Special Populations...

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Chapter 11

• Special Populations...

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Defined...

• Underserved, vulnerable, disadvantaged or
  underprivileged
• Those who encounter barriers in accessing
  healthcare services
• Often at greater risk of poor physical, mental
  and/or social health
• Examples?

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Reasons?

• Economic Factors
• Insured status
• Direct relationship between economic and health
  status
• Non-economic Factors
• Genetics, lifestyle, age, developmental factors
• Geographic
• MD maldistribution, access in rural areas

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Reasons?

• Gender
• Women have special needs
• Men have poorer health
• Social and cultural barriers
• Beliefs, religion

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Racial Minorities

• 1/5 of the U.S. population is minority
• Access Rankings
• White Black Hispanic
  Native Asian
• Physician contact for children lt age 6
• 1 2 4 5 3
• Usual source of healthcare (6-17)
• 1 3 5 2 4
• Usual source of healthcare (Adults)
• 1 2 5 3 4

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Examples of Discrepancy

• LBW (lt2,500 g)
• Highest among blacks
• Improvement in Blacks, none improvement in
  Hispanic and Asian
• Attributable to
• Smoking and lack of prenatal care
• Need to look at reasons??!!

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Examples of Discrepancy

• Infant Mortality
• Highest among Blacks
• Asians have the best outcomes
• Hispanics comparable to Whites

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More Health Status

• White Black Hispanic
  Native Asian
• Fair or poor health (self) 2 4 3 5 1
• Death from heart disease 4 5 2 3 1
• Death from cancer 4 5 2 3 1
• Death from diabetes 2 4 3 5 1
• Death from HIV/AIDS 3 5 4 2 1
• Suicide 4 3 1 5 2
• Accidental death 3 4 2 5 1
• Homicides 2 5 4 3 1

Implications??
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Uninsured

• 1 in 4 Americans
• Low income, less educated, service sector, small
  employers, young adults
• Native Americans covered under the Indian Health
  Service System
• 1/3 of all Hispanics uninsured
• 14 of all children

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Children

• Private health insurance limits
• Dependents, cost
• Childrens Health Insurance Program (CHIP)
• Genesis, basis and status (Florida)
• Reasons
• Developmental vulnerability
• Dependency
• New Morbidities

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Women

• Great life expectancy than men
• Greater morbiditities and poorer health
• Certain conditions more prevalent in women
• Depression
• Eating disorders
• Alzheimers disease
• Principle users decision makers of healthcare

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Rural Health

• Access issues
• Availability, transportation, poverty, MD
  Maldistribution, hospital closures
• Access programs
• National Health Services Corps (NHSC)
• Health Manpower Shortage Areas (HMSA)
• Medically Underserved Areas (MUA)
• Community and Migrant Health Centers (C/MHC)

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HIV/AIDS

• By the numbers (U.S.)
• 950,000 living HIV cases
• 1/4 are unaware of their status
• 362,000 AIDS cases
• 468,000 deaths
• 40,000 new cases annually
• Heterosexual infection increasing
• Homosexual infection stabilizing (decreasing)

2.5 million cases in Southeast Asia
42 million world wide
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Costs

• Rx therapy
• 12 - 16,000 per year
• Total Care
• Reported cases 8 billion annually
• Unreported cases 3 billion annually
• Still lt 1 of the total healthcare spending
• Wake Effect is staggering
• Orphans, lost productivity

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Drug Abuse

• Major issue in Central Florida
• gt 350 heroine deaths in Orange County in 2000
• In U.S.
• Fallen by 50 in past 15 years
• Some segments increasing
• 12 - 17 Y/O
• LSD use doubled between 1990 - 1998

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Homelessness

• 3 million Americans
• 8 parents with children
• 1/3 are veterans
• 20 are women
• High incidence of mental health and substance
  abuse issues
• Overuse healthcare services
• Interventions?

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Mental Health

• 20 of Americans suffer in any given year
• Economic burden 2nd only to heart disease
• Usually untreated
• Reasons?
• Social stigma
• Limited insurance coverage

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Mental Health

• Access Expenditures
• 40 private psych hospitals
• 22 government programs
• 38 state and local programs
• Managed care increasing role
• Employers increasing role
• Winter Park Health Foundation Study
• 11 of Central Floridians contemplated suicide
  last year