KING COUNTY, WASHINGTON - Dr. Alonzo Plough, Director of Public Health - Seattle & King County, is presenting unsettling data to Board of Health members today regarding insurance coverage and the state of the health care system in King County. In addition, he will be joined by a coalition of representatives from local health care organizations in offering recommendations for addressing the identified problems.
The Uninsured in King County: 1991-1998, one of two new reports to be issued today by Public Health, documents a substantial rise in the number of low-income people (in households that earn from $15,000 to $25,000 per year) locally who are uninsured. The report also indicates that as many as one in three members of specific ethnic groups residing in King County are without health insurance. For example, a survey of residents of Korean and Vietnamese origin revealed 33% are uninsured.
Overall, the uninsured rate for King County adults under 65 now stands at 11% and has not changed significantly since 1991, despite flourishing economic activity in this region. Twenty-eight percent of those earning less than $15,000 per year is uninsured compared to 3% of those earning more than $50,000 per year. Those earning between $15,000 and $25,000/year have seen their health insurance coverage erode substantially. During the three-year period from 1991 to 1993, this group's uninsured rate was 14%; in period from 1996 to 1998, this rate had risen to 33%.
The report also reveals that lack of insurance is a pervasive problem: most of the uninsured are relatively young (under 45), are non-poor and are employed. There are uninsured people in all ethnic groups.
The health care system is out of balance
In addition to lack of insurance, The Balance Points report documents other health system gaps that disproportionately impact vulnerable populations. More than two-thirds of the elderly lack dental insurance. 30,000 children in King County lack health insurance, and most of these are eligible for public programs. African Americans with diabetes are four times as likely to die from their condition as other diabetes patients. Only 7% of Vietnamese women in King County had a Pap test for cervical cancer in the last three years, compared to 86% of women in the general population.
Those within the health care system are not immune to financial and organizational troubles of their own. In 1999, the costs of health insurance rose at three times the rate of general inflation. Individual health insurance policies are no longer being written private insurers in King County. Nine out of ten of the largest health plans in Washington reported operating losses in 1997. Local physicians at Medalia have unionized. As hospitals have shortened stays and new technologies have kept very sick patients alive, nurses have borne greater workloads with less time to carry them out.
Local coalition proposes pilots for health system changes
The Action Plan maintains that we can build another path for change. "Deliberate public and private strategies can insert preventive approaches developed by a public system into the bottom line cost conscious world of the private sector. The health system and consumer both win", states Dr. Plough.
The incentive to keep people healthy is shared by public health and managed care. The King County Health Action Plan convenes leaders throughout the health care field to determine how public/private joint ventures can demonstrate the value of integrating population health promotion strategies more closely with the current medical system. The group believes cross-pollination of successful approaches can be mutually beneficial and can lead to a paradigm shift that will enhance the health of King County residents today and into the future.
The King County Health Action Plan is made up of Public Health, the Washington State Hospital Association, health plans, hospitals, long-term care providers, community organizations, and community clinics as well as university, state, business, labor, consumer, and foundation groups.
Summary of Action Plan recommendations:
- Support the Community Benefits program. Eight health plans and health care organizations in King County have donated over $50,000 to date to intervention programs addressing asthma, diabetes, and cervical cancer among specific populations. This is the first time public health data has been used by private health care organizations to focus their community giving jointly on local health care needs.
- Implement an integrated model for managing diabetes. Public health and managed care approaches can be combined to ward off serious health problems for diabetes patients among ethnic minorities.
- Kids Get Care. Focus on getting King County children the health care they need, instead of on processing paperwork to determine eligibility for public programs.
- Use data and purchasing power to measure and promote the delivery of high quality health care services.
- Support the voluntary adoption of comparable mental health and substance abuse treatment employee benefits among King County public and private employers.
- Secure the dental "safety net" for King County children and adults.
- Continue to convene major participants of the health care system to take an overall look at improvements that can be achieved in the region's health status and the health care system's performance.
