Anabel Lira, Karen Zheng, Greg Parkins, Wah Beh
Omaha is well known for its diverse regions. Each of these regions consist of people whose background can range from low-income to high-income earners and different races such as African Americans to Hispanics to Whites. Such a difference can be noticed in the image below, as it shows the residents of Omaha by race and where they live. The differences in each person’s background can affect many aspects of their lives, one aspect being healthcare. This research project takes a deeper look into how healthcare is affected by outside factors, such as income, race of a patient, or the location of the healthcare facility. The study is going to examine four different hospitals within the Omaha area, three of which will be in the low-income areas and the other in an high-income area. The information collected will be analyzed to point out the how low-income levels and the diverse cultural regions of Omaha affects the individual’s access and quality to health care.
To start this research, Omaha was broken apart into different regions. These different regions were based on the average income of their residents, which in turn also divided the residents by race. The lower income regions of Omaha were North Omaha, believed to be highly inhabited by African Americans, and South Omaha, which is mainly inhabited by Latinos. On the other hand, the higher income region of Omaha is West Omaha, whose residents are predominately White. As a group, we decided the best way to compare if the health care services provided were equal to all the residents of Omaha, was by focusing on at least one healthcare facility in each of these regions. A total of four healthcare facilities were chosen, each located on the map shown below. The healthcare facilities that were included in this research were CHI-Lakeside, Nebraska Medicine- Baker Place, the Charles Drew Health Center, and the Methodist Physician Urgent Care.
Following, each person in the group went to the healthcare facilities’ website and examined the information that the websites provided. The information included in each website was then analyzed and placed into similar categories. The best way chosen to compare the health care facilities, was to focus on the information provided by all four facilities; these categories were services, patient characteristics, accessibility, financial assistance, and community benefits. Each category played a significant role in viewing how equal or unequal the healthcare facilities are in Omaha. Lastly, the group examined a research report done by the Professional Research Consultant Inc; the report was the 2015 Community Health Need Assessment. Within this report, we could look at each of our categories from a statistical view.
Hospitals play an important role in the healthcare system. The health care institutions have an organized medical and other professional staff, inpatient facilities, deliver medical, nursing and related services daily. Quality health care services are important for the achievement of health fairness and for increasing the quality of a healthy life for everyone. The health care facilities provide medical/surgical services for all kinds of conditions, illnesses, injuries, or deformities for all the population. However, in all the four areas examined, Lakeside CHI is the only healthcare facility that does not provide interpretive services, which is in the high-income area of west Omaha. Lakeside CHI does not offer this service because it is not needed. The overall majority of residents living in the area are Caucasians, so the healthcare providers and patients are all proficient English speakers so interpretive services are not needed. In the north and south regions of Omaha, there are more minorities with limited English proficiency (LEP) living in the area. It becomes a challenge for the healthcare workers because there is a language barrier between them and their patients. It is common for hospital websites to have translations, however the north and south Omaha hospitals websites that were examined had more than just a Spanish translation, they also included Mandarin or Vietnamese. The South is known to have a large Hispanic population so Methodist had a Spanish translation. So with interpretive services available, healthcare providers can interact with patients from different cultures and make sure they receive proper healthcare and ensure that legal proceedings are properly conducted.
Language barrier is a common issue here in the Omaha metropolitan area, especially in the north and south regions of the city. The population of immigrants is expanding, so interpretive services are a great method that hospitals in the low-income areas need for their patients. West Omaha is known to be highly populated by the Caucasian population, but it is a possibility that the Hispanic, Asian, African American, etc., population will grow into that area in the future. If or when this happens, hospitals like Lakeside CHI will need to make changes to their health care services to make it convenient for patients with LEP to seek health care.
Omaha is diverse which can affect the businesses surrounding each area, such as hospitals. When considering hospitals in the north, there are little to no actual emergency care hospitals. There is one health care center that people in the north can go to if they cannot travel too far from the northern region. That health center would be the Charles Drew Health Center. This health center has a lot of information regarding their patient characteristics. Most of the patients they see are predominately African Americans, which is 45% of their overall patients. Other races seen at the health center are 8% Asians, 5% Native Americans, 4% Hispanics, 24% Whites, and 17% others. It is not surprising that the most seen race at the health center is African American since African Americans mainly populate North Omaha. The most common age group among the patients range from 20-64 at 60%. The next most common age group ranges from 0-19 years old at 35% and the least common is ages 65 or older at 5%. Out of all the patients, no matter what race or age, 89% of the patients are below the 100% poverty level. North Omaha is known to be the poorest part of Omaha, which is seen in the chart and graphs below provided by the Douglas County Health Department. North Omaha is part of Douglas County which has the highest in poverty in both <100% and <200% below poverty
level. Then if you take a look at the two graphs, the darkest clusters indicate poverty areas, which are all around the north side of Omaha. This could explain why the poverty level is so high at the health center opposed to other areas that are not as high in poverty.
Nebraska Medicine – Baker Place is also another health facility that is available to people in North Omaha. The most common age range at the hospital are ages 18-24 at 61.3%. Roughly eighty-eight percent of the patients at the hospital are Whites. Following right after whites were other races at 5.7% which is then followed by African Americans at 4.6%.
This difference is greatly significant, it points out that even though North Omaha is known for its’ African American presence, this belief may not be entirely true due to the large White presence at Nebraska Medicine. The change in patient race between Charles Drew Health Center and Nebraska Medicine might be due to the differences in the establishments. Compared to the Charles Drew Health Center, Nebraska Medicine – Baker Place is part of UNMC, which is a bigger corporation than a self-started health center. This difference between a large corporation and a self-started business is significant because African Americans have had a long history of distrust in the healthcare systems. This distrust started way back in the time of slavery. Slaves often did not have “the opportunity to [go to the doctors’ for any illnesses], so they relied on many of the folklore remedies that they brought with them from Africa” (Kennedy 57). Even after gaining access to health care, African Americans consistently faced racism, it is this “unique combination of racism, slavery, and segregation” that have lead to “African Americans to develop not only different behavioral patterns, values, and beliefs but also different definitions [and] standards” of healthcare systems (Kennedy 57). Not only has slavery, racism, and segregation put distrust on the healthcare system, it has also put distrust in Whites in general. After looking over the staff members of Nebraska Medicine – Baker Place, it is most definite that the majority of the staff are Whites. On the very first search page of a list of primary physicians only 1 out of 15 was a different race other than White. This may also be a reason why this hospital is not the prefered location for African Americans.
Lakeside hospital had little to no information about patient characteristics due to it being part of the big CHI corporation. However, the west part of Omaha appeared to have the smallest percentage for cultural/language barriers preventing medical care.
Just as having difficulty with cultural/language barriers, one immense issue with the low-socioeconomic status (SES) group is having access to healthcare. This means issues with transportation, affordability, having a primary care physician, technology, and no health insurance. The major issues focused on are affordability, having a primary care physician in Nebraska, transportation, and technology.
Nebraska has approximately two million people residing in the state, and Omaha has approximately 1/4th the population of the entire state. Omaha is extremely diverse with its people and its income. Minorities represent 19.5% of the entire state population, with Hispanics being the largest of the minority groups represented by 10.2%. North and South Omaha are known for their lower-SES communities, while West Omaha is known for their high-SES. There are significant differences in health care access between North/South Omaha and West Omaha. For the Charles Drew Health Center North, 42.2% of the community in the Northeast and 34.2% in the Northwest have greater difficulty gaining access to healthcare. In the Southeast, it’s 39.3% and in the Southwest, it’s 34.2%. This is compared to the 25.2% in Western Omaha.
Access to Primary Care- Physicians
According to the Douglas County Health Assessor, the percentage of people who were hindered from primary care physician visits in the past year were, 13.8% in the Northeast, 9.1% in the Southeast, 1.8% in the Northwest, and 3.0% in the Southwest. West Omaha’s percentage was 1.3%. A staggering 33.9% of the Metropolitan area adults report some type of difficulty or delay in obtaining healthcare services, that’s one out of every three adults having trouble with access to healthcare. Primary care is known as “preventative medicine”, when a person begins to feel ill or had a hospital visit, they are instructed to visit their primary care physician. These physicians offer counseling for illnesses and the medication/treatment to combat any illness or injury. This is difficult for many people with low-SES, especially minorities. According the DDHS, Hispanics represented by 39.6% had the highest proportion with no reported personal physician, which was 2.3 times higher than non-Hispanic Whites.
Cost is a major key as to why many people of low-SES do not see any primary care physician. Even people with health care are finding premiums or copayments increasing, causing more difficulty. Another issue is most primary care physicians operate during regular business hours, and many people work during those times. Low-SES people have difficulty taking the time off, whether that’s due to PTO or not being able to afford the absence from work. The Hispanic community experiences the highest percentage of people who are not able to see a primary care physician due to cost by 20.7%, compared to non-Hispanic Whites by 9.1%.
Access to Transportation
Omaha’s public transportation service is a major component for many of theses people suffering from these barriers. The Omaha-Metro area has public bus transportation throughout the entire city. However, these buses only run routine hours and stop at every location throughout specific times of the day. Unfortunately, Omaha does not have a subway/railcar system to provide frequent transportation.
Access to Technology
Another restriction many people are facing is the availability of different technological services. CHI-Health, Lakeside Hospital, located in West Omaha, offers a 24/7 service of virtual care. This provides instant healthcare counseling for any person who has this available to them. While some of specific hospitals/emergency care facilities are researching do provide some outreach services; Methodist Physician Urgent Care (South) provides an option for people to message them on their website with medical questions and will commonly receive a response within the hour, many people need access to a computer/smartphone with internet connection. The Nebraska Medicine – Bakers Place is attempting to increase the availability and accessibility of primary care physician appointments for the residents in the Omaha-Metro area, more specifically in the North Omaha area. They are focusing on expanding care for the underserved populations and creating outreach programs to assist people with low-SES to receive proper medical treatment.
Accessibility is a major issue in today’s healthcare system. Throughout the Omaha-Metro area, numerous healthcare operations are developing new programs to assist patients in accessing healthcare. Whether the issue is cost, transportation, or accessibility due to time/work, assisting people with low-SES is a necessity. Although these issues and disparities will not be fixed overnight, the process of facing these issues and creating solutions can be seen all around the Omaha-Metro area.
Financial Assistance and Community Benefits
Families not only need help in accessing healthcare, but also ways to pay for the healthcare. Families of low-SES also need help in getting educated about the diseases around them and ways to prevent from getting those diseases. In Omaha, there is a variety in the types of healthcare facilities available and the type of assistance they give to those families in need. All four of the healthcare facilities researched have some type of financial assistance program and in some way, give back to their communities.
When looking at the financial assistance provided by all four healthcare facilities, it is not difficult to see that they provide similar assistance. It is common that they would provide financial assistance to those patients with an income at or below the federal poverty level. For example, the Methodist Physician Urgent Care provides free assistance to those with a family income that is equal to less than two times the federal poverty level and had limited assets (Design, C.3., 2017). They also provide a discounted care to those with an income between two and four-times the poverty level (Design, C.3., 2017). Their application for financial aid was also available in multiple languages, specifically in Spanish and languages spoken by 5% of residents in their area (Design, C.3., 2017); this is very helpful since those who may need financial aid may not be proficient in English.
Similar, the financial assistance available by Nebraska Medicine-Baker Place made sure they reached patients with insurance that had a remaining liability. Nebraska Medicine-Baker Place goes on to also help patients with purchasing their prescriptions. Just like the other healthcare facilities, CHI-Lakeside provides financial assistance for those uninsured or underinsured whose household income is at or below 300% of the federal poverty level (Financial Assistance, 2017). Overall, CHI-Lakeside provided $50.7 million to those who couldn’t afford their care in 2016 (Community Benefit, 2017).
It is helpful that all four of the healthcare facilities have some sort of financial assistance provided for adults between ages 18-64 years old, many had reported not having any insurance coverage for healthcare expenses in 2015 (Community Health Needs Assessment). The adults located in the northeast part of Omaha reported that 21.6% did not have insurance, as well as the 4.5% of people located in the northwest part of Omaha (Community Health Needs Assessment). Those located in the southeast part of Omaha, reported 19.6% people did not have insurance, and 2.6% in the southwest did not have insurance as well (Community Health Needs Assessment). According to these statistics, the western part of Omaha has less uninsured adults than the rest of Omaha.
Although financial assistance should be fair for everyone, it may be more beneficial to have a greater amount of assistance to the lower income neighborhoods. It would make sense to offer more help to those who are in need of it more. As stated earlier, the western part of Omaha has less uninsured adults who have higher incomes than the other areas of Omaha. This shows that more financial assistance is needed to other areas outside of the western part of Omaha. The South for example, is highly populated with Hispanics and according to a previous study, Hispanics have been known to have the lowest education resulting in the highest rate of unemployment and homelessness (Bernstein, 2006). On the other hand, the West is highly populated with Whites who have been known to have higher levels of education and employment (Bernstein, 2016). If Hispanics or other minorities cannot get a good paying job due to their lack of education, then they cannot afford the healthcare they need and rely on financial assistance. It is also important they receive more financial assistance since they are more likely to have a higher prevalence of unhealthy behaviors that cause them to have more health problems (Lu, 2004).
Another reason financial assistance offered should be increased to these neighborhoods of low-SES is because it would decrease the chances of the patients relying on the emergency department. When families have no insurance or financial assistance, they are less likely to have a primary care physician and get follow ups (Ferayorni, 2011). These people of low-SES begin to have the mindset that going to the emergency department is their only option; this is caused by the federal law that assures patients are guaranteed to be treated and stabilized, regardless of their ability to pay (Ferayorni, 2011). When many low-income patients receive care in the ED, it can cause the ED to shut down because they have so many patients who are unable to pay for their bills (Ferayorni, 2011).
While all these healthcare facilities provide financial assistance, they also do much more to help their communities. For example, Charles Drew Health Center serves more than 2,000 WIC families in Omaha yearly (Affordable Healthcare, 2015). They help provide each family in need $30 seasonal benefits to use in the Farmer’s Market; the center itself helps in the market so that families could also use other types of benefits there, such as WIC (Farmers Market, 2015). The Charles Drew Health Center also provides a Healthy Start whose goal is to help lower the number of infant deaths yearly in Omaha; this is especially designed to help African American families (Omaha Healthy Start, 2015). A similar program that helps families is called Father’s for a Lifetime, designed to help men become the fathers they want to be (2015). Another program that the Charles Drew Health Center has is a Community Outreach and Enrollment where they have one-on-one social work case management, have nursing assessments and support, and have referrals for health and social services.
Similarly, the Methodist Physician Urgent Care have programs designed to help improve the access of health care and to enhance the community’s knowledge of medical or healthcare (Design, C.3., 2017). Overall, Methodist Physician help provide $73 million in benefits to community in 2015 (Design, C.3., 2017). When looking at the image below, one could identify how the money by Methodist Physician was divided for the community. In Nebraska Medicine-Baker Place, they also have educational support staff aimed to increase the community’s knowledge in health care (Community Benefit Report). In CHI-Lakeside, they were fortunate enough to help provide a total of $17.6 million in programs and partnerships meant to provide education to help improve the overall health of the community (Community Benefit, 2017).
The amount of community benefits provided by healthcare facilities is highly needed by the members of the community. Having programs to educate the population regarding preventative measures is highly important especially when living in a disadvantaged neighborhood increases the likelihood of having unmet medical care (Kirby,2005). It is also important when factors regarding the range of knowledge of health care practices and nutrition can disable someone from receiving the proper care (Mutchler, 1991). While Charles Drew Health Center, Methodist Physician Urgent Care, and Nebraska-Medicine-Baker Place do a great job in educating as many members in their community as they possibly can, educating their patients is only part of the problem.
There are numerous factors that shape how healthcare is carried out and those factors form a trend in Omaha. Hospitals in Omaha have the resources to provide excellent healthcare services, however there are other outside factors that affect a hospital’s ability to perform. These outside factors range from different language barriers between patient and doctor to types of financial aide needed by each patient. Unfortunately, those outside factors can only be managed, not controlled; how well a hospital manages the factors determines its success in each of its patient’s quality of healthcare. Information was taken and analyzed from four hospital websites, three in low-income areas and one in a high-income area. From those findings, it is evident that income level and the diversity of the region among other factors have a direct effect on each patient.
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