Making the Case for Indigent Care

Making the Case for Indigent CareIdentifying Clinic Facility needs in Los Angeles SPAs and MSSAsBrenda PrezUP 206AWinter 2011

Health Disparities in SPAsLA County community clinics and health centers (clinics) target communities where care is needed but scarce and improve access to care for nearly a million individuals regardless of their insurance status or ability to pay.However, data suggests there is still a high unmet demand for services and that it will remain high after health reform implementation.

MSSAs in LA: MUP and MUAMUA:Medically Underserved Area

MUP: Medically Underserved Population

Approximately one third of Californians live in a designated HPSA, MUP or MUA.

CA Office of Statewide Planning and Development (OSHPD)

SPAs in LAService Planning Areas (SPAs):Eight in LA County for health care planning purposes.

Each SPA is responsible for planning public health and clinical services according to the health needs of local communities:Assess health needs of local communitiesProvide services through clinics and community partnersPromote health & prevent disease

Note: The eight SPAs were derived by selecting SPAs in the view from LA County and converting to shapefile Los Angeles County Department of Public HealthRacial/Ethnic Makeup:MSSAs and SPAs

Racial/Ethnic Makeup: SPAsPopulation Density of Vulnerable PopulationsPopulation Density Under 5 population Density over 65

Percent Living below Federal Poverty Line (FPL)100% Below FPL200% Below FPL

Insurance Status in SPAsLA County has the largest total number of uninsured residents in California, with 2.2 million nonelderly adults and children (24% of the total population) experiencing some period without health insurance in 2009.

Clinics are a key source of care for these medically disenfranchised people. In LA County, 61% of all clinic patients are uninsured and 54% of health center patients are insured About 56% of clinic visits are by uninsured patients.

California Health Interview Survey, 2009Where are the Health Care Facilities in LA?Health Care Facilities in LA: All: 2,155Community Clinics: 275Free Clinics:14

CA Office of Statewide Planning and Development (OSHPD)Hotspot Analysis: Where is the most need?Need analyzed by:Population DensityPopulation Below 100% FPLPopulation Below 200% FPLPopulation over 65Population under 5Population on MedicarePopulation UninsuredCommunity Health Clinic LocationsFree Clinic Locations

Measurement Tools and Analysis Average Nearest NeighborH0: Clinic need is randomly distributedRatio: 2.04Z-Score: 5.64P-Value: .001

High/Low Clustering H0: There is no spatial clustering of clinic needZ-Score: 7.44P-Value: .001

Skills UtilizedInset MapChartGeoprocessingClippingBoundary Sub-SelectionsPoint Graduated SymbolsHotspot Analysis

MetadataModelingAutomate Race/Ethnicity graphicsOriginal Data Insurance Status layers derived from CHIS source and rendered to shp filesMeasurement Tool Average Nearest NeighborHigh/Low Clustering13Metadata

Model