A picture of Health a profile of the Health of Santa Fe County at the Beginning of the 21st Century



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A Picture of Health



A Profile of the Health of Santa Fe County
at the Beginning of the 21st Century



Strengths


Challenges

Resources


Needs

Version Dated January 7, 2002

Table of Contents


Preface i

Santa Fe County Health Policy Commission ii

I. Introduction 1

A. Vision & Mission of the HPC 1

B. Values & Operating Principles of the HPC 2

C. Report Overview 3

II. What Are the Access Issues in Our Community? 4

A. Lack of Health Insurance Coverage 4

B. Medicaid Under-Enrollment 4

C. Insufficient Subsidized Care for Low-Income Uninsured 4

D. Inadequate Number of Access Points for Primary & Specialty Care 5

E. Other Barriers to Access in Our Community 6

F. Lack of Alignment in Our Planning & Health Delivery Systems 6

G. Access Barriers Are Reflected in Disparities in Health Status 6

III. What Are Some of the Key Indicators of Our Health Status? 8

IV. What Are the Health Care Resources Currently Available? 11


A. Private Providers 11

B. Hospitals & Community Health Centers 13

C. Health Care Organizations & Agencies 14

V. What Do Others Perceive as Our Major Service Delivery Gaps? 17

VI. Who Is Working on These Access Issues and Health Concerns? 21

VII. What Health & Social Indicator Data Are Available that Inform Us About the Community’s Health Status? 23

A. Socio-Demographic & Quality of Life Factors 23

B. Health Status 27

1. Physical Health 27

2. Behavioral Health 40

3. Dental Health 43

VIII. What Funding and Financing Are Currently Available? 45
Preface

Shaening and Associates, Inc. herein submits this report, A Profile of Health, to the Santa Fe County Health Planning Commission (HPC). It should be stressed that this document is a “work in progress,” to be continuously modified and expanded as we move forward to accomplish our mission of improving the health status of our community.

The health and social indicator data, as well as the analysis of the issues of access, disparity, and resource availability, suggest several directions the HPC and others might take. First and foremost, the report suggests a critical need to align the planning and health care reform efforts currently in place in our community. Leadership and a focal point for this alignment must continue to evolve, be it with the HPC or some other group. (There is some difference of opinion on this point.) We need to get beyond turf issues and the unspoken competition to be in charge. We need to move from a concept of patient “ownership” to one of patient “sharing.” We need to develop community participation and community ownership of health care issues.

In evolving leadership and developing a focal point for alignment, it is clear that there must be some entity such as the HPC that “keeps the big picture;” inclusively sets goals and priorities for areas of focus; convenes and supports the appropriate networks of providers, advocates, and consumers to move from planning to action; and monitors performance and overall health improvement. Such an entity must have the authority to do this work. That authority would likely derive from inclusive membership representing the many constituent groups in our community, and from the explicit recognition of community members, health care providers, local government and others. Such an entity must also have staff and other resources to do this work.
Overall goals for community health improvement should also be explicitly stated and optimally adopted by all planning groups, health care providers, consumers, advocates, and other community members. These goals might be “100% access” and “zero disparity,” as suggested by the Bureau of Primary Care, U.S. Department of Health and Human Services. Whatever the goal statements, all stakeholders need to be able to see their individual, organizational, and network roles in achieving them.
Above all, we need to be deeply committed to this work, consumer and community focused, action oriented, and collaborative. Our experience with numerous individuals and groups in developing this document suggests that we are already on this path and committed to community health improvement.
Respectfully submitted,
Mary Ann Shaening, Ph.D.

Andrea Poole

Shaening and Associates, Inc.
November 8, 2001
Santa Fe County Health Planning Commission

Richard Taaffe, Chair


Rebecca Frenkel, Vice-Chair

Jaime Estremera-Fitzgerald, Vice-Chair
Jaime Estremera-Fitzgerald

District IV Representative

Rebecca Frenkel

District II Representative

Arturo Gonzales, Ph.D.

St. Vincent Hospital

Ron Hale

MCH Planning Council

Brad Hill

District V Representative

Valery Henderson

New Mexico Department of Health

Kevin Henson

District III Representative

Donna Lockridge, R.N.

Town of Edgewood

Larry Martinez

District I Representative

Dr. Cleveland H. Pardue

Physician Representative

Fredrick Sandoval

City of Santa Fe Community Services Department

Richard Taafe

Primary Health Care Clinic

John T.C. White

Healthcare Workers Union

Glenn Wieringa

DWI Planning Council

Santa Fe County Health Planning Commission

Staff

Robert Anaya, Director

Santa Fe County

Community Health & Economic Development Department (CHEDD)

PO Box 276

Santa Fe, NM 87504-0276

Ph: 505-992-3056

Fax: 505-992-3050

Email: robanaya@co.santa-fe.nm.us

Virginia Vigil, Policy Analyst

Santa Fe County Manager’s Office


PO Box 276

Santa Fe, NM 87504-0276

Ph: 505-986-6276

Fax: 505-995-2740

Email: vvigil@co.santa-fe.nm.us

Steve Shepherd, Director

Santa Fe County Health Division, CHEDD

PO Box 276

Santa Fe, NM 87504-0276

Ph: 505-954-8814

Fax: 505-954-8818

Email: sshepher@co.santa-fe.nm.us

I. Introduction
In December 1999 the Santa Fe County Health Planning Commission (HPC) set out its vision, mission, goals, values, and operating procedures. This document, A Picture of Health, is intended to provide the HPC and numerous other groups with an analysis of the issues, challenges, and resources we have in our community to improve health status, and to develop the policy and planning necessary to achieve the HPC vision.


  1. Vision and Mission of the HPC

As originally formulated, the vision of the HPC is essentially the vision of the County as a whole:



A healthier community, as reflected by the improved health status of the residents of

Santa Fe County

In this vision, health is understood to mean both well-being and the absence of illness; health is understood to be affected by social, personal, environmental and economic determinants; and health is understood to be inter-related with a wide range of human service issues and needs.

The mission of the HPC is to assist, inform, and advise the Board of County Commissioners (BCC) and the County Health Division to carry out their roles in developing public policy, planning, and programming directed at overall health improvement. The mission is presented as two inter-related tracks, one focusing on policy development and the other addressing health planning.


Policy Development

Focus: System and Access Issues

Goal: Improve access to health care services by assessing and removing system barriers.

Approach: Study system and policy issues and make recommendations to the Board of County Commissioners:

1. Assess system barriers to accessing health care services, including:



  • Ability to pay or secure third party payment

  • Knowledge about the availability of services

  • Language and cultural limitations

  • Managed care restrictions

  • Limited resources and waiting lists

  • Geographical distribution of health care resources

  • Transportation

  • Other barriers



  1. Identify and prioritize critical access issues in terms of those most likely to result in minimizing and eliminating barriers.

  2. Begin with “ability to pay or secure third party payment” as a critical barrier, focusing on the Medically Indigent Fund.

  3. Develop and present options to maximize the use of the Medically Indigent Fund.

  4. Make recommendations for policy and procedures regarding the Medically Indigent Fund.

  5. Identify additional opportunities to expand resources by integrating, coordinating, pooling, and leveraging existing funds and other resources, and by seeking grants to support health improvement initiatives.

  6. Establish accountability and monitor performance.

  7. Address additional barriers to access, developing options and recommending policy.

  8. Routinely report to the BCC.

Health Planning


Focus: Health Needs of Residents

Goal: Integrate, coordinate and leverage services to meet the priority health needs of residents.

Approach: Make recommendations and provide oversight to the Health Division in terms of its role and responsibility to:

1. Assess health care needs and create a community health profile, including:



  • Social, economic, and demographic characteristics

  • Health status indicators: incidence & prevalence of select conditions & illnesses; morbidity & mortality data

  • Health risk factors

  • Health care consumption and utilization

  • Quality of life indicators



  1. Map resources in the community to identify and inventory:

  • Payors and Purchasers

  • Providers and Program Types

  • Regulators

  1. Identify groups who are unserved or underserved and gaps in service array.

  2. Identify and prioritize critical health issues (needs and resources) and develop annual Health Action Plan. Such a plan would consist of perhaps 2-3 priorities each year, focused where appropriate on prevention initiatives so as to maximize impact on overall health status of the community.

  3. Coordinate with other local, regional, and statewide councils and groups engaged in similar or overlapping efforts, including but not limited to the Maternal and Child Health Council, the DWI Planning Council, the Santa Fe County Public Health Office, the City of Santa Fe Community Services Division, and the Santa Fe Community Partnership.

  4. Recommend health improvement initiatives and convene stakeholders to develop strategies.
  5. Establish accountability and monitor performance.


  6. Routinely report to the BCC.





B. Values and Operating Principles of the HPC
The values and operating principles of the HPC, as formulated in December 1999, are as follows:


  • HPC will maintain a consumer focus, organizing its efforts around the health needs of Santa Fe County residents.

  • HPC will strive to improve access to health care resources.

  • HPC will advocate for the needs of all residents, with particular emphasis on those residents who are uninsured, underinsured, or uninsurable.

  • HPC will promote prevention oriented health and community services.

  • HPC will keep the community informed of its work on a regular basis.

  • HPC will be inclusive in all of its efforts, convening residents, providers, community organizations, advocates, educational institutions and others in its policy development and health planning work.

  • HPC will be data-driven in its needs assessments and performance monitoring. HPC will research and recommend science-based practices wherever possible.



C. Report Overview
Given a vision and mission to improve health status with an emphasis on increasing access, this report is intended to provide data and other information in response to the following critical concerns:

  • What are the access issues in our community? (Part II)

  • What are some of the key indicators of our health status? (Part III)

  • What are the health care resources currently available? (Part IV)

  • What do others perceive as our major service delivery gaps? (Part V)

  • Who is currently working on these access issues and health concerns? (Part VI)
  • What health and social indicator data are available that inform us about the community’s health status? (Part VII)


  • What funding and financing are currently available? (Part VIII)

It should be noted that this report is intended as a starting point; it is not something that should be considered “finished.” Rather, it is anticipated that a number of individuals, groups, and agencies will continue to contribute to it and that it will evolve over time. In fact, it should not be “finished” until we achieve 100% access and overall health improvement.



II. What Are the Access Issues in Our Community?
A. Lack of Health Insurance Coverage

While various data sources quote different statistics, it is probably safe to say that somewhere around 20% to 25% of the population of Santa Fe County is uninsured. Given a current County population of 129,292, that amounts to over 25,000 uninsured people!

The Sangre de Cristo Community Health Partnership, in their application for HRSA Community Access Program (CAP) funds, stated that 22.7% of the population in the eight county area they serve are uninsured and underinsured.

Although discussing New Mexico as a whole, and not specifically Santa Fe County, the Kids Count 2001 Data Book quotes the US Census Bureau, which estimates that 25.8% of New Mexicans lacked health insurance in 1999, and despite the availability of Medicaid, 27.7% of New Mexico’s children remained uninsured. According to the Kaiser Family Foundation website, in 1998 only 48% of private sector establishments in New Mexico offered health insurance to employees, compared to 55% nationally. This same source reports 23% of New Mexico’s population is uninsured, compared to 16% nationally.

Finally, many persons who do have some health insurance coverage, especially that provided to low-wage workers by employers, have limits in terms of what is covered. In addition, these plans often require a prohibitively high degree of employee cost-sharing.





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