UNION COUNTY — Lack of transportation and education, extended unemployment and dependancy on government assistance, a high ratio of patients to physicians, and poor health in the community are having impact on the ability of the local health sector to meet the medical needs of the people of Union County.
The State of South Carolina is in the process of implementing its “Healthy Outcomes Initiative” which enables participating rural hospitals to receive funding from the state to cover the cost of indigent care. In addition, all participating hospitals, both rural and urban, will receive a 3 percent increase in Medicaid reimbursement. To participate in the initiative, hospitals were required to submit a plan outling the steps they will take to reduce the use of their emergency rooms by patients with conditions that do not require emergency medical care.
Among the plans submitted was the “Healthy Outcomes Plan for Union County” which was developed by the Union Hospital District. The plan, which was approved without changes by the S.C. Department of Health and Human Services, is part of the district’s efforts to improve its financial condition. District CEO Paul Newhouse said last week that being accepted into the initiative means the district will receive approximately $1 million a year from the state.
The district lost $1.1 million in July and has lost approximately $6 million since the beginning of the current fiscal year. A large part of those losses have been due to the indigent care the district has had to provide to patients who are unable to pay for their medical treatment. Many of those patients receive that treatment through the emergency room at Wallace Thomson Hospital even though many times they are seeking treatment for non-emergency conditions. This in turn leads to what the district’s plan calls the “over utilization” of the emergency room.
In the “background and rationale” section of the plan it submitted to the SCDHHS, the hospital district looks at the factors that contribute to this over utilization and the resulting high cost of indigent care.
The section begins by describing Union County as a “rural community with a current population of 28,252 (2012), down from 28,961 (2010).” The rural nature of the county and its small population base has limited the ability of the poor to easily access local health care services. The plan states that “this small community has no mode of public transportation making it difficult for many uninsured, indigent and Medicaid patients to get the medical services they require on routine basis.”
Other factors that have combined to impact the ability of the county’s poorer residents to obtain health services and to do so without resorting to the emergency room have been unemployment and a lack of education. The plan points out that Union County has the sixth highest unemployment rate in South Carolina “at 13.2 percent, with 58 percent of the adult population having a high school diploma or less education.”
The plan asserts that the high unemployment rate is due to the loss of the county’s major employer which has in turn fostered a culture of dependancy on government assistance among many of the unemployed.
“Until recent additions of manufacturing industries in Union, textile mills were the prevalent employer. Over the past 15 years, these mills have shut down, laying off hundreds of workers with no other skill set. Many of these workers have become dependent and content to live on unemployment and government aid instead of trying to learn a new skill set.”
The increase in unemployment has in turn “put increased financial pressure on the local health care system as the higher percentage of indigent care has driven off several primary care physicians and specialists, driving more insured patients out of town for medical services.” As a result, the plan states that the “28,252 people living in Union County currently have 8 primary care and internal medicine physicians to choose from, makes the ratio of patients to physcians 3,531:1. South Carolina physician provider guidelines list the average ratio of patients to physicians is 2,500:1.”
In addition to a high unemployment rate, the plan states that Union County “has approximately twice the disability rate compared to state and national statistics. A 2010 American Community Survey reflected that for the 18-64 age groups, Union County has 8.7 percent of its population with an independent living difficulty compared to 4.3 percent for South Carolina and 3.4 percent in the U.S. the percentage of individuals with a self-care disability is 4.6 percent for Union County compared to 2.2 percent in South Carolina and 1.8 percent in the U.S. In 2009, a report noted that 19 percent of Union families utilized the Food Stamp program.”
The plan also states that “the health of the community is listed amongst the worst in the state. A 2011 statistics review reflected a 12.2 percent rate of adult onset diabetes compared to (the) South Carolina rate of 10.6 percent and 8.3 percent nationally. The adult obesity rate in Union is 32.1 percent compared to (the) South Carolina rate of 29.4 percent. High rates of COPD, Hypertension and mental health issues have also been idenfitied both on the Environmental scans and in the patients seen within our system.”
Newhouse said Monday that the plan is designed to try and change these conditions and improve the health of the community. The plan will go into effect on Oct. 1.
Editor Charles Warner can be reached at 864-427-1234, ext. 14, or by email at firstname.lastname@example.org.