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Bring Health Reform Home: New Orleans

Bring Health Reform Home: New Orleans
2012Health
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Community health is complex—poverty, environmental conditions, and the health delivery system are all implicated in health outcomes and help us understand health disparities in our communities. To better understand this complex system, we are using emergency room (ER) visits from the LSU (Louisiana State University) Interim Public Hospital, in particular preventable admissions, as an indicator of the New Orleans community’s larger systemic health issues. Emergency room data show us what health crises are happening in our communities. Those crises may be heart attacks, strokes or other critical conditions, or they may be complications from chronic or common conditions, ranging from diabetes to influenza. These emergency room admissions for preventable conditions and untreated chronic conditions suggest that communities producing these conditions are underserved by the health care delivery system and living under the constant duress of various social and environmental conditions which degrade health.

The purpose of our study is to map where there are high concentrations of emergency room usage, the “hot spots,” in order to better understand the primary care needs of the community, the costs of using the ER system, and how to transform health care away from ER use and instead reinvest in these “hot spot” communities to build stronger, thriving and healthier families. The analysis shows that a handful of Zip Codes have the highest rates of ER admissions (the “hot spots”). In New Orleans, there are eleven Zip Codes that contain approximately 55% of all ER admissions to the LSU Interim Public Hospital. These eleven represent about one-quarter of New Orleans. These Zip Codes include: 70112, 70113, 70114, 70116, 70117, 70119, 70122, 70125, 70126, 70127, and 70128.

The mapping and analysis revealed that these areas are sicker, especially with preventable conditions, are poorer, and have greater concentrations of racial minorities. While African Americans make up about 60% of the New Orleans population, they make up about 75% of the population in the “hot spot” Zip Codes. The reverse is true for Whites. While Whites represent approximately 51% of the city’s population, they represent only 20% of the population in the “hot spots.” The city has a poverty rate of 20%, compared to an almost 28% poverty rate in the “hot spot” Zip Codes.

Access to insurance is a critical issue in New Orleans. ER patients in the “hot spot” Zip Codes are more likely to rely on charity care, government sponsored health insurance, or their own money to cover their medical costs. These areas also have far fewer primary care physician locations than New Orleans as a whole, a key point of intervention in the health care delivery system. For example, there are only 63 primary care physician locations, out of a city-wide total of 478, in the “hot spots.”

We also looked at two social determinants of health indicators: unemployment and vacancy rates. Mapping and analysis show that “hot spot” Zip Codes have higher rates of unemployment and vacancy than New Orleans as a whole. 

Reliance on the ER for treatment of preventable conditions is not sustainable, and represents a cost to the system, in terms of ER visit costs, patient admitted costs, and costs to others who have actual emergencies. It also represents a major cost to people in terms of poorer health and shorter life expectancies. Reliance on emergency rooms clearly signals a sign of distress for our health care delivery system, and represents an ineffective use of limited health care dollars that does not serve anyone in the system well, from patients to ER doctors to the state.

We believe that it is possible to begin to address these disparities by addressing the Medicaid system that serves these communities. Due to the Affordable Care Act, Medicaid is going to expand across the country to include an additional 15 million people. Yet we see that in New Orleans, families with Medicaid are forced to use the ER as a source of primary care. In other words, having Medicaid insurance is not equating to real preventative healthcare. Additionally, efforts to expand access to preventative care through other strategies and efforts to address social determinants of health are needed to meet the health care needs of these communities.

In organizing, we look for concrete solutions to what seem like insurmountable social issues. Therefore, beginning with reorganizing the local Medicaid system to work better for the families in these eleven Zip Codes, we can begin to save lives and build stronger and healthier communities throughout New Orleans. 

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