IMPROVING ACCESS TO HEALTH IMPROVING ACCESS TO HEALTH CARE AND REDUCING HEALTH CARE AND REDUCING HEALTH

DISPARITIES IN ARKANSASDISPARITIES IN ARKANSAS

INTERIM COMMITTEE ON INTERIM COMMITTEE ON PUBLIC HEALTH, WELFARE, PUBLIC HEALTH, WELFARE,

AND LABORAND LABORINTERIM STUDYINTERIM STUDY

INTERIM STUDY PROPOSAL 2005INTERIM STUDY PROPOSAL 2005--011011

REQUESTING THE HOUSE AND SENATE INTERIM COMMITTEES ON PUBLIC HEALTH, WELFARE, AND LABOR TO STUDY WAYS TO IMPROVE ACCESS TO COMPREHENSIVE PRIMARY AND PREVENTATIVE HEALTH CARE FOR THE UNINSURED AND MEDICALLY UNDERSERVED WHILE REDUCING HEALTH DISPARITIES ACROSS ETHNIC, ECONOMIC, AND GEOGRAPHIC COMMUNITIES IN THIS STATE.

Representative Roebuck Representative Roebuck District 20District 20

INTERIM STUDYINTERIM STUDY1. To determine the medical needs of our most 1. To determine the medical needs of our most vulnerable citizens.vulnerable citizens.2. To determine the availability of adequate medical care 2. To determine the availability of adequate medical care at the least restrictive point of service.at the least restrictive point of service.3. To address the medical needs of the medically 3. To address the medical needs of the medically uninsured, especially between 19 and 64 years of age.uninsured, especially between 19 and 64 years of age.4. To address enabling factors that influence the health 4. To address enabling factors that influence the health care delivery system in Arkansas.care delivery system in Arkansas.5. To address the ethnic inequalities in our health care 5. To address the ethnic inequalities in our health care system.system.6. To compile this information in a written report to the 6. To compile this information in a written report to the Arkansas Legislative Council.Arkansas Legislative Council.7. To develop a Legislative agenda that will address 7. To develop a Legislative agenda that will address these critical Health Issues for the 2007 Legislative these critical Health Issues for the 2007 Legislative Session. Session.

FACTORS DETERMINING QUALITY OF FACTORS DETERMINING QUALITY OF HEALTH CARE IN ARKANSASHEALTH CARE IN ARKANSAS

1. Family income 1. Family income –– Poverty levelPoverty level2. Ethnic factors2. Ethnic factors3. Geographic factors3. Geographic factors4. Medically Uninsured4. Medically Uninsured5. Enabling Services5. Enabling Services6. Medical Care Safety Net6. Medical Care Safety Net7. Medical Literacy7. Medical Literacy

FAMILY INCOMEFAMILY INCOME1. The median household income for Arkansas families 1. The median household income for Arkansas families is $34,246. This is below the federal 200% of poverty is $34,246. This is below the federal 200% of poverty level which is $37,700 for a family of four.level which is $37,700 for a family of four. Source: ACHI 2005 Source: ACHI 2005 Arkansas Fact Book. Page 4, 12. Arkansas Fact Book. Page 4, 12.

2. More than half of Arkansas families make less than 2. More than half of Arkansas families make less than $35,000 a year. $35,000 a year.

3.3. Fifty percent of Arkansas kids are in the free or Fifty percent of Arkansas kids are in the free or reduced school lunch program.reduced school lunch program.4. Arkansas has 14.8% of households receiving food 4. Arkansas has 14.8% of households receiving food stamps. Mississippi has 15.8%. The national average is stamps. Mississippi has 15.8%. The national average is 11.9%.11.9%.5. Clark County median income in 2004 was $29,394.00 5. Clark County median income in 2004 was $29,394.00 per household. This is almost $8,000.00 less than per household. This is almost $8,000.00 less than federal poverty level for a family of four at 200 percent federal poverty level for a family of four at 200 percent poverty level. poverty level.

FAMILY INCOMEFAMILY INCOMEPOVERTY POVERTY –– INDIGENT CARE INDIGENT CARE

1. Less likely to receive regular health care for 1. Less likely to receive regular health care for chronic diseases.chronic diseases.2. Less likely to get prescriptions filled.2. Less likely to get prescriptions filled.3. More likely to forego or delay medical care.3. More likely to forego or delay medical care.4. Less likely to receive preventive services.4. Less likely to receive preventive services.5. More likely to utilize hospital emergency 5. More likely to utilize hospital emergency services. services. 6. More likely to be hospitalized.6. More likely to be hospitalized.

ETHNIC FACTORSETHNIC FACTORS

EQUALITY OF HEALTH CAREEQUALITY OF HEALTH CARE

1. 1. Study estimates that 886,000 AfricanStudy estimates that 886,000 African--American American deaths could have been prevented in the decade of the deaths could have been prevented in the decade of the 1990’s if they had received equitable health care.1990’s if they had received equitable health care. ---- “State “State News”, American Journal of Public Health, May 2005, Page 31.News”, American Journal of Public Health, May 2005, Page 31.

2. David Atkins 2. David Atkins –– Agency for Health Care Research and Agency for Health Care Research and Quality, States that health inequality in the United States Quality, States that health inequality in the United States causes about 84,000 additional deaths each year.causes about 84,000 additional deaths each year.

3. The increasing Hispanic population with language and 3. The increasing Hispanic population with language and cultural barriers must be addressed. cultural barriers must be addressed.

ETHNIC FACTORS CONTINUEDETHNIC FACTORS CONTINUED

4. More medically uninsured.4. More medically uninsured.5. Less likely to seek medical care.5. Less likely to seek medical care.6. Access to health care more difficult in 6. Access to health care more difficult in medically underserved areas.medically underserved areas.7. Lack of enabling services.7. Lack of enabling services.8. Lack of health care facilities in rural 8. Lack of health care facilities in rural economically depressed areas of the state.economically depressed areas of the state.

ETHNIC FACTORSETHNIC FACTORSArkansans are healthier and living longer, Arkansans are healthier and living longer, but when you narrow it down to the but when you narrow it down to the minority population, we are still dying at a minority population, we are still dying at a much faster rate. We still have lots of much faster rate. We still have lots of people, particularly minority population, people, particularly minority population, that do not trust our health system.that do not trust our health system.Ms. Christine Patterson, Director of the Ms. Christine Patterson, Director of the Office of Minority Health and Health Office of Minority Health and Health Disparities, Division of Health, Department Disparities, Division of Health, Department of Health and Human Services.of Health and Human Services.

GEOGRAPHICAL FACTORSGEOGRAPHICAL FACTORS

1. Regional economic factors.1. Regional economic factors.2. Lack of primary health care in medically 2. Lack of primary health care in medically underserved regions of the state.underserved regions of the state.3. Regional difference in the number of 3. Regional difference in the number of medically uninsured.medically uninsured.4. Lack of rural health care facilities, 4. Lack of rural health care facilities, hospitals and medical clinics.hospitals and medical clinics.

FEWER HOSPITALSFEWER HOSPITALSCities where hospitals have been sold, merged or closed

within the last year.1. Blytheville

2. Osceola

3. Cherokee Village – Closed

4. Newport – Closed

5. Searcy

6. Gravette – Closed

7. Forrest City

8. Hope

Prior to 2005 several other hospitals have closed.

MEDICALLY UNINSUREDMEDICALLY UNINSURED

““The death rate in any given year for someone The death rate in any given year for someone without health insurance is twentywithout health insurance is twenty--five percent five percent higher than for someone with medical insurance. higher than for someone with medical insurance. Because the uninsured are sicker, they can’t get Because the uninsured are sicker, they can’t get better jobs, and because they can’t get better better jobs, and because they can’t get better jobs, they can’t afford health insurance and jobs, they can’t afford health insurance and because they can’t afford health insurance they because they can’t afford health insurance they get even sicker.” get even sicker.” –– ““The MoralThe Moral--Hazard Myth,” by Malcolm Hazard Myth,” by Malcolm Gladwell. New Yorker. August 29, 2005. Gladwell. New Yorker. August 29, 2005.

MEDICALLY UNINSUREDMEDICALLY UNINSURED

1. 17.2% of Arkansans are medically uninsured.1. 17.2% of Arkansans are medically uninsured.2. 456,000 Arkansas citizens.2. 456,000 Arkansas citizens.3. Most uninsured are between ages 19 and 64.3. Most uninsured are between ages 19 and 64.4. Prior to age 19, they are covered under 4. Prior to age 19, they are covered under ARKIDS A, ARKIDS B and Medicaid.ARKIDS A, ARKIDS B and Medicaid.5. After age 65, they are covered under 5. After age 65, they are covered under Medicare.Medicare.6. Most uncompensated health6. Most uncompensated health--care cost is for care cost is for patients between 19 and 64 years of age. patients between 19 and 64 years of age.

Summary of Bo Ryall’s TestimonySummary of Bo Ryall’s TestimonyArkansas Hospital AssociationArkansas Hospital Association

As numbers of uninsured increase, amount of As numbers of uninsured increase, amount of uncompensated care increases.uncompensated care increases.The uninsured are sicker, and, thus, more expensive to The uninsured are sicker, and, thus, more expensive to care for, when they do access the health care system.care for, when they do access the health care system.Emergency rooms are used as safetyEmergency rooms are used as safety--net by the net by the uninsured.uninsured.By 2003, the number of uninsured admitted to hospitals By 2003, the number of uninsured admitted to hospitals in Arkansas had increased to 30,063. This is a 69% in Arkansas had increased to 30,063. This is a 69% increase in three years.increase in three years.In 2004, Arkansas hospitals provided $307,483,117 in In 2004, Arkansas hospitals provided $307,483,117 in uncompensated care. The Arkansas Hospital uncompensated care. The Arkansas Hospital Association reported in the Arkansas DemocratAssociation reported in the Arkansas Democrat--Gazette, Gazette, November 13, 2005, that state hospital bad debts totaled November 13, 2005, that state hospital bad debts totaled $531 million and $207 million in charity care.$531 million and $207 million in charity care.

UNCOMPENSATED HOSPITALUNCOMPENSATED HOSPITALEMERGENCY TREATMENTEMERGENCY TREATMENT

1. In 2003 the uncompensated emergency treatment 1. In 2003 the uncompensated emergency treatment totaled $475 million dollars. totaled $475 million dollars. ACHI. Mr. Kevin Ryan ACHI. Mr. Kevin Ryan –– 2005 ACHI 2005 ACHI Report. Report.

2. This amount is probably over $500 million in 2005.2. This amount is probably over $500 million in 2005.3. UAMS Hospital emergency room uncompensated 3. UAMS Hospital emergency room uncompensated care was $40 million dollars. care was $40 million dollars. Dr. Smith, Director, UAMS Hospital.Dr. Smith, Director, UAMS Hospital.

4. Baptist Medical System 4. Baptist Medical System –– total for year from five total for year from five hospitals $99,253,000.hospitals $99,253,000.5. Arkadelphia Baptist Hospital 5. Arkadelphia Baptist Hospital –– 2005 is projected to be 2005 is projected to be $3,192,000.$3,192,000.6. This uncompensated treatment cost the medically 6. This uncompensated treatment cost the medically insured family an additional $941. insured family an additional $941.

MINIMIZE UNCOMPENSATED MINIMIZE UNCOMPENSATED HEALTH CAREHEALTH CARE

1. Must provide a medical safety1. Must provide a medical safety--net system to treat net system to treat patients at the least restrictive level of care.patients at the least restrictive level of care.2. Must continue to stress the need for increasing and 2. Must continue to stress the need for increasing and improving health care preventive programs.improving health care preventive programs.3. Must provide incentives to reduce the number of 3. Must provide incentives to reduce the number of uninsured.uninsured.4. Must place more burden on the individual to be more 4. Must place more burden on the individual to be more involved in treatment to reduce the cost of medical care.involved in treatment to reduce the cost of medical care.5. Consider incentives to employers to keep employees 5. Consider incentives to employers to keep employees health insurance.health insurance.6. Enhance medical literacy through outreach programs.6. Enhance medical literacy through outreach programs.

LACK OF ENABLING SERVICESLACK OF ENABLING SERVICES

1. Transportation1. Transportation2. Case Management2. Case Management3. Language 3. Language –– availability of translatorsavailability of translators4. Medical Literacy4. Medical Literacy5. Medical Safety5. Medical Safety--net. Gatenet. Gate--keeper.keeper.6. Medical personnel and clinic facilities.6. Medical personnel and clinic facilities.

MEDICAL LITERACYMEDICAL LITERACY

1. Health literacy is defined as the degree 1. Health literacy is defined as the degree to which individuals have the capacity to to which individuals have the capacity to obtain, process, and understand basic obtain, process, and understand basic health information and services needed to health information and services needed to make appropriate health decisions. Source make appropriate health decisions. Source U.S. Department of Health and Human U.S. Department of Health and Human Services.Services.

MEDICAL LITERACY MEDICAL LITERACY continuedcontinued

2. The consequences of inadequate health literacy 2. The consequences of inadequate health literacy include: include:

A. Poorer health statusA. Poorer health statusB. Lack of medical care knowledgeB. Lack of medical care knowledgeC. Impaired comprehension of medical information C. Impaired comprehension of medical information D. Lack of knowledge about medical conditionsD. Lack of knowledge about medical conditionsE. Lack of understanding and use of preventive E. Lack of understanding and use of preventive

servicesservicesF. Poorer selfF. Poorer self--reported healthreported healthG. Poorer compliance rates with treatment modalitiesG. Poorer compliance rates with treatment modalitiesH. Increased hospitalizationH. Increased hospitalizationI. Increased health costsI. Increased health costs

MEDICAL LITERACY MEDICAL LITERACY continuedcontinued

3. Weiss and colleagues state that the average annual 3. Weiss and colleagues state that the average annual health care cost of persons with very low literacy may be health care cost of persons with very low literacy may be four times greater than for the general population. four times greater than for the general population. Source: Economic Consideration of Health Literacy, Roberta PawlaSource: Economic Consideration of Health Literacy, Roberta Pawlak, Nurse k, Nurse Economist 2005; 23(4):173Economist 2005; 23(4):173--180, Jannett Publication 10/14/2005. 180, Jannett Publication 10/14/2005.

4. The Institute of Medicine in 2000 determined that out 4. The Institute of Medicine in 2000 determined that out of twenty things necessary for health care to improve, of twenty things necessary for health care to improve, literacy affects all twenty. literacy affects all twenty. Source: Dr. Chad Rodgers, Little Rock, Arkansas, PhysicianSource: Dr. Chad Rodgers, Little Rock, Arkansas, Physician

Summary of Dr. Chad Rogers’ TestimonySummary of Dr. Chad Rogers’ TestimonyHealth Literacy Educator, Arkansas Literacy CouncilsHealth Literacy Educator, Arkansas Literacy Councils

The Institute of Medicine, in 2000, decided that out of The Institute of Medicine, in 2000, decided that out of twenty things necessary for health care to improve, twenty things necessary for health care to improve, literacy affects all twenty. literacy affects all twenty. FiftyFifty--six percent (56%) of Arkansans are functionally or six percent (56%) of Arkansans are functionally or marginally illiterate. In Lee, Phillips, and Chicot counties, marginally illiterate. In Lee, Phillips, and Chicot counties, 8080--89% of the population functions at level two literacy 89% of the population functions at level two literacy or below.or below.Lower health literacy leads to lower health outcomes and Lower health literacy leads to lower health outcomes and less healthy behaviors.less healthy behaviors.Low level literate patients are twice as likely to be Low level literate patients are twice as likely to be hospitalized when they access the health care system.hospitalized when they access the health care system.Poor health literacy costs health care system $50Poor health literacy costs health care system $50--73 73 billion a year.billion a year.

Summary of Dr. Charles Cranford’s TestimonySummary of Dr. Charles Cranford’s TestimonyArea Health Education Centers (AHEC)Area Health Education Centers (AHEC)

There are seven AHECs in Arkansas, each There are seven AHECs in Arkansas, each covering a multiple county service area.covering a multiple county service area.Mission is to improve the supply and distribution Mission is to improve the supply and distribution of health care providers while serving as an of health care providers while serving as an education setting for UAMS students.education setting for UAMS students.AHECs were a safetyAHECs were a safety--net for 83,000 patients in net for 83,000 patients in 2004.2004.Reimbursement is on a sliding scale fee with Reimbursement is on a sliding scale fee with 68% of the patient base either Medicaid or non68% of the patient base either Medicaid or non--paying patients.paying patients.

Summary of Kevin Ryan’s TestimonySummary of Kevin Ryan’s TestimonyArkansas Center for Health ImprovementArkansas Center for Health Improvement

In 2004, 17% of Arkansans, 455,798 In 2004, 17% of Arkansans, 455,798 individuals lacked health insurance.individuals lacked health insurance.Rate of uninsurance is higher in rural Rate of uninsurance is higher in rural areas.areas.Uninsurance is a leading cause of Uninsurance is a leading cause of bankruptcy filings.bankruptcy filings.Lack of health insurance is related to both Lack of health insurance is related to both more expensive and less efficient care.more expensive and less efficient care.

Summary of Dr. Charles Smith’s TestimonySummary of Dr. Charles Smith’s TestimonyUniversity of Arkansas for Medical SciencesUniversity of Arkansas for Medical Sciences

In fiscal year 2005, 32,309 patients were seen in In fiscal year 2005, 32,309 patients were seen in the UAMS emergency department.the UAMS emergency department.In fiscal year 2005, UAMS had $40 million in In fiscal year 2005, UAMS had $40 million in unreimbursed charges from the emergency unreimbursed charges from the emergency department alone.department alone.$13.5 million of the $40 million resulted from $13.5 million of the $40 million resulted from visits where the emergency department was visits where the emergency department was being used as a clinic facility.being used as a clinic facility.UAMS has difficulty meeting the demand for UAMS has difficulty meeting the demand for care in its clinics.care in its clinics.

Summary of David Wroten’s TestimonySummary of David Wroten’s TestimonyArkansas Medical SocietyArkansas Medical Society

Arkansas Health Care Access Foundation Arkansas Health Care Access Foundation (AHCAF) was established by the Arkansas (AHCAF) was established by the Arkansas Medical Society in 1989 in order to provide free Medical Society in 1989 in order to provide free medical care to the indigent.medical care to the indigent.1,870 providers, including 1,200 physicians, in 1,870 providers, including 1,200 physicians, in the state participate in this program.the state participate in this program.The various providers of uncompensated and The various providers of uncompensated and charity care don’t really work together; with no charity care don’t really work together; with no centralized office for coordinating charitable and centralized office for coordinating charitable and uncompensated care.uncompensated care.

Summary of Sip Mouden’s TestimonySummary of Sip Mouden’s TestimonyCommunity Health CentersCommunity Health Centers

Community Health Centers (CHCs) provide, or Community Health Centers (CHCs) provide, or make provisions for, affordable and accessible make provisions for, affordable and accessible comprehensive, continuous primary medical, comprehensive, continuous primary medical, dental, mental health, prevention, and enabling dental, mental health, prevention, and enabling services to everyone, regardless of ability to pay.services to everyone, regardless of ability to pay.123,790 patients served in 2005123,790 patients served in 200556% at 200% FPL or below56% at 200% FPL or below57,896 or 47% are medically uninsured57,896 or 47% are medically uninsured99,991 underserved (Medicare, Medicaid, 99,991 underserved (Medicare, Medicaid, Uninsured) patientsUninsured) patients

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Summary of Sip Mouden’s Testimony Summary of Sip Mouden’s Testimony ContinuedContinued

12 CHCs with 58 health center locations in medically 12 CHCs with 58 health center locations in medically underserved areas (73 out 75 counties are full or partial underserved areas (73 out 75 counties are full or partial medically underserved)medically underserved)CHCs can save the state 30% on the dollar if Medicaid CHCs can save the state 30% on the dollar if Medicaid patients are treated within the CHCs as opposed to patients are treated within the CHCs as opposed to seeking care in the ER. In 2005 data reported (by seeking care in the ER. In 2005 data reported (by NACHC) this amount could have equated to NACHC) this amount could have equated to 189,500,122 for unnecessary emergency visits.189,500,122 for unnecessary emergency visits.CHCs are partially federally funded by the Department of CHCs are partially federally funded by the Department of HHS, Bureau of Primary Health Care, to help offset the HHS, Bureau of Primary Health Care, to help offset the costs for serving the uninsured of which CHCs serve costs for serving the uninsured of which CHCs serve 11% of the total Arkansas uninsured, but could serve 11% of the total Arkansas uninsured, but could serve more with state general revenue.more with state general revenue.

Summary of Dr. Steven Strode’s TestimonySummary of Dr. Steven Strode’s TestimonyArkansas Healthcare Access FoundationArkansas Healthcare Access Foundation

Established in 1989 by the Arkansas Medical Established in 1989 by the Arkansas Medical Society to make health care available to those Society to make health care available to those that do not qualify for other health service that do not qualify for other health service providers.providers.The AHCAF has served nearly 80,000 eligible The AHCAF has served nearly 80,000 eligible Arkansans since 1990.Arkansans since 1990.AHCAF staff received more than 12,000 calls in AHCAF staff received more than 12,000 calls in 2005 from people without money to pay for 2005 from people without money to pay for medical care. Source: Arkansas Medical medical care. Source: Arkansas Medical Society JournalSociety Journal

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Summary of Dr. Steven Strode’s Testimony Summary of Dr. Steven Strode’s Testimony ContinuedContinued

We estimate that between 250,000 and 300,000 We estimate that between 250,000 and 300,000 Arkansans would qualify for this program if it Arkansans would qualify for this program if it were available. Source: “Saving Starfish”, were available. Source: “Saving Starfish”, Arkansas Medical Journal, April 2006Arkansas Medical Journal, April 2006Services are provided by physicians, dentists, Services are provided by physicians, dentists, pharmacists, and other medical providers at no pharmacists, and other medical providers at no charge to patients.charge to patients.

Summary of Dr. Paul Halverson’s TestimonySummary of Dr. Paul Halverson’s TestimonyDHHS, Division of Health, County Health UnitsDHHS, Division of Health, County Health Units

Emphasis should not merely be on increasing Emphasis should not merely be on increasing the number of clinics. Instead, find system the number of clinics. Instead, find system related solutions to health issues with an related solutions to health issues with an emphasis on prevention and behavioral causes emphasis on prevention and behavioral causes of disease and death.of disease and death.Prevention is keyPrevention is key——”focus of our system really ”focus of our system really ought to be on trying to create an environment in ought to be on trying to create an environment in which people don’t become sick with disease which people don’t become sick with disease and need expensive medical care.” We spend and need expensive medical care.” We spend 3% of our health care dollars on prevention and 3% of our health care dollars on prevention and protection.protection.

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Summary of Dr. Paul Halverson’s TestimonySummary of Dr. Paul Halverson’s TestimonyContinuedContinued

In the U.S., we spend 97% of our health care In the U.S., we spend 97% of our health care dollars dealing with those that already have dollars dealing with those that already have disease.disease.

Summary of Chuck Morrison’s TestimonySummary of Chuck Morrison’s TestimonyArkansas Association of Charitable ClinicsArkansas Association of Charitable Clinics

Arkansas Association of Charitable Clinics Arkansas Association of Charitable Clinics (AACC) is composed of 23 independent clinics (AACC) is composed of 23 independent clinics located throughout the state, the first of which located throughout the state, the first of which opened in 1972.opened in 1972.Patients are typically low income with no Patients are typically low income with no Medicaid, no Medicare and no health insurance.Medicaid, no Medicare and no health insurance.Most clinics use 200% of the Federal Poverty Most clinics use 200% of the Federal Poverty Level (FPL). Level (FPL). Typical charitable clinic holds hours two to four Typical charitable clinic holds hours two to four times per month, usually in the evenings.times per month, usually in the evenings.

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Summary of Chuck Morrison’s TestimonySummary of Chuck Morrison’s TestimonyContinuedContinued

In 2005, the clinics had 44,000 patient visits.In 2005, the clinics had 44,000 patient visits.The charitable clinics are funded by private The charitable clinics are funded by private contributions and receive almost no federal or contributions and receive almost no federal or state government money.state government money.

Summary of Christine Patterson’s TestimonySummary of Christine Patterson’s TestimonyDHHS, Division of Health DHHS, Division of Health

Office of Minority Health and Health DisparitiesOffice of Minority Health and Health Disparities

Office of Minority Health was established in 1985Office of Minority Health was established in 1985When you look at age adjusted death rates, When you look at age adjusted death rates, African Americans are dying at a higher rate African Americans are dying at a higher rate than Caucasians for the following diseases: than Caucasians for the following diseases: heart disease, cancer, diabetes, stroke, heart disease, cancer, diabetes, stroke, HIV/AIDS and infant mortality.HIV/AIDS and infant mortality.African Americans still mistrust the medical African Americans still mistrust the medical community.community.

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Summary of Christine Patterson’s TestimonySummary of Christine Patterson’s TestimonyContinuedContinued

Racism and discrimination still exist and should Racism and discrimination still exist and should be dealt with because they affect access to the be dealt with because they affect access to the health care system.health care system.

Summary of Darlene Bird’s TestimonySummary of Darlene Bird’s TestimonyAdvanced Practice Nurses CouncilAdvanced Practice Nurses Council

Arkansas Nursing AssociationArkansas Nursing Association

There are 1,115 license Advanced Practice There are 1,115 license Advanced Practice Nurses (APNs) in the State of Arkansas; 633 of Nurses (APNs) in the State of Arkansas; 633 of these nurses have prescriptive authority.these nurses have prescriptive authority.Arkansas is a rural state and has a problem with Arkansas is a rural state and has a problem with health care access.health care access.In Arkansas, the ratio of primary care providers In Arkansas, the ratio of primary care providers to patients is 1 to 3,000. If APNs were to patients is 1 to 3,000. If APNs were considered primary health care providers, the considered primary health care providers, the ratio of primary care providers to patients in the ratio of primary care providers to patients in the State of Arkansas would drop to 1 to 2,000.State of Arkansas would drop to 1 to 2,000.

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Summary of Darlene Bird’s TestimonySummary of Darlene Bird’s TestimonyContinuedContinued

A national study found that, if APNs were used A national study found that, if APNs were used efficiently in primary health care, it could result in efficiently in primary health care, it could result in a savings of up to $8 billion.a savings of up to $8 billion.

Summary of Dr. Lynn Mouden’s TestimonySummary of Dr. Lynn Mouden’s TestimonyDirector of the Office of Oral HealthDirector of the Office of Oral Health

Department of Health and Human ServicesDepartment of Health and Human Services

We truly have a crisis in oral health in Arkansas.We truly have a crisis in oral health in Arkansas.Survey indicates that more than 50% of the Survey indicates that more than 50% of the children in Arkansas have or have had tooth children in Arkansas have or have had tooth decay.decay.In the southeast region of the state, minorities In the southeast region of the state, minorities have more than 75% of children afflicted with have more than 75% of children afflicted with tooth decay.tooth decay.Ten percent of the children have emergency Ten percent of the children have emergency dental needs. This is also true for our senior dental needs. This is also true for our senior citizens.citizens.

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Summary of Dr. Lynn Mouden’s TestimonySummary of Dr. Lynn Mouden’s TestimonyContinuedContinued

Neither Medicaid nor Medicare pays for dental Neither Medicaid nor Medicare pays for dental coverage for adults.coverage for adults.The single most effective method to reduce The single most effective method to reduce dental decay is to add to the fluoride already in dental decay is to add to the fluoride already in our water up to the optimum amount that will our water up to the optimum amount that will reduce dental decay.reduce dental decay.Failure to get the fluoridation bill (House Bill Failure to get the fluoridation bill (House Bill 2627) out the Senate Health Committee was 2627) out the Senate Health Committee was considered by the “Arkansas Times” as the considered by the “Arkansas Times” as the worst legislative mistake or blunder in the 2005 worst legislative mistake or blunder in the 2005 session.session.

Summary of Kenny Whitlock’s TestimonySummary of Kenny Whitlock’s TestimonyCommunity Mental Health CentersCommunity Mental Health Centers

Executive Vice President, Mental Health Council of ArkansasExecutive Vice President, Mental Health Council of Arkansas

There are 15 nonThere are 15 non--profit, citizen governed mental health profit, citizen governed mental health centers in Arkansas.centers in Arkansas.They are regulated by the Division of Behavioral Health They are regulated by the Division of Behavioral Health of DHHS.of DHHS.Total Arkansans treated in FY 05 was 73,471; this Total Arkansans treated in FY 05 was 73,471; this included children and youth up to the age 21 and all included children and youth up to the age 21 and all adults above age 21.adults above age 21.An increase in the numbers and severity of mental An increase in the numbers and severity of mental illness in young children.illness in young children.Difficulty in acquiring and maintaining professional staff Difficulty in acquiring and maintaining professional staff with cultural diversity.with cultural diversity.

Summary of Dr. Glen Mays’ TestimonySummary of Dr. Glen Mays’ TestimonyUniversity of Arkansas for Medical SciencesUniversity of Arkansas for Medical Sciences

College of Public HealthCollege of Public Health

Nationally, only about 3% of our health spending Nationally, only about 3% of our health spending goes to preventive services, with the remaining goes to preventive services, with the remaining 97% going to the treatment of disease.97% going to the treatment of disease.In Arkansas, we are currently spending a little In Arkansas, we are currently spending a little over $50 per capita, on local public health and over $50 per capita, on local public health and preventive services delivery. We need to be preventive services delivery. We need to be spending closer to $70 per capita.spending closer to $70 per capita.Our local public health agencies in Arkansas are Our local public health agencies in Arkansas are really only delivering about half of the really only delivering about half of the recommended chronic disease screenings.recommended chronic disease screenings.

Amount of Care Provided byAmount of Care Provided bySafety Net ProvidersSafety Net Providers

AR Health Care Access Foundation:AR Health Care Access Foundation:In 2005, 3,000 Arkansans enrolled in this programIn 2005, 3,000 Arkansans enrolled in this programAmount of Services Provided in 2003Amount of Services Provided in 2003--2004 was 2004 was $542,636$542,636

Arkansas Health Education Centers:Arkansas Health Education Centers:In 2004, over 160,000 patient visitsIn 2004, over 160,000 patient visitsOver 83,000 Arkansans rely on AHECs for careOver 83,000 Arkansans rely on AHECs for care

Amount of Care Provided byAmount of Care Provided bySafety Net Providers Safety Net Providers continuedcontinued

Community Health Centers:Community Health Centers:More than 50,000 or 11% of the uninsured used CHC More than 50,000 or 11% of the uninsured used CHC services in 2004services in 2004Total patients served in 2005: 123,790Total patients served in 2005: 123,790

Charitable Clinics:Charitable Clinics:In 2005, over 44,000 patient visitsIn 2005, over 44,000 patient visits

AcknowledgementsAcknowledgements1. ACHI, Arkansas Center for Health 1. ACHI, Arkansas Center for Health

Improvement, Mr. Kevin Ryan.Improvement, Mr. Kevin Ryan.2. AHEC, Arkansas Health Education Centers, Dr. 2. AHEC, Arkansas Health Education Centers, Dr.

Charles O. Cranford, Executive DirectorCharles O. Cranford, Executive Director3. Arkansas Medical Society, Mr. David Worten, 3. Arkansas Medical Society, Mr. David Worten,

Executive ViceExecutive Vice--PresidentPresident4. Arkansas Health Care Access Foundation, Inc., 4. Arkansas Health Care Access Foundation, Inc.,

Dr. Steven Strode, M.D., PresidentDr. Steven Strode, M.D., President5. Community Health Centers of Arkansas, Inc., 5. Community Health Centers of Arkansas, Inc.,

Mrs. Sip B. Mouden, Executive DirectorMrs. Sip B. Mouden, Executive Director

Acknowledgements Acknowledgements continuedcontinued

66. UAMS, University of Arkansas for Medical . UAMS, University of Arkansas for Medical Sciences, Dr. Charles Smith, Medical DirectorSciences, Dr. Charles Smith, Medical Director

77. Arkansas Association of Charitable . Arkansas Association of Charitable Clinics, Mr. Chuck Morrison, Executive Clinics, Mr. Chuck Morrison, Executive DirectorDirector

8. DHHS, Arkansas Division of Health, 8. DHHS, Arkansas Division of Health, Dr. Paul Halverson, DirectorDr. Paul Halverson, Director

Acknowledgements Acknowledgements continuedcontinued

9. Dr. Chad Rodgers, Medical Literacy9. Dr. Chad Rodgers, Medical Literacy10. Mrs. Christine Patterson, Director, 10. Mrs. Christine Patterson, Director,

DHHS, Office of Minority Health and DHHS, Office of Minority Health and Health DisparitiesHealth Disparities

11. Association of Advanced Nurse 11. Association of Advanced Nurse PractitionersPractitioners

12. Office of Oral Health, Lynn D. Mouden, 12. Office of Oral Health, Lynn D. Mouden, D.D.S., M.P.H., DirectorD.D.S., M.P.H., Director

Acknowledgements Acknowledgements continuedcontinued

13. Mr. Kenny Whitlock, Mental Health 13. Mr. Kenny Whitlock, Mental Health Council of ArkansasCouncil of Arkansas

14. Mr. Bo Ryall, Arkansas Hospital 14. Mr. Bo Ryall, Arkansas Hospital AssociationAssociation

15. Dr. Glen Mays, UAMS15. Dr. Glen Mays, UAMS--Fay W. Boozman Fay W. Boozman College of Public HealthCollege of Public Health

Special ThanksSpecial Thanks

Suzanne BiermanSuzanne BiermanJerri DerlikowskiJerri DerlikowskiKim BaxterKim BaxterDebbie VeachDebbie VeachJuanita WithamJuanita WithamVicki FreeburnVicki FreeburnFlo TaylorFlo Taylor

Thank you. Thank you.