Sunday Briefing / An occasional look at Orange County issues : A Profile of Health Care

More than 300,000 Orange County residents are without health insurance of any kind, and many more don’t have full coverage. Of the nearly 7 million Californians without health insurance, more than half reside in the Southland. National health care spending is more than $900 billion a year and devours 14% of the nation’s economic output. A report on the state of Orange County’s health:

Insurance: Who’s Covered, Who’s Not

Lacking Coverage

There are 37 million Americans who have no health insurance, nearly 7 million of them in California. With more than 300,000 residents 65 ad younger lacking health insurance, Orange County ranks second in the state for non-elderly residents with no coverage. Insured and uninsured among those 65 and younger, in Orange County compared to the state and nation in 1992:

Orange County State Nation Insured 80% 78% 83% Uninsured 20% 22% 17%

*Four Major Coverage Plans

Indemnity: Subscriber chooses own physician or clinic. Insurance plan generally reimburses 80% of billed charges.

Health Maintenance Organization (HMO): Subscribers must stay within a network of physicians and hospitals. No benefits payable outside the network. Most plans call for employees to share costs in the form of deductibles and co-payments.

Preferred Provider Organization (PPO): Similar to an HMO, except subscribers can go outside the network and pay higher prices. Subscribers are free to choose specialists within the network without authorization from a primary care physician.

Point-of-service (POS): Plans are sometimes called “open-ended HMO.” Subscribers pay less if they stay within the network. They must get approval from their primary care physicians before seeing network specialists. Subscribers may choose a non-network doctor, but they pay more.

Profiles: Insured

Fermin Escobar, 35

Santa Ana; chemical plant worker

“I broke my leg from the shinbone almost to the knee. I have insurance with my work, but it doesn’t cover me outside of my work. The doctors told me I have to pay $4,000. They also told me I would not be ables to work for at least a month. I don’t know where I’m going to get the money.”

* Pamela Rios, 27

Orange; clerk at vocation center

“My hospital care has been excellent. I just changed to a PPO, and it’s excellent for a mother-to-be. I’ve never had any problems with any of my hospitals or insurance.”

* Woodrow L. White, 75

Downey; real estate broker

“I live in Downey, but they make me come all the way to Anaheim Hills. The doctor that operated on my eyes works in Bellflower, but I can’t see him anymore. He told me it’s Kaiser’s fault. I have two eye implants. Now they are being treated for infection. The doctor dumped me because I’m sick. He sent me down here and told me not to come back. I keep sending him letters, but he won’t answer me.”

* Paul Chun, 20

Balboa; student

“It’s really hard to get a appointment. There are so many people, so few staff. I dislocated my shoulder over two months ago. I called up and about a month later they gave me an appointment. I called back and it was so severe, they made it a special occasion for me and only waited for a week.”

* Andre Garrett, 34

Laguna Niguel; health insurance salesman

“I pay $107 a month for a family of four. My insurance is excellent. My wife delivered and it cost me nothing. I was on the plan for about a month. We paid zero dollars.”

*

Profiles: Uninsured

Aieda Mukassti, 44

Fullerton; dress shop owner

“I have a stomach problem. I want to take some tests for my blood. It will cost me $3,000 because I have no health insurance. It costs a lot of money. We don’t make this kind of money.”

* Alex Brehm, 24

San Clemente; machinist

“I have a slipped disk. The other day I crashed on the bicycle. I’m lucky I didn’t break anything. I don’t know what I would have done if I had broken anything. I guess I would go to the hospital and have them bill me, if they still do that. I’m unemployed right now. I have to pay the gas bill, electric bill and rent. I have to eat, but I’m on unemployment. That’s $400 a month. Rent is $350 a month.”

* Jannet Kawai, 24

Placentia; student

“I would probably go to my dad if something happened to me. He is under his company health plan. But I don’t think I’m covered under his health plan. That’s terrible that I don’t have any insurance.”

* David Salinas, 37

Anaheim; construction worker

“I should worry but I don’t. I still have the old Indian remedies. Weeds and stuff. It keeps us healthy. Prescriptions make you more ill. A lot of old people use these remedies because they don’t have health insurance.”

* Ginny Blanchard, 60

Dana Point; retired business person

“I’m healthy. But I don’t have insurance. It’s definitely a gamble. I want to stay healthy for five more years when I can get Medicare.”

*

The Insured: Who Has What Type of Coverage

Orange County employers offer HMOs more than any other plan. The county’s PPOs cost more than the national average. How the county compares to the nation: Percentage of employers offering*

Orange County Nation HMO 85% 61% PPO 67 39 Indemnity 41 70 POS 18 11

Average annual cost employer pays per employee (in thousands)

Orange County Nation HMO $3.1 $3.3 PPO 4.3 3.7 Indemnity 4.2 4.0 POS 4.2 3.5

Average monthly contribution by employee only**

Orange County Nation HMO $30 $40 PPO 28 37 Indemnity 52 38 POS 35 40

Average monthly employee contribution for family**

Orange County Nation HMO $82 $115 PPO 92 117 Indemnity 91 107 POS 103 118

* Totals exceed 100% because employers can offer more than one plan. ** Among employers requiring employee contribution.

A Profile of the Uninsured

Full-time workers, all year

Orange County California Uninsured 42% 47% Insured 58% 53%

Full-time workers, part of the year

Orange County California Uninsured 26% 32% Insured 74% 68%

Part-time workers

Orange County California Uninsured 33% 21% Insured 67% 79%

The Human Condition

Causes of Death

Heart disease and cancer were the biggest killers of people in the county and the nation in 1991. Nationwide, heart disease claimed 720,058 lives and cancer killed 505,322. The 10 leading causes of death in Orange County:

Cause Men Women Total Rate per 100,000 Heart disease 2,208 2,383 4,591 185.3 Cancer 1,775 1,809 3,584 144.7 Stroke 371 622 993 40.1 Pneumonia, influenza 339 409 748 30.2 Respiratory diseases 314 361 675 27.2 Accidents (all kinds) 399 183 582 23.5 AIDS/HIV infection 255 12 267 10.8 Chronic liver disease 161 92 253 10.2 Atherosclerosis 92 150 242 9.8 Suicide 178 60 238 9.6 All other causes 1,101 1,095 2,196 88.6 Total 7,193 7,176 14,369 579.9

* A look at What Ails Us

Sexually transmitted diseases dominate the list of communicable diseases reported in the county. Local health officials say this is consistent with the national findings. The top 10 communicable diseases reported in the county compared to the nation.

Orange County (1992) Cases Chlamydia* 3,223 Non-specific urethritis* 1,507 Hepatitis B carriers 1,450 Gonorrhea* 1,104 Meningitis 790 Giardiasis (intestine) 670 AIDS* 462 Tuberculosis 411 Salmonella 395 Campylobacter (intestinal) 307

*Sexually transmitted diseases *

Nation (1991) Cases Gonorrhea* 620,478 Chickenpox 147,076 Syphilis*,,128,569 Salmonella 48,154 AIDS* 43,672 Tuberculosis 26,283 Hepatitis A 24,378 Shigellosis (dysentery) 23,548 Hepatitis B 18,003 Meningitis 14,526

*Sexually transmitted diseases Infant Mortality In 1991, 317 local children died before their first birthday. The deaths may have occurred outside the county but were counted if Orange County was listed as the primary residence.

Infant death rate per thousand live births:

Orange County: 6.18

Nation: 9.22

County Breakdown:

Blacks: 13.3

Whites: 7.2

Latinos: 5.7

Asians: 3.7

Southeast Asians: 2.7

Doctors and Hospitals

Doctors

Doctor-Population Ratio:

In 1992, there were 79,178 licensed physicians in the state, or one for every 398 people. In the county, there was one doctor for every 350 people.

Nationwide, there were 631,137 licensed physicians, not including those employed by the federal government.

People per physician, nationwide: 403 (1992)

People per physician:

Orange County: 350

State: 398

Nation: 403

What They Practice:

Internal medicine is the biggest specialty in the county and nationwide.

Six biggest specialties:

Specialty by percentage

Orange County Nation Internal medicine 15% 17% General practice 13% 11% Pediatrics 7% 7% Psychiatry 7% 6% Obstetrics & Gynecology 6% 5% Anesthesiology 5% 4%

Hospitals Claim to Fame

There are 7,081 beds in Orange County’s 36 major hospitals. Each facility is equipped to handle most acute care needs as well as specialize in a number of fields. The main specialty areas:

Trauma Centers

Mission Hospital Medical Center (Mission Viejo)

UCI Medical Center (Orange)

Western Medical Center-Santa Ana

Alternative Birth/Family Birth Centers

AMI Medical Center of Garden Grove

Anaheim General Hospital

Chapman General Hospital (Orange)

FHP Hospital (Fountain Valley)

Hoag Hospital (Newport Beach)

Huntington Beach Medical Center

West Anaheim Medical Center

Kaiser Permanente Hospital (Orange County)

La Palma Intercommunity Hospital

Los Alamitos Medical Center

Martin Luther Hospital (Anaheim)

Placentia Linda Community Hospital

Saddleback Memorial Medical Center (Laguna Hills)

St. Joseph Hospital (Orange)

Samaritan Medical Center (San Clemente)

South Coast Medical Center (South Laguna)

Magnetic Resonance Imaging Centers

AMI Irvine Medical Center

Doctors Hospital of Santa Ana

Friendly Hills Regional Medical Center (La Habra)

Pacifica Community Hospital (Huntington Beach)

Santa Ana Hospital Medical Center

Cardiovascular Surgery

Anaheim Memorial Hospital

Children’s Hospital of Orange County (Orange)

Fountain Valley Regional Hospital (Buena Park)

Psychiatric

Orange County Community Hospital (Buena Park)

CPC Brea Canyon Hospital

CPC Laguna Hills Hospital

CPC Santa Ana Hospital

College Hospital Costa Mesa

Substance Abuse Treatment

Tustin Hospital Medical Center

Spinal Cord Center

St. Jude Medical Center (Fullerton)

Paramedic Base Station

Coastal Communities Hospital (Santa Ana)

Teaching Hospitals

Western Medical Center (Anaheim)

UCI Medical Center (Orange)

Did You Know?

Progress: In 1992, Children’s Hospital of Orange County performed 24 bone marrow transplants Twelve years ago, children had to go outside the County for this procedure. Since then, the survival rate for children with cancer nationwide has more than doubled to 60% partly because of new therapies researched by CHOC’s oncology center.

Willingness to Pay: More than 85% of Americans would accept a new 50-cent tax on a six-pack of beer to help finance health care reform.

Source: Orange County Health Care Agency, Foster Higgins 1992 Health Care Benefits Survey, Hospital Council of Southern California, California Medical Assn., Centers for Disease Control and Prevention, American Hospital Assn., UCLA, NBC News-Wall Street Journal Poll, National Center for Health Statistics, Los Angeles Times reports; Researched by CAROLINE LEMKE AND DAVID A. AVILA / Los Angeles Times