increasing access but also having limitations. State budget cuts limited resources. Climate change and marriage equality presented threats and opportunities. Incarceration and lack of economic opportunity disproportionately affected minorities and women. Large corporations were seen as prioritizing profits over communities. Focus group members felt average citizens had less power than wealthy individuals and corporations to influence policies impacting health.
The document is a letter from the National Council for Community Behavioral Healthcare responding to CMS's proposed rule on the Electronic Health Record Incentive Program. It discusses challenges community behavioral health organizations face in adopting electronic health records, including a significant digital divide compared to primary care. It recommends that CMS simplify requirements around reassigning EHR incentive payments from eligible professionals to their employing organizations to help more community behavioral health providers participate. The letter emphasizes the importance of behavioral health in overall healthcare and urges CMS to ensure the proposed rule does not further isolate behavioral health providers.
The National Council for Community Behavioral Healthcare submitted a response to the Department of Health and Human Services' strategic framework for individuals with multiple chronic conditions. The National Council represents over 1,700 community mental health and addiction treatment organizations. They stressed that mental illness and substance use disorders often co-occur with physical health conditions, worsening health outcomes. They supported several of the strategic framework's goals, including identifying best practices and tools for treating individuals with multiple chronic conditions, enhancing health professionals' training, and facilitating self-care management programs which have been effective for other chronic conditions like mental illnesses and substance use disorders. Community behavioral health organizations are well positioned to coordinate care for those with multiple chronic conditions.
The document proposes the creation of "BAND" (Behavioral-health and Addiction-training in North Dakota), a collaborative unit between the University of North Dakota and state/local partners. It would address North Dakota's behavioral health crisis by expanding training/workforce development, improving access to evidence-based services, and analyzing/disseminating data. The proposed unit would focus on issues like rapid population growth, substance use in rural areas, and expanding tele-behavioral health. It would include various specialists and have an annual budget of around $918,500. The goal is to leverage university resources and expertise to develop community-centered solutions for the state's mental health and addiction problems.
The Enrollment Opportunity for Criminal Justice PopulationsEnroll America
Slides from a webinar Enroll America co-hosted (April 9, 2014) with The California Endowment and Californians for Safety and Justice to discuss the work currently being done to ensure that criminal justice populations are connecting to the new coverage options available as a result of the Affordable Care Act. Watch the recording above — and check out the slides and related resources below — to learn about successful partnerships between criminal justice and health care systems in three states, best practices for setting up a health care enrollment program for people in the justice system, and resources for taking this work to the next level.
Colorectal cancer screening rates in West Virginia remain below national averages, with only 63.5% of residents over 50 receiving appropriate screening. West Virginia faces numerous challenges to increasing these rates, including a largely rural population with limited access to healthcare, high rates of poverty, smoking, and other cancer risk factors. However, numerous organizations are working together through the Mountains of Hope Cancer Coalition and other initiatives to help West Virginia achieve the national goal of 80% colorectal cancer screening rates by 2018 by implementing widespread screening programs, raising awareness, and improving access to care.
This document discusses plans to integrate primary care and behavioral health care in Eastern Tennessee through strategic guidance, performance improvement solutions, and addressing compatibility issues between clinical documentation systems. It provides demographics on Eastern Tennessee, which has a population of over 2 million people. Top community health needs identified include nutrition/obesity/fitness, after hours access to care, substance abuse, mental illness, diabetes, cancer, tobacco use, and cardiovascular disease. Barriers to healthcare access like lack of insurance, transportation, and provider shortages are also examined.
Healthcare causal essay sample from assignmentsupport.com essay writing ser...https://writeessayuk.com/
The document discusses challenges facing the US healthcare system as life expectancy increases and the population ages. Advancements in medicine have led to unprecedented growth in the elderly population. This will strain Medicare and increase demands for healthcare services, home care, and healthcare workers. It will also drive up overall healthcare expenditures. To support the growing elderly population, the government should promote education in health fields and encourage careers in geriatric, primary, and preventative care.
Health Care Continuity in Jail, Prison and Community brighteyes
Health Care Continuity in Jail, Prison and Community Thomas.Lincoln@bhs.org
Hampden County Correctional Center Baystate Brightwood Health Center Springfield, MA 2006
The presentation identifies vulnerable populations in rural areas and their health disparities. Rural areas are defined as having low population density and distance from urban centers with few economic activities. Approximately 19% of Americans live in rural areas and are more likely to be uninsured compared to urban residents. Rural residents experience higher rates of chronic diseases, injuries, cancer deaths and less access to preventive healthcare services. The presentation proposes a plan to address mammography compliance among uninsured rural women using a mobile mammography unit on a quarterly basis. Key elements of the plan include qualifying patients, an interdisciplinary team and addressing challenges of cost, participation and evaluating effectiveness.
This summary analyzes health and social care usage patterns for over 73,000 people in their last year of life across seven local authorities in England. It finds that while most people (89.6%) used hospital care, social care was also significant, with 27.8% receiving local authority-funded social care. Social care needs were apparent well before the end of life. The study aims to better understand the contributions of health and social care at the end of life through analyzing linked administrative data.
The Los Angeles Healthy Community Neighborhood Initiative- A Ten Year Ex...Courtney Porter
The document describes the formation and evolution of the Healthy Community Neighborhood Initiative (HCNI), a community-academic partnership in South Los Angeles aimed at addressing health disparities. It discusses how the partnership was formed between 2005-2013 through a shared vision and mutual respect between partners. Five key elements were identified as critical to building and sustaining the partnership: trust, transparency, equity and fairness, adequate resources, and developing protocols. The partnership also addressed challenges through strategies like developing a memorandum of understanding and valuing community expertise.
The Ella Faye Childs Memorial Program aims to prevent suicide among the elderly by partnering with nursing homes in Denton County, Texas that have deficiencies related to elderly mental healthcare and quality of life according to Medicare reports. The program will provide training to nursing home staff to increase quality of care and implement a 12-month prevention program with mental health services and counseling. Goals are to improve the quality of care provided by staff, increase staff competence, and decrease elderly suicide risk factors like depression and isolation among residents. The program will be piloted over 14 months in two cycles to collect outcome data and demonstrate effectiveness with the goal of expanding statewide.
This document provides a summary of the key findings from a 2011 community health needs assessment of Osceola and Lake Counties in Michigan. It finds that while the counties have some strengths like low crime rates and coordination of care, there are also many challenges. These include high unemployment, poverty, and lower educational attainment. Health indicators like mortality rates are worse than state averages. Risk behaviors like smoking and obesity are prevalent. Access to care is an issue, especially for specialty and primary care. The assessment gathered data from surveys, interviews, and secondary sources to develop a comprehensive view of the health landscape and identify priority areas for improvement.
This document provides a summary of Henry Ford Health System's 2016 Community Health Needs Assessment. It describes HFHS's service area as Wayne, Oakland, and Macomb counties, with a focus on communities where it receives most inpatient discharges. Demographic data on the Tri-County region is presented, showing a population of nearly 4 million that is 65% white and 25% black. Input from community stakeholders was gathered through surveys to understand health needs. Chronic diseases, access to care, and racial disparities were identified as ongoing priorities from the previous 2013 assessment.
The document provides an agenda and overview for the 2016 Minnesota Public Health Association Annual Conference being held on May 25-26, 2016. The conference will focus on progress being made to achieve health equity across multiple sectors through breakout sessions on implementing strategies, cross-sector partnerships, and global health. It will also include a joint session with the Minnesota Community Health Worker Alliance conference on improving health equity. The agenda outlines keynote speakers, breakout sessions on topics like food access, gun violence prevention, and addressing institutional racism. It provides learning objectives for sessions and details on presentations from state departments of health and human services.
A three-member panel at a June 3rd meeting convened by the Cook County Department of Public Health called violence a serious health threat. The panel provided examples of policies and programs that can reduce violence, including addressing social conditions like poverty. Panelists called for mentoring programs for youth and policies focused less on incarceration. They also discussed the disproportionate impact of violence on poor communities and communities of color in suburban Cook County.
The document describes the therapeutic justice model used in Bexar County, Texas to integrate treatment services and the criminal justice system. It discusses collaborations between various agencies to provide alternatives to incarceration like crisis centers, courts focused on treatment, and programs for veterans. Data is presented showing improvements in wait times and outcomes from these diversion and treatment initiatives.
The document provides information about adult day care programs and the FiftyForward adult day program in Nashville, TN. It summarizes that adult day programs provide supervision and care for seniors, allowing caregivers to work and providing social interaction for participants. It then discusses trends showing Nashville's senior population is projected to increase substantially. The purpose of the study was to describe client needs at FiftyForward. The methodology section outlines that the study used a survey of 28 current FiftyForward participants to collect demographic and health information to describe participants. Key findings included that most participants were aged 81-85, female, and Caucasian.
Jefferson County, WA has a population of around 30,000 people spread across a rural area. Access to health care is challenging due to the geography, with 80% of the county more than 30 minutes from key services like emergency care. Insurance coverage is also an issue, with 24% uninsured. The document proposes interventions to address these priorities of access and insurance, such as expanding the roles of telehealth, physician extenders, and EMS providers in remote areas, as well as providing insurance outreach and developing community health clinics. Community engagement is seen as essential to developing a successful plan.
The document provides a community health assessment of Cuyahoga County, Ohio. It finds that the county faces several health challenges, particularly in the city of Cleveland and inner ring suburbs, including high rates of poverty, cardiovascular disease, cancer, diabetes, and obesity. It also identifies issues with access to healthcare, food security, and the physical environment. The assessment concludes that addressing the needs of Cleveland and inner suburbs should be a priority and that stakeholder groups need to collaboratively prioritize issues and allocate available resources from organizations throughout the county.
The document discusses the need for improved mental health programs and services, especially in schools. It notes that while the Affordable Care Act has expanded coverage and services, stigma remains a significant barrier preventing many Asian Americans from seeking treatment. Left unaddressed, this could worsen health outcomes and social risks. The document advocates passing the Mental Health in Schools Act to establish comprehensive school-based programs and promote early intervention and prevention.
This study assessed barriers to HIV/AIDS services for Latinos in 9 Southern states. Key findings included immigration status as a major barrier, as many Latinos avoided testing and treatment due to fears of deportation. Cultural norms around homophobia and stigma also prevented many from accessing care. The report recommends developing patient navigators and legal advisors to help Latinos overcome these barriers to HIV/AIDS services.
The document provides recommendations for the Santa Clara County Public Health Department to establish goals and activities to prevent violence. It summarizes findings from an assessment of local violence data and interviews with community leaders. Key recommendations include establishing goals to frame violence as a public health issue, increase evidence-based prevention practices, integrate prevention into department programs, change social norms, and advance neighborhood-level strategies targeting high-risk groups. The department will continue prioritizing recommendations and seeking resources to implement them.
Sase and Eddy. End of Life Care. Georgetown Public Policy (2016)eriesase
This document summarizes a study examining end-of-life care for millennials caring for aging parents through a public health and human rights lens. The study analyzed key areas of end-of-life care theory and practice, finding both achievements and concerns. While concepts like patient well-being and quality of care are legally required, their lack of clear definitions creates ambiguity. Disparities also exist in availability, accessibility, acceptability and quality of care. To better support millennials and future patients, standardized services and strong public health systems are needed to ensure high quality, universal end-of-life care.
This document provides an overview of issues related to reforming the US health sector from a global perspective. It discusses how the US health system is underperforming compared to other countries despite high spending. Lessons can be learned from reviewing other countries' health reforms and systems. While no single system can be copied, aspects of different approaches may inform US reforms. The document also outlines various health care financing and delivery models used internationally, noting most countries use hybrid approaches and reforms are gradually converging around managed competition between public and private sectors.
This document summarizes the findings of a community health needs assessment conducted in Osceola and Lake Counties in Michigan. It identifies several health challenges facing residents, including higher rates of chronic conditions like diabetes and heart disease compared to the state. Social issues like poverty and lack of education negatively impact health. Access to specialty care is limited and transportation presents a barrier. However, the community benefits from strong emergency services, care coordination, and programs to address needs. Addressing issues like access to primary care, transportation, prevention/wellness, and underserved groups were prioritized for improvement.
This document provides information about a qualitative community health assessment conducted in Galveston County, Texas as part of a larger assessment of the 16 counties in Region 2. Key findings from interviews and surveys with community members and leaders in Galveston County include: barriers to health mentioned were lack of access to affordable healthcare resources and transportation, as well as economic factors; access to primary care was considered fair to good for those with insurance but limited for the uninsured, and access to specialty care was difficult even for the insured; and while the quality of services was noted to be improving, the healthcare system was seen as provider-centered rather than patient-centered.
Healthcare causal essay sample from assignmentsupport.com essay writing ser...https://writeessayuk.com/
The document discusses challenges facing the US healthcare system as life expectancy increases and the population ages. Advancements in medicine have led to unprecedented growth in the elderly population. This will strain Medicare and increase demands for healthcare services, home care, and healthcare workers. It will also drive up overall healthcare expenditures. To support the growing elderly population, the government should promote education in health fields and encourage careers in geriatric, primary, and preventative care.
Health Care Continuity in Jail, Prison and Community brighteyes
Health Care Continuity in Jail, Prison and Community Thomas.Lincoln@bhs.org
Hampden County Correctional Center Baystate Brightwood Health Center Springfield, MA 2006
The presentation identifies vulnerable populations in rural areas and their health disparities. Rural areas are defined as having low population density and distance from urban centers with few economic activities. Approximately 19% of Americans live in rural areas and are more likely to be uninsured compared to urban residents. Rural residents experience higher rates of chronic diseases, injuries, cancer deaths and less access to preventive healthcare services. The presentation proposes a plan to address mammography compliance among uninsured rural women using a mobile mammography unit on a quarterly basis. Key elements of the plan include qualifying patients, an interdisciplinary team and addressing challenges of cost, participation and evaluating effectiveness.
This summary analyzes health and social care usage patterns for over 73,000 people in their last year of life across seven local authorities in England. It finds that while most people (89.6%) used hospital care, social care was also significant, with 27.8% receiving local authority-funded social care. Social care needs were apparent well before the end of life. The study aims to better understand the contributions of health and social care at the end of life through analyzing linked administrative data.
The Los Angeles Healthy Community Neighborhood Initiative- A Ten Year Ex...Courtney Porter
The document describes the formation and evolution of the Healthy Community Neighborhood Initiative (HCNI), a community-academic partnership in South Los Angeles aimed at addressing health disparities. It discusses how the partnership was formed between 2005-2013 through a shared vision and mutual respect between partners. Five key elements were identified as critical to building and sustaining the partnership: trust, transparency, equity and fairness, adequate resources, and developing protocols. The partnership also addressed challenges through strategies like developing a memorandum of understanding and valuing community expertise.
The Ella Faye Childs Memorial Program aims to prevent suicide among the elderly by partnering with nursing homes in Denton County, Texas that have deficiencies related to elderly mental healthcare and quality of life according to Medicare reports. The program will provide training to nursing home staff to increase quality of care and implement a 12-month prevention program with mental health services and counseling. Goals are to improve the quality of care provided by staff, increase staff competence, and decrease elderly suicide risk factors like depression and isolation among residents. The program will be piloted over 14 months in two cycles to collect outcome data and demonstrate effectiveness with the goal of expanding statewide.
This document provides a summary of the key findings from a 2011 community health needs assessment of Osceola and Lake Counties in Michigan. It finds that while the counties have some strengths like low crime rates and coordination of care, there are also many challenges. These include high unemployment, poverty, and lower educational attainment. Health indicators like mortality rates are worse than state averages. Risk behaviors like smoking and obesity are prevalent. Access to care is an issue, especially for specialty and primary care. The assessment gathered data from surveys, interviews, and secondary sources to develop a comprehensive view of the health landscape and identify priority areas for improvement.
This document provides a summary of Henry Ford Health System's 2016 Community Health Needs Assessment. It describes HFHS's service area as Wayne, Oakland, and Macomb counties, with a focus on communities where it receives most inpatient discharges. Demographic data on the Tri-County region is presented, showing a population of nearly 4 million that is 65% white and 25% black. Input from community stakeholders was gathered through surveys to understand health needs. Chronic diseases, access to care, and racial disparities were identified as ongoing priorities from the previous 2013 assessment.
The document provides an agenda and overview for the 2016 Minnesota Public Health Association Annual Conference being held on May 25-26, 2016. The conference will focus on progress being made to achieve health equity across multiple sectors through breakout sessions on implementing strategies, cross-sector partnerships, and global health. It will also include a joint session with the Minnesota Community Health Worker Alliance conference on improving health equity. The agenda outlines keynote speakers, breakout sessions on topics like food access, gun violence prevention, and addressing institutional racism. It provides learning objectives for sessions and details on presentations from state departments of health and human services.
A three-member panel at a June 3rd meeting convened by the Cook County Department of Public Health called violence a serious health threat. The panel provided examples of policies and programs that can reduce violence, including addressing social conditions like poverty. Panelists called for mentoring programs for youth and policies focused less on incarceration. They also discussed the disproportionate impact of violence on poor communities and communities of color in suburban Cook County.
The document describes the therapeutic justice model used in Bexar County, Texas to integrate treatment services and the criminal justice system. It discusses collaborations between various agencies to provide alternatives to incarceration like crisis centers, courts focused on treatment, and programs for veterans. Data is presented showing improvements in wait times and outcomes from these diversion and treatment initiatives.
The document provides information about adult day care programs and the FiftyForward adult day program in Nashville, TN. It summarizes that adult day programs provide supervision and care for seniors, allowing caregivers to work and providing social interaction for participants. It then discusses trends showing Nashville's senior population is projected to increase substantially. The purpose of the study was to describe client needs at FiftyForward. The methodology section outlines that the study used a survey of 28 current FiftyForward participants to collect demographic and health information to describe participants. Key findings included that most participants were aged 81-85, female, and Caucasian.
Jefferson County, WA has a population of around 30,000 people spread across a rural area. Access to health care is challenging due to the geography, with 80% of the county more than 30 minutes from key services like emergency care. Insurance coverage is also an issue, with 24% uninsured. The document proposes interventions to address these priorities of access and insurance, such as expanding the roles of telehealth, physician extenders, and EMS providers in remote areas, as well as providing insurance outreach and developing community health clinics. Community engagement is seen as essential to developing a successful plan.
The document provides a community health assessment of Cuyahoga County, Ohio. It finds that the county faces several health challenges, particularly in the city of Cleveland and inner ring suburbs, including high rates of poverty, cardiovascular disease, cancer, diabetes, and obesity. It also identifies issues with access to healthcare, food security, and the physical environment. The assessment concludes that addressing the needs of Cleveland and inner suburbs should be a priority and that stakeholder groups need to collaboratively prioritize issues and allocate available resources from organizations throughout the county.
The document discusses the need for improved mental health programs and services, especially in schools. It notes that while the Affordable Care Act has expanded coverage and services, stigma remains a significant barrier preventing many Asian Americans from seeking treatment. Left unaddressed, this could worsen health outcomes and social risks. The document advocates passing the Mental Health in Schools Act to establish comprehensive school-based programs and promote early intervention and prevention.
This study assessed barriers to HIV/AIDS services for Latinos in 9 Southern states. Key findings included immigration status as a major barrier, as many Latinos avoided testing and treatment due to fears of deportation. Cultural norms around homophobia and stigma also prevented many from accessing care. The report recommends developing patient navigators and legal advisors to help Latinos overcome these barriers to HIV/AIDS services.
The document provides recommendations for the Santa Clara County Public Health Department to establish goals and activities to prevent violence. It summarizes findings from an assessment of local violence data and interviews with community leaders. Key recommendations include establishing goals to frame violence as a public health issue, increase evidence-based prevention practices, integrate prevention into department programs, change social norms, and advance neighborhood-level strategies targeting high-risk groups. The department will continue prioritizing recommendations and seeking resources to implement them.
Sase and Eddy. End of Life Care. Georgetown Public Policy (2016)eriesase
This document summarizes a study examining end-of-life care for millennials caring for aging parents through a public health and human rights lens. The study analyzed key areas of end-of-life care theory and practice, finding both achievements and concerns. While concepts like patient well-being and quality of care are legally required, their lack of clear definitions creates ambiguity. Disparities also exist in availability, accessibility, acceptability and quality of care. To better support millennials and future patients, standardized services and strong public health systems are needed to ensure high quality, universal end-of-life care.
This document provides an overview of issues related to reforming the US health sector from a global perspective. It discusses how the US health system is underperforming compared to other countries despite high spending. Lessons can be learned from reviewing other countries' health reforms and systems. While no single system can be copied, aspects of different approaches may inform US reforms. The document also outlines various health care financing and delivery models used internationally, noting most countries use hybrid approaches and reforms are gradually converging around managed competition between public and private sectors.
This document summarizes the findings of a community health needs assessment conducted in Osceola and Lake Counties in Michigan. It identifies several health challenges facing residents, including higher rates of chronic conditions like diabetes and heart disease compared to the state. Social issues like poverty and lack of education negatively impact health. Access to specialty care is limited and transportation presents a barrier. However, the community benefits from strong emergency services, care coordination, and programs to address needs. Addressing issues like access to primary care, transportation, prevention/wellness, and underserved groups were prioritized for improvement.
This document provides information about a qualitative community health assessment conducted in Galveston County, Texas as part of a larger assessment of the 16 counties in Region 2. Key findings from interviews and surveys with community members and leaders in Galveston County include: barriers to health mentioned were lack of access to affordable healthcare resources and transportation, as well as economic factors; access to primary care was considered fair to good for those with insurance but limited for the uninsured, and access to specialty care was difficult even for the insured; and while the quality of services was noted to be improving, the healthcare system was seen as provider-centered rather than patient-centered.
The document discusses conducting a community health needs assessment (CHNA) for senior citizens in the Hispanic community. The goals of the CHNA are to understand the current health status, risks, and resources for elderly Hispanics in order to identify issues and guide health improvement efforts. Methods of data collection and key community resources will be examined. The CHNA will provide insight to help address health needs and prioritize community health planning.
The document provides an executive summary of the 2016 Community Health Needs Assessment conducted by Excela Health for Westmoreland County, Pennsylvania. It identifies the top three community health issues selected for focus based on data collection and prioritization: 1) obesity, exercise, and nutrition, 2) substance abuse, and 3) women's health. Primary data was collected through stakeholder interviews, focus groups, and a community survey, which identified issues like poverty, substance abuse, transportation barriers, and access to care. The assessment will be used to develop an implementation plan to address the selected health issues.
The document discusses the roles and responsibilities of local health departments in providing public health services. It describes how the nearly 3,000 local health departments in the US vary in size and services depending on the community needs. The core services identified by the National Public Health Performance Standards Program include monitoring health status, diagnosing and investigating diseases, informing and educating the public, developing health policies and plans, and enforcing regulations. Employees of local health departments are responsible for assessing community health needs, investigating disease outbreaks, providing health education, and ensuring access to healthcare. The Washington County Health Department in Tennessee was used as an example, outlining its mission and services such as WIC, immunizations, and health promotion programs.
The document discusses homelessness and health care in Multnomah County, Oregon. It notes that homelessness remains a major public health challenge, leaving those without housing vulnerable to disease and health issues. The expansion of Medicaid under the Affordable Care Act in 2014 has the potential to significantly improve access to health care for the homeless population in Multnomah County. The document analyzes data on homelessness in the county, health outcomes for the homeless, the health care system prior to reform, implementation of the ACA, and initial outreach efforts to the homeless. It concludes with recommendations for maximizing health benefits for the homeless under health care reform.
Qualitative Research on Health as a Human Right in Lewis & Clark County, Mont...Purvi P. Patel
The final presentation of my Applied Learning Experience Presentation (ALE), the thesis requirement for my Masters of Public Health degree. The National Economic and Social Rights Initiative (NESRI) served as the host organization for my project. The final community presentation/defense was presented to the Tufts Medical School community in December 2009.
This document summarizes a presentation about addressing health equity in rural communities. It discusses exploring issues of health equity and social determinants of health. It provides examples of how social factors like income, education and housing affect health outcomes. It also describes the PLACE MATTERS initiative which helps communities address social conditions that impact health and discusses challenges to addressing social determinants of health.
This document provides a summary of the 2015 Community Health Needs Assessment conducted by Lake Regional Health System. Key findings from the assessment include:
1) The leading causes of death in the community as defined by Camden, Miller, and Morgan counties are heart disease, cancer, and smoking-related illness. Rates of premature death are higher than the state average.
2) Overweight and obesity rates are high, with over one-third of adults considered overweight or obese. This puts residents at risk for other health issues.
3) Through a community survey and focus groups, the top four prioritized health needs were identified as access to primary/specialty care, mental health, smoking/tobacco use,
Community members and stakeholders in North Carolina provided perspectives on health equity as part of a statewide healthy environments initiative. Through focus groups and interviews, they discussed three strategies - farmers markets, shared outdoor spaces, and smoke-free housing. Two key themes emerged. First, "access" - how easy it is for communities to use resources. Factors like location, cost, and safety can create barriers. Second, "community fit" - whether a strategy aligns with community values and norms. Suggestions to improve equity focused on transportation, market hours, safety, and involving both smokers and nonsmokers in policy decisions. The views of community members and stakeholders can help shape culturally-relevant strategies to promote health and prevent chronic diseases
Final lomboy nosorh congregational health presentationalomboy
The document summarizes a study on community engagement models for rural congregational health initiatives. Surveys were conducted with civic, clergy, education, government, and medical leaders across 4 counties to assess existing health programs and resources. The surveys found that while religious institutions see a connection between physical and spiritual health, barriers like lack of information and funding prevent greater collaboration between congregations and secular organizations on health issues.
This document summarizes a pilot program assessing the health needs of congregations in Essex County, Virginia. Surveys were conducted with clergy, civic leaders, medical professionals, government officials, and educators. The surveys found that while few congregations had active health ministries, most pastors were interested in offering health education if provided guidance and resources. Common health concerns were aging, heart disease, and cancer. The report recommends developing a model health ministry program, toolkit, and continued research to engage faith communities in improving community health.
1. The document describes a community health needs assessment (CHNA) conducted for a rural hospital in Georgia through a partnership between the hospital, local communities, and the University of Georgia.
2. A team of students and faculty used a 5-step process recommended by Georgia Watch to define the community, collect secondary health data, gather primary data through surveys, focus groups and interviews, prioritize health issues, and develop an implementation strategy.
3. The CHNA identified four priority health issues in the community through analysis of primary and secondary data and prioritization by community stakeholders. An implementation strategy was developed to address the priorities.
'I Need Connection' City Life research paper 2010Janet Reid
This document provides an executive summary and background for a research project conducted by two community development students. The research was commissioned by City Life, a Christian charity that provides services to the homeless and disadvantaged in Frankston, Victoria. The objectives of the research were to understand what health and wellbeing means to City Life's clients, identify barriers they face, and discover services that could help support their health and wellbeing. The research utilized participatory action research methods including surveys, focus groups, and a forum with 50 total clients. Key findings included that clients have physical and/or mental illnesses, rely on government pensions, and desire better social connections and support groups to improve their health and wellbeing. Based on the findings, the researchers
This document is a final report from the Congregational Health ReSource analyzing a pilot program assessing the health needs of congregations in Luray, Virginia. Surveys of clergy, medical, and civic leaders found that while none had active health ministries, churches support member health in other ways. Leaders saw connections between physical, emotional and spiritual health. The report recommends developing a model statewide health ministry program, toolkit, and pilot rural program to engage faith communities in improving public health.
This white paper summarizes the proceedings of the 2014 National Summit on Cancer in LGBT Communities. The summit brought together 56 experts to discuss cancer-related issues for LGBT populations and develop a national action plan. Key topics included a lack of data on cancer incidence and outcomes for LGBT people, health disparities such as higher tobacco use, and barriers to care like lack of protections from discrimination. The white paper outlines 16 recommendations across data collection, clinical care, and provider education to address cancer disparities experienced by LGBT communities.
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Qualitative Research on Health as a Human Right in Lewis & Clark County, Montana
1. Purvi Patel
JD/MPH Class of 2010
Tufts University School of Medicine
Department of Public Health & Professional Degrees
Master of Public Health
Applied Learning Experience (ALE)
Project Title: Implementing a Human Right to Healthcare: A Qualitative Case Study in Lewis &
Clark County, Montana.
Project Site: National Economic & Social Rights Initiative
Preceptor: Anja Rudiger, Human Right to Health Program Director
Community Presentation: available at http://www.slideshare.net/patelpurvip/qualitative-research-
on-health-as-a-human-right-in-lewis-clark-county-montana
Abstract
Lewis & Clark County, Montana is home to approximately 60,000 Montana residents, many of
them concentrated in a few small towns, such as Helena (the state capital), Augusta, and Lincoln.
The best available data indicated that 21% of county residents live without health insurance.
Furthermore, residents without health insurance experience serious lack of access to healthcare,
factors that contribute to serious health problems such as increased risk of dying from cancer,
serious complications and worse clinical outcomes for chronic diseases like diabetes, cardiovascular
disease, and mental illness. On December 4, 2008, the Lewis & Clark County Board passed a
resolution declaring health and healthcare to be a human right for all of its county residents, and
creating a task force charged with conducting a countywide health needs assessment to investigate
ways to implement the new mandate.
To assist with the county’s health needs assessment, this project (working with NESRI) sought
to evaluate qualitative focus group data gathered from Lewis & Clark county residents regarding
current access to healthcare, quality of services, and barriers to receiving or seeking care, as well as
opinions on the notion of health and health care as a human right. Qualitative research was
conducted by NESRI and the Montana Human Rights Network (MHRN) through eight focus groups
in four towns within Lewis & Clark County between mid-August and early-November 2009.
Groups ranged in size from two to fourteen participants, with a total of 47 participants. Focus
groups sought:
1. To identify how sample populations (rural, uninsured, underinsured, etc.) use health
services;
2. To identify barriers to accessing health care;
3. To identify unmet health needs;
4. To solicit recommendations on what measures the county should take to move toward
universal access; and
5. To obtain feedback on the Board of Health’s resolution
2. IRB exemption was sought and granted because analysis consisted of evaluating de-identified
qualitative data from focus group transcripts. Group-by-group demographics were gathered through
the use of participant monitoring forms, and aggregated to provide an overall picture of research
demographics for the project. Over half of focus group participants were between the ages of 45-64
years; none of the participants fell between 35-44 years-old, which was seen as a short coming in
the sample groups researchers were able to recruit. Education level was fairly well distributed
among participants, however about two-thirds or participants had $50,000 of income per year or
less. Almost two-thirds of participants depended on employer-sponsored or governments-sponsored
(i.e. Medicare or Medicaid) plans for health insurance; around one quarter of participants were
uninsured.
Qualitative data was analyzed according to a human right to health framework, looking at
themes of access to care (costs and financing), availability of services, quality of care, and dignity in
treatment. Participants of all groups except one (Augusta) were also asked to discuss whether they
believe health and healthcare to be a human right. Participants offered a range of suggestions for
the county in the areas of expanding health care services, particularly primary care, improving care
coordination, improving the navigability of the health system, improving transportation, and
expanding financing options. Based on these findings, we drafted preliminary recommendations for
reform to the Lewis & Clark County Health Task Force.
3. Problem Analysis
Lewis & Clark County, home to Montana state capital Helena, hosts 60,925 residents,1
21% of
whom currently live without health insurance – which amounts to thousands of individuals.2
In
2006, it was estimated that 12% of the Montana adult population in general was unable to visit a
doctor due to cost.3
Such data suggest serious complications and worse clinical outcomes for
chronic diseases like diabetes, cardiovascular disease, and mental illness.4
Montana is also ranked
highest in the country in the number of completed suicides.5
In Lewis & Clark County specifically:
Almost 29% of people in Lewis and Clark County live below 200% of the federal poverty
level (FPL)
21% lack health insurance
7% are on Medicaid
54% of Community Health Center clients were uninsured in 20046
As the 2008-09 debate over national healthcare reform grew increasingly contentious, many
state and local governments increasingly felt compelled to respond to the health needs of their
residents. Based on statistics such as those above, and in the shadow of the ongoing debate over
health reform, and the fierce arguments over a potential national pubic health insurance option, the
Health Board of Lewis & Clark County in Montana approved a resolution in early December 2008
recognizing a “basic human right” to healthcare for all of its residents7
.
To comply with the new county health care resolution, the Lewis & County Clark County
Health Board created a locally-grounded Task Force on local Access to Universal Healthcare
charged with assessing the health care needs in the county, and to make recommendations about
implementing the new healthcare mandate. The Task Force is currently developing an action plan
for providing access to universal health care in Lewis and Clark County and moving toward a
universal, equitable system. To this end, the Task Force is expected to produce a final report of its
recommendations by March 2010. Based on the task force’s recommendations, the county Health
Board will then try to design some a plan or system that provides universal health care for the area.8
In the words of one Helena city commissioner and Health Board member, “[the Board] said, ‘Let’s
see what we can do to change the debate, and maybe end up with some solutions that we don’t even
know exist at this point.’ ”9
Description of the Agency and Partners: NESRI & the Montana Human Rights Network
As an initial step, the L&C county health Task Force sought the assistance of the Montana
1
Lewis & Clark County population statistics, 2008. Available at: http://quickfacts.census.gov/qfd/states/30/30049.html.
2
Mike Dennison, City-County Health Board proposes universal health care. IR State Bureau, HelenaIR.com, Dec 12, 2008.
3
Lewis & Clark County, 2009 Leading Public Health Indicators, Lewis & Clark City-County Health Department, 13.
4
Draft resolution available at www.nesri.org/.../Local_Universal_Healthcare_Resolution_Final_December.pdf.
5
Lewis & Clark County, 2009 Leading Public Health Indicators, , 12.
6
Health and Health Care in Lewis & Clark County: An Initial Data Review. Human Right to Health Program, NESRI / NHeLP, 18.
7
Dennison
8
Dennison.
9
Dennison.
4. Human Rights Network (MHRN) and NESRI to better understand the needs of county residents
through a health needs assessment.
National Economic and Human Rights Initiative
The National Economic and Social Rights Initiative (NESRI) promotes a human rights vision
for the United States that ensures dignity and access to the basic resources needed for human
development and civic participation. Towards this end, NESRI works with organizers, policy
advocates and legal organizations to incorporate a human rights perspective into their work and
build human rights advocacy models tailored for the United States. NESRI takes a partnership
approach to building a human rights culture in the United States, and prioritizes partnerships at the
community level.
Preceptor: Anja Rudiger (NESRI)
Anja Rudiger is the Director of the Human Right to Health Program, a joint program run by
NESRI and the National Health Law Program. Ms. Rudiger works with state-based coalitions to
develop human rights approaches and tools for health care reform efforts. She is an expert on
human rights and equality, specializing in policy analysis of disparities in the exercise of civic,
economic and social rights. She has extensive experience integrating a rights-based approach to
policymaking at local, national and international level. Previously, Ms. Rudiger carried out
consultancies for governmental and non-governmental organizations, led the research department at
the British Refugee Council in London, and managed the UK Secretariat of the European
Monitoring Centre on Racism and Xenophobia. She received her Ph.D. in Political Science from
the University of Kiel in Germany.
Collaborators: Montana Human Rights Network
Based in Helena, the Montana Human Rights Network (MHRN) is a grassroots, membership-
based organization of over 1400 members. MHRN’s mission is two-fold: 1) To promote
democratic values such as pluralism, equality and justice; challenge bigotry and intolerance; and
organize communities to speak out in support of democratic principles and institutions; and 2) To
challenge hate groups and other extremists who use violence and intimidation as tools for political
activism.
Methodology
To implement a countywide health needs assessment, the partner agencies began consulting
with community members and collecting their suggestions for improving access to care. Based on
the belief that community members’ health needs and ideas for improvement can best be explored
through qualitative and participatory research, the Task Force and its partners decided to implement
use of a qualitative research component to the assessment through focus groups with community
members. Through focus groups, the Task Force hoped to be able to get useful in-depth information
on barriers to access, diagnose specific issues that need to be addressed, gain views on potential
improvements, and build awareness and support within the community for the planning phase of
project.
[rest of Methods section truncated]
5. Using a Human Rights Framework of Analysis
Initial drafting of the focus group protocol used basic tenets of a human rights framework to
guide the questions asked of participants. The human rights framework protects civil, political,
economic, social and cultural rights. Each right recognized under this framework adheres to basic
principals that are always part of human rights standards and implementation. These principals
include universality, indivisibility, participation, accountability, transparency, and non-
discrimination.
Data gathered from the focus groups was analyzed under a human right to health framework,
which assumes that the purpose of a health care system is to protect health of each member of
society. As such, its design must be guided by the following key human rights standards:
Universal access: Access to health care must be universal, guaranteed for all on an equitable
basis. Health care must be affordable and comprehensive for everyone, and physically
accessible where and when needed.
o Affordability: Health care must be affordable for everyone, with charges based on the
ability to pay, regardless of how health care delivery is financed
o Equity: Health care must be distributed equitably, with resources allocated and used
according to needs and health risks.
o Comprehensiveness: Health care must include all screening, treatments, therapies
and drugs needed to preserve and restore health, including reproductive health.
Availability: Adequate health care infrastructure (e.g. hospitals, community health facilities,
trained health care professionals), goods (e.g. drugs, equipment) and services (e.g. primary
care, mental health) must be available in all geographical areas and to all communities.
Acceptability and Dignity: Health care institutions and providers must respect dignity,
provide culturally appropriate care, be responsive to needs based on gender, age, culture,
language, and different ways of life and abilities. They must respect medical ethics and
protect confidentiality.
Quality: All health care must be medically appropriate and of good quality, guided by
quality standards and control mechanisms, and provided in a timely, safe, and patient-
centered manner.
The following principles, which apply to all human rights, are also essential elements of a health
care system:
Non-discrimination: Health care must be accessible and provided without discrimination (in
intent or effect) based on health status, race, ethnicity, age, sex, sexuality, disability,
language, religion, national origin, income, or social status
Information and Transparency: Health information must be easily accessible for everyone,
enabling people to protect their health and claim quality health services. Institutions that
organize, finance or deliver health care must operate transparently.
Participation: Individuals and communities must be able to take an active role in decisions
6. that affect their health, including in the organization and implementation of health care
services.
Accountability: Private companies and public agencies must be held accountable for
protecting the right to health care through enforceable standards, regulations, and
independent compliance monitoring.
Results: Participant Demographics
Of the 47 participants, across eight focus groups, over half (57.1%) were between 45-64 years
of age. Not a single participant fell into the 35-44 years-old range, reflecting a gap in our sampling
pool. Participants’ education levels were considerable more varied. Three quarters of participants
who responded about their education level had either a high school diploma, an associates degree,
or a bachelors degree. An additional 20% of responding participants had obtained a graduate
degree, while 5% had not finished high school.
Over two-thirds (almost 70%) of participants made incomes of $50,000 or less. In 16 of those
cases (41%) cases, participants made less than $15,000 per year. Of those who had health care
insurance at the time of the focus group, about 37% had employer based insurance, while over 39%
had government sponsored program (i.e. Medicare and Medicaid, excluding coverage through the
Department of Veterans Affairs). About one quarter of participants (24) were uninsured.
Racial or ethnic discrimination was not a big issue. The vast majority of participants identified
as US-born Caucasians, with two of the participants identifying as Native American, and one
defining as a naturalized America citizen from China. As a result, racial or ethnic/discrimination
was not as much of a concern as economic disparities between participants.
Groups Conducted (8 groups, 47 Participants)
Group Date # Participants
Experts 8/17/09 3
YWCA 8/17/09 7
Canyon Creek 8/19/09 2
Lincoln 1 8/20/09 2
Augusta 8/25/09 13
FoodShare 10/13/09 10
Lincoln 2 10/14/09 3
Helena 4 11/5/09 7
Gender Percentages
Male Female
40% 60%
7. Residency Status
(Unknowns excluded) number percentage
US-born Citz. 45 98%
Naturalized Citz. 1 2%
Immigrant 0 0%
Race/Ethnicity number percentage
White 45 96%
American Indian/
Alaskan Native
2 4%
Education no HS Diploma
HS/GED
Associate's
Bachelor's
Graduate
Education Level
(Unknowns excluded) number percentage
no HS Diploma 2 5%
HS/GED 14 34%
Associate's 4 10%
Bachelor's 13 32%
Graduate 8 20%
Income
< $20,000
$20,000 - $49,999
$50,000 - $100,000
$100K+
HouseholdIn come
(Unknowns excluded) number percentage
< $20,000 16 41%
$20,000 - $49,999 11 28%
$50,000 - $100,000 9 23%
$100K+ 3 8%
Average Age = 52.0 years-old
(Unknowns excluded)
Age Range number percentage
18-24 years 2 5%
25-34 years 5 12%
35-44 years 0 0%
45-54 years 11 26%
55-64 years 13 31%
65+ years 11 26%
Health Insurance Status
Uninsured
Employer-based
Gov-sponsored
Individual
Other (e.g. VA,
parents)
NOTE: some participants had more than one source of insurance
Insurance Status
(Unknowns excluded) number percentage
Uninsured 11 24%
Employer-based 17 37%
Gov-sponsored 14 30%
Individual 6 13%
Other (e.g. VA, parents) 5 11%
8. “Some of the doctors, that are listed in the yellow pages, they’re full. I’ve been having trouble finding a family
doctor because I was going to one, but I can’t see him anymore. I’m trying to find a new one, but the people that
people have been referring me to, they’re full so they won’t take any more. And I stopped looking, but I’ve had
that happen a few times.”
YWCA Focus Group
Results: Key Findings
GENERAL OVERVIEW
Availability of health care– lower income residents generally felt there was a shortage of service
providers in the county. Rural residents felt this particularly acutely. Low income residents also had
difficulty finding health care providers. Higher income residents experienced fewer problems with
finding service providers, with the possible exception of in-county mental health services.
Access (Cost) – Most participants, particularly
low-income and middle-income residents have
experienced difficulty finding insurance, using the
insurance they have, or paying out of pocket.
Quality – There were many positive statements
regarding quality of care, particularly regarding the Lincoln Clinic. However, across the board there
were serious quality concerns, about aspects of care, particularly related to St Peter’s Hospital.
Acceptability/Dignity –Concerns about dignity during provision of service were raised by low-
income residents – particularly the uninsured and those on Medicaid – as well as residents seeking
long-term mental health care.
Health Care as a Human Right –The majority of participants did consider health care to be a
human right. Several others emphasized ethical obligations to meet health care needs, but did not
feel comfortable expressing that in human rights terms. Many participants stressed that to have a
healthy community, the government or community needed to help everybody to be healthy.
Suggestions for reform – participants offered a range of suggestions in the areas of expanding
health services, improving care coordination, improving navigability, etc.
Discussion
Availability of Services
Availability of health services in Lewis and Clark County can be poor. Availability of primary
care to local residents is impeded by a shortage of primary care providers, as well as a lack of off-
peak office hours during which patients can make appointments without conflicting with their work
schedules. Residents also noted a shortage of specialists, particularly quality dental care for low-
income residents as well as mental health providers in general. Referrals to specialists often require
“The cost of medical care is probably the
number one thing preventing anyone from
going to the doctor”
Augusta Focus Group
9. patients go out-of-county or out-of-network for services, the latter resulting in the patient having to
pay out of pocket for care.
Physicians working within the current health care model are required to operate as businesses.
Because their financial survival depends upon making smart business decisions, health care
professionals may only open practices in areas that promise large populations to care for and the
potential to recruit and retain staff. Consequently, rural populations will lack local services, and will
consequently have to travel great distances to find available care. This can also be a particular
problem for low-income patients because, working within a market model, health care professionals
may only take patients with insurance, may restrict the number of publically-insured patients that
they care for, or may not accept Medicare or Medicaid patients altogether.
There is also poor availability of transportation options to get rural residents and the elderly – other
than private transportation or dependence on family and friends. The ambulance service in Helena
is too expensive for many residence, although residents in Lincoln and Augusta praised the service
provided local volunteer ambulances. Issues of transportation go hand in hand with geographic
isolation from medical facilities, especially for the elderly and northern county residents.
The structure of the current system and its many different forms of administration means that
each person, depending on their insurance (or lack of insurance), requires a different set of
information in order for them to successfully navigate the health system. Patients often do not know
where to go to get the information they particularly need in order to access the available health
services that they can personally afford. Information about ways to obtain cheaper medication or
insurance is also difficult to come by, and prices for services may not be uniform in different
locations, making it difficult for patients to determine whether or not they are getting the best deal.
Thus, availability can be restricted financially, physically, and through a lack of knowledge of what
is available. Lastly, children and teenagers may face additional barriers such that, even if they do
know where to get the services they need, they may not feel comfortable with telling their parents
about their health needs, or might have parents who wish for their children not to seek services.
Access: Cost & Financing
Almost all respondents felt that health care and health insurance was too expensive, and many
residents had (at some point) chosen to forgo health insurance or healthcare, or both, due to
financial considerations. In some cases, uninsured individuals were uninsured simply because of a
calculated decision that insurance was too expensive to be worth purchasing. As a market good,
access to health care is based on a person’s ability to pay for it, but there is overwhelming evidence
that market mechanisms fail to provide equal access to health care.
Although most respondents had insurance, many
had very meager plans with high deductibles that
precluded them from using their insurance to obtain
needed care, instead reserving insurance for use only in
“You know, I grew up pretty darn poor. And I remember 15 years of early marriage paying 5 or 10 dollars to a
whole bunch of separate medical providers. And not being able to, I mean, it takes 15 years to pay off something.
Well that’s going on all over the country right now. And there’s a whole bunch of people that aren’t getting
service at all. I mean that makes me sad.”
2nd
Lincoln Focus Group
“[I]f you don’t have money, then you
don’t have the right to care.”
Helena 4 Focus Group
10. cases of extreme emergency. Because of the expense, participants reported forgoing care or waiting
to get care until they can no longer avoid it. In some cases, people felt that it would be better for
them to die so that financial burdens on their families could be eased. When care was sought,
information about bills was in several cases confusing or incomprehensible without assistance. In
some cases, bills contained errors that patients had difficulty getting corrected. Many respondents
felt threatened by medical bills, did not feel supported by their insurer, and in some cases, feared
legal repercussions on their finances.
Government-sponsored insurance was generally seen as a positive option; however there were
problems with its availability and administration. There was concern that people who needed
government-sponsored insurance but were not eligible (particularly poor people who made too
much for Medicaid and retired individuals that were not yet old enough to qualify for Medicare).
There was also concern that applying for the programs, particularly the Medicaid application
process, was too difficult to navigate alone.
Quality of Care
There were many services in Lewis and Clark County that garnered praise. However, such
comments were overshadowed by many negative comments about quality of care received. The
quality of care at the Lincoln clinic, county WIC services, the Helena Foodshare, and volunteer
ambulance services especially were highly praised. Some concerns were related to the current
system’s rewards for the use of technology and pharmaceuticals rather than quality, appropriate
care. Repeated concerns over quality of care were raised regarding St. Peter’s Hospital in Helena,
particularly for emergency care.
Some, participants, particularly those without financial means, and those with specific health
conditions, felt judged, stigmatized, and treated badly in the local health care system. They
attributed this to their inability to pay for their care, or a lack of proper understanding of their health
problems. For example, participants raised multiple concerns over quality, patient-centered mental
health care tailored to what was appropriate for the individual patient.
Participants also reported a lack of communication between providers in cases where they were
seeing multiple providers, both regarding patient care as well as valuable knowledge and
information. This created frustration for patients, who may have been subjected to inefficient care.
In some cases, participants stated or implied that service providers prioritized profitability at the
expense of quality care. When health care is viewed as a commodity to be bought and sold, low-
income people that are unable to pay for their care may be seen to be taking advantage of the
system, or receiving “charity”. The presence of this view was reflected, and particularly apparent, in
prejudice by other participants against alleged “welfare” recipients (a term sometimes erroneously
used to refer to anyone participating in a government-sponsored program) or “illegal” immigrants.
“I was really in pain, and nobody came out in all this time to say ‘ok, is there anything we can do?’ … And I was
getting madder and madder, but there wasn’t anything I could do about it because I couldn’t move. [He] gave me a
couple of pills, and said I could take one or two of them, and said, ‘Alright, I’ll have the nurse get you a walker so
that you can get home alright.’ I have steps going up to my house, and my bathroom was upstairs, I live alone, and
I told him this. And he said, you know, ‘I’d really like to admit you but I can’t.’”
Taskforce Focus Group
11. Acceptability & Dignity in Treatment
Some respondents, particularly low-income participants, expressed concern about being treated
with respect by health providers. Multiple participa9nts felt that doctors had been dismissive of
their concerns, and in some cases, were made to feel that they had no right to express concerns over
quality of care simply because they were not paying for the full cost of their care.
There was also concern about mental health care, and particularly a lack of understanding
among county providers about differen mental health disorders (ex: understanding about PTSD
among medical providers outside the VA system). Patients reported being given excessive
medications, or not receiving adequate care such that when their condition worsened, they were
reported to the police rather than mental health providers.
Health and Healthcare as a Human Right?
All but one of the focus groups were posed the question of whether they considered health care
to be a human right, and the majority generally agreed that health care was a human right. Low-
income participants, as well as Medicare and Medicaid beneficiaries overwhelmingly agreed on
health and healthcare as a human right. Some participants qualified their agreement with a caveat
that healthcare went hand-in-hand a certain degree of personal responsibility to keep oneself
healthy. Of those who stated that they did not believe healthcare to be a human right, participants
still placed high importance on healthcare, and often associated the availability of healthcare with
ethical responsibility. For example, some participants qualified healthcare as a “human need” rather
than a “human right.” When asked to explain the term “human need”, the explanation was couched
in human rights doctrine, suggesting that it was the terminology of “human right” that participants
hesitated to use, rather than reservations about the concept itself.
Participants were more split over the question of government involvement in providing residents
with healthcare. While many participants (especially Medicare beneficiaries) were in favor of
government involvement in providing healthcare coverage, several other participants – especially
rural participants – were resistant to the idea of government involvement. Some participants chose
“I believe [health care] is a right, but it does come with responsibility, and that's the challenge for society, to
impress upon people what their basic responsibility is to each other, as a society what we're all responsible
to each other here to do our best to be contributors to society, to be honest, to be good parents, good
friends, you know it's the community. Somehow we have to rise up better, I think, than we do."
Lincoln 2 Focus Group
“I went in Wednesday, pulled a tooth that was abscessed. I told them I needed antibiotics, and they said
no. I went back Friday as my face was even more swollen than it is now. He kind of laughed and said, “Well,
I guess we should have started those antibiotics anyhow.” Then reminded me that I was getting the care for
free. … I’m going to get into a different dentist that will take payments because it broke one tooth, pulling
one out, and I was reminded twice that I was getting the service for free.”
YWCA Focus Group
12. a middle ground of “moderate” guidance by the
government in healthcare matters. Participants did
generally agree that children should be covered by
health insurance. For those who opposed government
involvement, there was a general agreement that where
individuals had difficulty taking care of themselves,
the community should provide some assistance in
filling the gap. Some participants voiced skepticism
that there was anything that could be done at the
county-level to address their concerns, but there was
some hope that the county could maybe address some
transportation issues, improving funding for facilities
like the cooperative health center, and engage with neighboring counties to better address the needs
of residents on the borders. There was, however, a general agreement that some collective
obligation exists to ensure access to health care for all, especially in order to have a healthy
community. Most participants saw some role for either government or the local community to help
everybody to be as healthy as possible.
Recommendations
The focus groups yielded a host of suggestions from participants about what needed to be done
in order to improve health care for county residents, most of which centered on expanding existing
services, improving care-coordination, improving navigability of health services, and expanding or
improving financing options. While some suggestions referred to issues outside the county’s
authority, many others would require only minor changes. In many instances, participants did not
readily think of systemic changes and instead focused on specific improvements to make their usage
of the system easier. Some participants, mainly from Augusta, voiced skepticism that there was
anything that could be done at the county level to address their concerns.
Residents particularly pointed to a need to expand primary care services, especially for low-
income and more rural patients. Suggestions included improving funding for satellite or traveling
clinics to northern parts of the counties, and expanding office hours to include some options for off-
peak hour appointments. There were multiple suggestions to improve the availability of children-
centered services, both primary care and mental health services. Improved coordination of health-
related information sharingwas a major issue raised in several contexts: disseminating health
services information to residents, improving communication between providers, and coordinating
with neighboring counties to ensure adequate services for northern county residents. Multiple
suggestions to improve transportation, particularly for the elderly, were also made.
Among the recommendations that may need to be addressed at the state level are extending
eligibility for Medicaid, requiring employers to allow paid sick days, and addressing high costs of
coverage and care. Some suggestions however could be easily implemented at the county level,
starting with improving the availability of comprehensive, user-friendly information and advice
about health services, for example through creating a health information center or an 800-number,
and improving public transportation, particularly within Helena and between Lincoln and Helena.
More systemic changes, however, are clearly needed and demanded. Expanding primary care
services, including dental care, through the Cooperative Health Center and satellites would fill
crucial gaps particularly for rural and lower-income communities. Finally, based on participants’
“We’re human beings; it doesn’t matter
whether we make $7 an hour or six digits
a year. We’re humans and we all have
something to offer. … Why can’t we get
room deserves excellent doctors and
caring, patient people. Why is our
income a factor in that? I don’t
understand that. So it should be a right,
and it is very much about respect.”
YWCA Focus Group
13. comments, the role of the hospital in the community would need to be improved with some
urgency.
Limitations
The fact that we were not able recruit
participants quite in the manner as we had
hoped to do under the sampling framework
presented a major limitation. Of the eight
focus groups held, four of them had either
only two or three participants, while two
groups had ten or more participants. Thus
the distribution of participants among focus groups was not as even as we would have liked.
However, the larger groups were held outside of Helena, and while some of the Helena groups were
smaller, there were more groups conducted in Helena (4) than anywhere else. The other issues in
sample can be seen in the fact that none of our participants fell into the 35-44 years age group. The
average participant age was over 50 years-old, indicating a generally older set of participants.
Aside from sampling limitations, there was also acknowledgement that uniformity in how each
of the groups was conducted might be difficult to ensure. This is due to the fact that while the first
few focus groups were conducted with representatives from NESRI (trained in qualitative research),
later groups were run solely by MHRN and Task Force representatives, who had been trained by
NESRI but were themselves new and much less familiar with conducting qualitative research.
Conclusion
Overall, the participants and partner response to
the project seemed positive, and hopefully, the project
will provide the county health Task Force with some
ideas for county-level improvements to the existing
system. While the county might not have the funds to open a full clinic in August to serve northern
county residents, a small satellite clinic or traveling services to the northern areas of the county
might fill some of the gap. Furthermore, although the county may not be able to require more
providers to accept sliding-scale fees or payment plans, increased funding to the community health
center or a new similar facility would help increase the availability of primary care and dental
services to low-income patients. The county also needs some way of monitoring respect issues –
maybe setting up a forum for residents to voice concerns about care at local facilities, and possibly
addressing concerns to a county health coordinator position if one is created.
“We’re Medicare, and it’s wonderful. It’s
wonderful. I mean I wish everybody in the
country had it.”
2nd
Lincoln Focus Group
“The group we did last week…it’s not a reflection of
the entire community, but it’s a reflection of some
parts of the community…”
Researcher, about one focus group