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This is information provided by the
(DHH)
Department of Health and Hospitals website
CONTACT: Bob Johannessen, 225-342-4742
THE PROBLEMS
In Louisiana, we treat
sickness more than we prevent it, and we treat sickness late more
than we catch it early.
We get care later because the
state is short of primary care providers whose role
it is to detect disease early and coordinate effective treatment.
FACT: Louisiana
ranked last among states in primary health care access in 1999. This
ranking was based on a federal measure of the shortage or
maldistribution of health care practitioners in a state.
Almost every part of Louisiana
fits the definition of a primary care health professional shortage
area (HPSA). Rural areas are hard hit, but even our urban areas lack
enough primary care providers to provide minimum coverage to the
entire population.
FACT: The federal
government classifies any area with a population to practitioner
ratio of 3,500:1 or higher a Health Professional Shortage Area. As
of October 2000, Louisiana had 66 HPSAs, and 30.8% of the state's
total population (1.31 million people) lived in these areas - more
than double the U.S. average.
We get care later because many
of us - almost 1 in 4 - are poor and uninsured and
lack access to comprehensive health care, most notably primary care
and prescription drugs.
FACT: In 1999, 22.5%
of Louisianans (984,000 people) were without health insurance, up
from 19% (829,000 people) in 1998. Louisiana had a greater
proportion of its population without health insurance coverage than
either the U.S. (15.5%) or the South (17.6%). The state ranked 3rd
highest in the nation in the percentage of its population that was
uninsured. Only New Mexico (25.8%) and Texas (23.3%) ranked higher.
The poor and uninsured
frequently go without health care or get care only when health
problems become serious. They tend to rely on hospital emergency
rooms and inpatient stays because they cannot afford a doctor's
visit or prescription drugs and know that emergency care cannot be
refused for inability to pay.
FACT: National
research has shown that the uninsured are less likely to get
preventive and primary care, less likely to have continuity of care,
more likely to be diagnosed and treated at a later stage of illness,
more likely to be hospitalized for avoidable conditions, and have
higher death rates.
Louisiana's reliance on
Disproportionate Share (DSH) payments to finance health care for the
poor and uninsured contributes to the problem because DSH can pay
only for hospital services, creating barriers to doctor's office
visits, prescription drugs and other preventive and primary care for
the uninsured.
FACT: Louisiana
limits Medicaid eligibility to federally mandated populations more
than most states. Recent coverage for low-income children, pregnant
women, and women with breast and cervical cancer are notable
exceptions. Low-income parents and childless adults, accounting for
the vast majority of the state's uninsured population, remain
ineligible for Medicaid coverage.
FACT: National
research shows that Medicaid recipients have better health outcomes
than the uninsured. The uninsured access physicians care only half
as much as those with medical insurance. Preliminary in-state
research suggests the same. For example, a comparison of CHIP and
comparable uninsured teen moms suggests fewer low birth weight
babies among CHIP moms with coverage for prenatal care than among
uninsured teen moms without it
We rely on institutional
care and a one-size fits all approach more than individualized, home
and community-based services.
Louisiana has more acute
care hospital beds, higher use and lower occupancy rates
than most states in the nation. Medicaid payments to acute care
hospitals support this excess capacity and overuse, often at the
expense of investments in preventive and primary care that is more
clinically effective and economically efficient.
FACT: Louisiana ranks
9th in US in the rate of beds in community hospitals per
100,000 population in 2000. Louisiana ranked 3rd among
SLC states.
FACT: Louisiana ranks
48th nationally in occupancy rate in community hospitals
in 2000. Louisiana ranked last among SLC states.
FACT: Louisiana
ranked 5th among SLC states in inpatient days per in
2000.
Louisiana has more
nursing home beds, higher use and lower occupancy rates
than most other states in the nation. Medicaid payments for
long-term care support this excess capacity and overuse at the
expense of investments to build capacity for home and
community-based alternatives to nursing home care.
FACT: Louisiana ranks
3rd in the nation in the rate of nursing home beds per
1,000 population age 85 and older in 1999.
FACT: Louisiana ranks
1st in the nation in the rate of nursing home residents
per 1,000 population age 85 and older in 1999.
FACT: Louisiana ranks
37th in the nation in nursing home occupancy rates in
2002.
FACT: For every
Medicaid dollar spent in Louisiana for long-term care services for
the elderly and disabled in 1999, 93 cents went to nursing homes and
7 cents to home and community based alternatives (compared to the
national averages of 81 and 19 cents, respectively).
FACT: Louisiana ranks
second to last among SLC states in the use of Medicaid home and
community-based waiver services for the elderly and disabled
(serving just .02% of the eligible population).
THE SOLUTIONS
Invest in preventive and primary
care and home and community based long term care services.
- Maintain funding for medical
education loan repayment programs for primary care providers
practicing in underserved areas as well as health scholarships for
students from rural areas who will commit to returning to rural
areas to practice
- Expand funding to implement
the primary care case management program (CommunityCARE)
statewide, including targeted rate increases for participating
physicians
- Maintain Medicaid eligibility
for low-income children, pregnant women, and women with breast and
cervical cancer
- Expand Medicaid eligibility
to low-income parents through a HIFA waiver for preventive and
primary care and prescription drug coverage only paid for by DSH
savings
- Maintain funding for home and
community based long term care services for the elderly and
disabled, including adult day health and PCA services
- Maintain funding for home and
community based long term care services for people with
developmental disabilities (the MR/DD and Children's Choice
waivers, MR/DD waiver rewrite and a new adult capped waiver
program)
- Maintain community-based
developmental disability services provided by OCDD and community
capacity building efforts within state developmental centers
Divest from
institutional care, including acute care hospital and nursing home
services.
- Target cuts to inpatient
hospital services, first "extra" payments then base rates
- Target cuts to nursing
facility rates, avoiding payments for direct care costs
National Study, All
State Rankings
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