425,000 in O.C. Lack Health Insurance, Study Finds

A sweeping survey of health care in Orange County has found that 425,000 county residents lack health insurance, most in the Vietnamese and Latino communities.

This and many other conclusions in the exhaustive new study of health problems and practices provide what experts call a road map for setting priorities to improve health care in the county.

The $400,000 report, to be released today, was prepared after a yearlong study funded largely by the county and local hospitals. The 400-page report details who gets sick and who gets cared for in the county. Though the study contains few surprises, it is the most comprehensive look at medical needs ever undertaken by a California county, said state and local officials.

Several groups already are pointing to its conclusions in calling on county supervisors to spend the county’s $30-million annual share of a tobacco suit settlement on health care, rather than on retiring bankruptcy debt.

Community activists said the report should serve as a catalyst for change, but they also declared their frustration that yet another study is needed to point out that many working poor, elderly and children are uninsured or have limited access to health care.

Mary Paul of Latino Health Access in Santa Ana called it the “broken record methodology” of getting action.

“I hope this does finally push people to advocate on the part of the uninsured,” she said. “Yes, we have heard it before, but sometimes repetition works.”

Unlike previous reports, including one released by the state earlier this week comparing county death rates and other statistics, the new report goes beyond collecting traditional health data. Its authors also used interviews and focus groups to compile information about health issues, medical care, attitudes and behavior.

Called the Orange County Health Needs Assessment, the report includes results of telephone surveys of more than 5,000 residents. The study compiled information on everything from who is insured to whether children wear bicycle helmets and lovers use condoms, as well as data on the primary causes of illnesses and hospitalizations.

“This was an incredible, ambitious undertaking,” said Len Foster, interim director of public health in the county Health Care Agency. But he and others said the report would be an empty gesture if it does not provoke action.

“What is important is what you do with it,” he said.

Health care advocates hope the report’s detail will help them push for new public and private programs and increased funding for existing ones. Even the business community, several said, does not see its own self-interest in supporting better medical services for all.

“I think this is a wake-up call,” said Felix Schwarz of the Orange County Health Care Council, a coalition of 100 organizations that advocates for improved access. “If you are going to influence health policy, you have to have facts.”

Among the key findings:

* 17% of county adults--335,000 people--have no health insurance, and almost 52% of these are Latino or Vietnamese.

* 13% of children--90,000 people--have no health coverage, and 57% of these are Latino.

* 12% of seniors have no insurance.

* 13% of Orange County residents are eligible for Medi-Cal, yet only 8% participate.

The report grows out of a state requirement that nonprofit hospitals analyze needs in their service areas every three years and annually submit a report on how they will address those problems.

For the first time in Orange County, the 17 nonprofit hospitals formed a partnership instead of writing individual reports. They were joined in doing this analysis by the 18 for-profit hospitals, the county Health Care Agency, as well as the 19 community clinics and several dozen other agencies.

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Participants called the report a first step, adding that it is significant that all the county’s major health care players took part and are committed to going ahead with the next step, which is wading into the data, identifying priorities and finding solutions.

“This is just the beginning,” said Ron DiLuigi, vice president of the St. Joseph Health System, which operates three nonprofit hospitals in the county.

The county’s hospitals are committed to spending money on charity and low-cost services to better serve and market themselves to their communities, said Jon Gilwee, a spokesman for the HealthCare Assn. of Southern California, a hospital trade group.

One obvious point of agreement for hospitals and physicians would be spending money to persuade employers to provide health insurance or to fund educational programs to reach eligible people who are not yet enrolled in Medi-Cal or the new government-subsidized insurance program for the working poor.

In particular, hospitals would be interested in supporting programs such as free immunizations, clinics on preventive medicine, health screenings with low-cost or no-cost treatment and mobile clinics to underprivileged areas, Gilwee said. That’s because in the managed care environment--in which hospitals get a set fee per month per patient--it makes sense to do more preventive care, he said.

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One clear area of conflict will come at the county level, where the supervisors have cut county funds spent on health care from $42 million before the bankruptcy to $30 million this year.

Supervisor Charles V. Smith said he and others want to spend tobacco settlement money to retire bankruptcy bonds and cut interest payments, which total $75 million a year.

“Everyone will have his hand out when the tobacco money comes in,” he said. “We are not going to take this problem and just throw money at it. That would be a big waste. We want to see some kind of plan before we come up with any more funding” for health programs.

Paul and Schwarz say they wonder whether the county will continue to be shortsighted.

“We still have people going to back-street clinics, and kids will die,” Schwarz said. “Your child could be sitting next to someone in school with tuberculosis, or the cook at your restaurant could have hepatitis. Those things happen if a large segment of the population has poor access to health care.”

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Picture of Health

More than one Latino child in five lacks health insurance in Orange County, according to a groundbreaking survey of health needs sponsored by local hospitals, the county and other organizations.

Children without health-care coverage

(by race)

All races: 13%

White: 7%

Hispanic: 21%

Vietnamese: 8%

Other Asian/Pacific Islander: 15%

Other: 14%

Some other key findings:

* Nearly 17% of adults surveyed lack any health-care coverage.

* More than 9% said they needed to see a doctor in the last year but were unable to afford the visit.

* About one person in five reported exercising five days a week or more.

* High-income residents were more likely than others to use alternative medicine, such as acupuncture and herbal therapy.

* About one child in five has been diagnosed with asthma.

* Nearly half of residents surveyed called themselves overweight or obese.

* Low-income residents were more likely to report extended periods of poor mental health in the past year.

* About one-fifth of adults smoke tobacco; three-quarters of these smokers would like to quit.

Source: Orange Countywide Health Needs Assessment