INTRODUCTION
Objective
Clermont County Community Services has prepared this community health assessment for distribution to any interested parties. The assessment has been put together through various methods including data from other county assessments, census information and surveys from organizations and Clermont county residents. The goal of the community health assessment is to analyze the county’s health problems, needs and assets, and to document resources within the county and the capacity of the county to address the needs.
This information is to be used to further promote the health care needs of women and children and to continually monitor and update data as new information is gained. The assessment is not completely inclusive of all maternal and child health care needs in the county but is a good indication of most major needs and concerns that the county can work on to improve health.
Methodology
The methodology process used included a questionnaire design, survey implementation, data analysis, limitations and demographics. The questionnaire design was based on a survey that was either completed by hand or online. The questions were developed through the consortium to focus on child and prenatal health care. The survey was open from May 1, 2010 through July 31, 2010. A total of 230 surveys were completed. The majority of surveys was completed through various organizations and were returned to Clermont County Community Services and entered online. Other surveys were completed online. A small amount of data was also taken from the Clermont County General Health District’s health assessment. The health districts assessment conducted phone interviews at random of Clermont County residents. The health district’s assessment was targeted at nutrition and physical activity. Clermont County Community Services also conducted a phone survey of child and prenatal providers in the county. This survey sought to find how many providers accepted Medicaid, how many providers offered sliding fee scales, and the wait times for entering practices. The data analysis was weighted according to age, gender, marital status, income level and educational back ground. The data from Clermont County were compared to state and national data.
Demographic Information
Based on the raw data, most of the respondents were married females, ages 22 to 49, with annual household incomes less than $20,000 who had completed their senior year of high school. Below is a chart that illustrates the demographic information.
Characteristic / Percent / NumberSex
Female / 80.6 / 175
Male / 19.4 / 42
Age
15 or younger / 2.2 / 5
16 – 21 / 8.3 / 19
22-29 / 22.4 / 51
30-39 / 26.8 / 61
40-49 / 20.6 / 47
50-59 / 13.2 / 30
60 or older / 6.6 / 15
Annual Household Income
0-$10,000 / 49.3 / 106
$10,000 – 20,000 / 23.3 / 50
$20,000-$30,000 / 9.8 / 21
$30,000-$40,000 / 7.0 / 15
$40,000-$50,000 / 1.9 / 4
More than $50,000 / 8.8 / 19
Marital Status
Single / 33.8 / 75
Married / 41.0 / 91
Divorced/Separated / 22.5 / 50
Widowed / 2.7 / 6
Education
Grades 1-8 / 3.6 / 8
Freshman / 3.6 / 8
Sophomore / 6.3 / 14
Junior / 11.8 / 26
Senior / 45.2 / 100
College Graduate / 7.7 / 17
Health Insurance
Most respondents (67.1%) and their children (92.8%) had health insurance. In many cases,it was federal/state insurance, such as Medicaid/Caresource or Medicare (76.8%); otherwise, it was employer-provided (23.2%). Only one respondent purchased insurance individually. Eighty-six percent (86.2%) of children were insured through Medicaid programs.
Percent / NumberAdults without Insurance / 32.9 / 73
Adults with Insurance / 67.1 / 149
Medicaid / 71.0 / 110
Medicare / 5.8 / 9
Employer-provided / 23.2 / 36
Self-purchased / .6 / 1
Children without Insurance / 8.8 / 13
Children with Insurance / 91.2 / 167
Medicaid / 86.8 / 145
Employer-provided / 13.2 / 22
Self-purchased / .6 / 1
A question CCCS sought to answer was, do children who are insured see their physician/pediatrician more often than children who are not insured? According to the survey responses, a higher percentage of children with insurance had seen a provider during the most recent twelve months.
Healthcare visit in the past year / Medical HomeChildren with Insurance (n=167) / 94.3% / 94.3%
Children without Insurance (n=13) / 83.3% / 83.3%
The chart below illustrates how many times over a twelve-month period children with and children without insurance had seen their pediatrician/physician. A higher percentage of children without insurance saw their doctor one to three times, 63.6%, than those children with insurance (55.8%).
Number of Visits / Without Insurance / With InsurancePercent / Number / Percent / Number
1 – 3 / 63.6 / 7 / 55.8 / 82
4 – 6 / 27.3 / 3 / 28.6 / 42
7 – 10 / 9.1 / 1 / 8.8 / 13
10 - 12 / 0 / 0 / 5.4 / 8
More than 12 / 0 / 0 / 1.4 / 2
Health Insurance (continued)
There was a significant difference between children with health insurance and those without, regarding why they visited a healthcare provider. In general, children without health insurance saw a doctor for illness (100%) or for injury (30%) more often than for immunizations or preventative care. While children with insurance were less likely to see a doctor for illness or injury, they were much more likely to obtain preventative care and immunizations.
Reason for Visit / Without Insurance / With InsurancePercent / Number / Percent / Number
Illness / 100 / 10 / 68.5 / 89
Injury / 30 / 3 / 10.8 / 14
Preventative Care / 20 / 2 / 53.8 / 70
Immunizations / 1 / 10 / 64.6 / 84
Other / 0 / 0 / 2.3 / 3
The most common conditions for which children received treatment, whether with or without insurance were ear infections, asthma and learning disabilities. These results are illustrated in the chart below.
Condition / Percent / NumberEar Infection / 81.0 / 98
Asthma / 32.2 / 39
Other (Learning Disability) / 14 / 11
Below is demographic information that was developed based on whether the children had health insurance. Children without health insurance were more likely to have a female parent who was divorced/separated, between the ages of 30 and 49, and who had little or no college education. Children of families with annual household incomes less than $20,000 were more likely to be insured.
Characteristic / Children with Insurance / Children without InsurancePercent / Number / Percent / Number
Sex
Female / 85.4 / 134 / 100 / 13
Male / 14.6 / 23 / 0 / 0
Age
15 or younger / 1.8 / 3 / 0 / 0
16 – 21 / 10.3 / 17 / 0 / 0
22-29 / 26.7 / 44 / 15.4 / 2
30-39 / 30.3 / 50 / 46.2 / 6
40-49 / 19.4 / 32 / 30.8 / 4
50-59 / 8.5 / 14 / 7.7 / 1
60 or older / 3.0 / 5 / 0 / 0
Percent / Number / Percent / Number
Annual Household Income
0-$10,000 / 48.8 / 78 / 30.8 / 4
$10,000 – 20,000 / 24.4 / 36 / 23.1 / 3
$20,000-$30,000 / 10.6 / 17 / 0 / 0
$30,000-$40,000 / 6.3 / 10 / 30.8 / 4
$40,000-$50,000 / 2.5 / 4 / 0 / 0
More than $50,000 / 7.5 / 12 / 15.4 / 2
Marital Status
Single / 33.5 / 54 / 30.8 / 4
Married / 47.2 / 76 / 38.5 / 5
Divorced/Separated / 18.0 / 29 / 30.8 / 4
Widowed / 1.2 / 2 / 0 / 0
Education
Grades 1-8 / 3.1 / 5 / 0 / 0
Freshman / 3.1 / 5 / 0 / 0
Sophomore / 5.7 / 9 / 7.7 / 1
Junior / 11.9 / 19 / 0 / 0
Senior / 44.0 / 70 / 61.5 / 8
College Graduate / 7.5 / 12 / 7.7 / 1
Prenatal Behavior & Care
Forty-three percent of women surveyed reported that they smoked during pregnancy. All these women reported receiving prenatal care. They were not asked whether their doctor had warned them about smoking while they were pregnant.Data were developed on these women to determine for what conditions their children had been treated most frequently. Children of these women had been treated for ear infections (84%) or asthma (45%).
Characteristic / Percent / NumberSmoked while pregnant / 100 / 43
Received prenatal care / 100 / 43
First Trimester / 83.7 / 36
Second Trimester / 97.7 / 42
Third Trimester / 100 / 43
Women who had smoked while they were pregnant were likely to be 22-29 years old (39.5%) who had completed high school and some college (81.4%), were married, with income of $10,000 or less using Medicaid or employer-provided insurance (97.1%).
Dentist Visits and Dental Insurance
According to the survey results seen below, most adults (54.9%) had not seen a dentist in the last twelve months. Although this question was not asked about children, it is safe to assume similar percentages of children also have not seen a dentist in the past year. Most people stated they had not seen a dentist due to lack of income or having no dental insurance.
Question / Percent / NumberDo you see a dentist one or more times each year?
No / 54.9 / 124
Yes / 45.1 / 102
If no, why not?
Lack of income / 48.9 / 45
No dental insurance / 73.9 / 68
Transportation problems / 6.5 / 6
All other / 6.6 / 6
Of the adults who had insurance, 62.6% had seen a dentist in the past year while only 11.1% of adults without health insurance had seen a dentist. Regardless of whether people had insurance, if they had not seen a dentist over the past year, it was the result of inadequate income or no dental insurance. It should be noted, 71.9% of people with health insurance had Medicaid/Caresource insurance.
Ohio Department of Health CFHS & FP Health Status Profile: Clermont County
The following table was taken from the Ohio Department of Health website. This information is a health status profile for Clermont County. Highlights of this data suggest that the majority of persons in Clermont County are white with less than 3.1% of persons not speaking English. The percent of children living below 100 percent of the poverty level is 12.7%. Uninsured children is 6.4% and the percentage of children overweight is 30.2%.
Although this data suggests that 6.4% of children are uninsured, Clermont County Community Services survey documents 8.8% of children are uninsured. Data taken from the MATCHR system also shows a higher rate of uninsured children. 2009 data showed a 10.2% of uninsured children while 2010 showed 8.5%.
Clermont County Community Services conducted a phone survey of pediatric providers in the county. Out of 10 providers, half accept Medicaid. Of the half that does accept Medicaid Four of the providers are from Health Source Ohio. This organization is a FQHC. Although they do accept Medicaid they have strict rules for their practice. If a patient breaks more than 3 appointments they are terminated from the practice. Clermont County Community Services does not turn away any child due to broken or missed appointments. Many of our clients have barriers to getting their children to appointments. One of the largest barriers is transportation. The County has a very small transportation line that does not meet the needs of the county. The line is very small and only operates in certain areas of the county. A client must schedule their pick up a week in advance. This will not meet a parents need for transportation when a child suddenly becomes ill.
The next survey question asked was if the practice had a sliding fee scale. This chart shows that the same amount of providers accept sliding fee scale as well as Medicaid. This is again due to 4 of the 5 providers who offer a sliding fee scale is from the same corporation, Health Source Ohio. Their corporation has a very strong guideline with sliding fee scale patients as they do with broken appointments. If a client does not pay their sliding fee scale balance they are also terminated from the practice. Clermont County Community Service again does not discriminate against any client due to inability to pay. Since the recession the agency has seen a 30 % increase in patients, particularly sliding fee scale patients. People have lost their jobs with no health insurance and must bring their children to the clinic for medical care.
The following diagram shows the wait time for physicals. Out of 10 providers, 7 have wait times greater than 30 days. Only 3 providers including Clermont County Community Services offer physicals within 30 days. The other 2 providers stated the wait time is 3 weeks, with the condition that the patients bring prior records to this appointment. If the patients are not able to provide the past records the visit will be rescheduled. Clermont County Community Services does not allow a barrier of past records to stop the patients from being seen. The agency will work with the patients and help to secure the records in a timely manner.
The agency also conducted a survey of prenatal providers. The agency contracts with Anderson Mercy Hospital offering a prenatal clinic for Clermont county women. There were only 2 other providers in the county accepting Medicaid. Neither of these 2 providers offer sliding fee scales. The wait time for a prenatal visit at these 2 providers exceeded 3 weeks.
The following data was taken from the Clermont County General Health District Health Needs Assessment. The Center for Urban Affairs at Wright State University conducted the needs assessment for the health district. This data relates to disease prevalence including cardiovascular and asthma.
Clermont County Community Services Health Survey1