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2001 CHAP
Telephone Survey Executive Summary
The overall goals of the
1997
Wichita/Sedgwick County Community Health Assessment Project (CHAP)
were to:
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Study health and health-related matters in Wichita/Sedgwick
County in order to provide information to guide community efforts
to improve the health of all people in the County, and
To provide benchmarks that can be used to judge the success of
future efforts to improve the health of all people in the
County.
Objectives of the 2001 CHAP were to determine
the extent of medical care problems in the community, including:
- Problems related to medical
care access and cost of medical care,
- Determine the health status of
the community, and
- Examine the behavioral risk
problems in the community.
Communicate the results
of our ongoing Community Health Assessment Project (CHAP)
2001 CHAP
The 2001 CHAP includes the
analysis of the 1998 and 1999 Behavioral Risk Surveillance System
(BRFSS) data for Sedgwick County and the results of a telephone
survey of the general population of Sedgwick County. The 2001
CHAP is narrower in scope than the 1997 CHAP, none-the-less, it
provides a snap shot of access to care issues, and the health of
Sedgwick County residents. The 2001 CHAP Telephone Survey
elicited information about health insurance coverage and medical
care access among Sedgwick County households. The survey
collected information not only about the respondent, but also
obtained data about their dependents and other adults who reside
in their household. Several areas were investigated, including
demographic characteristics of survey respondents, the type and
costs of health care insurance coverage, where their coverage is
purchased, and reasons for not being insured. Secondly, the
survey assessed medical care seeking behaviors, such as frequency,
location, type of services, costs associated with medical care
services, and perceptions about barriers to health care services.
Sedgwick County data for 1998 and
1999 from the Kansas Behavioral Risk Factor Surveillance System (BRFSS)
were combined to provide sufficient sample size for analysis for
Sedgwick County. The standard core questionnaire, which is
collected annually, contains health behavior questions about
obesity, diabetes, tobacco use, and women’s prevention service
use, as well as health insurance coverage and health status.
These analyses are a portion of the 2001 CHAP.
2001 CHAP Demographic
Characteristics
When demographic information from
the telephone survey of the general population is compared to 2000
U.S. Census Bureau figures and estimates for Sedgwick County, we
find the sample to be dissimilar to the population in terms of
gender, ethnicity, and age. The female representation of the 2001
CHAP Telephone survey is nearly 20 percent higher than 1999
Sedgwick County estimates (68.1% vs. 51.1%), and the Sedgwick
County BRFSS female representation is nearly 10% higher than 1999
Sedgwick County estimates (59.2% vs. 51.1%). The ethnic diversity
of the 2001 CHAP Telephone survey and Sedgwick County BRFSS are
dissimilar from 1999 Sedgwick County estimates. Minorities are
slightly under represented in both the 2001 CHAP Telephone survey
and the Sedgwick County BRFSS data set. Moreover, in both data
sets, adults aged 18-24 years are under represented (8.1%, 9.8%,
respectively) when compared to Sedgwick County estimates (14.7%).
Approximately 60% of the 2001 CHAP sample was between 18 and 44
years old, and nearly 40% were between 45 and 64 years, whereas
65.9% of the Sedgwick County BRFSS sample was between 18 and 44
years old, and 34.2% were between 45 and 64 years.
Furthermore, the survey may under
represent low-income residents, because a growing number of less
affluent people are adopting the cell phone rather than the usual
full-service phone line. Thus, the increase in cell phone use
reduces access to available telephone numbers for the
random-selection pool. The under representation may result in
underestimates of the uninsured and Medicaid recipients in the
telephone survey.
The disproportionate number of
women surveyed may reflect that women tend to know more about
health insurance in families, particularly in less affluent
families. Another reason is that, for the sake of randomness,
calls were placed both during the day (typically late afternoon)
and early evening, with the result that women tend the answer the
phone more than men at these times. Therefore, the findings from
the 2001 CHAP telephone survey and Sedgwick County BRFSS data may
not be representative of the general population of Sedgwick
County; however, they do provide a snapshot of the current
activity in Wichita/Sedgwick County.
Health Status of Sedgwick
County
Overall, the self-reported
health status of respondents in the 2001 survey is excellent to
very good (61.9%), and 26.9% reported that their health is good.
However, 11.2% reported fair or poor health. When 2001 and 1996
results are compared, there is a statistically significant
difference in health status perceptions (c2=13.461,
df=4, p=.009). This difference appears to be related to a lower
percentage of 2001 respondents who perceive their health as very
good. In age-stratified analysis, younger respondents perceived
their health as good, very good or excellent, whereas perceptions
of poor health increased with age.
Insurance Status of Sedgwick County
When asked, “about how long has
it been since you have been without health insurance?”
approximately 87.0% of respondents report never being without
health insurance. For those reporting they have been uninsured,
10.9% reported being uninsured less than one year (periodically
uninsured), and 2.5% have been uninsured greater than one year
(chronically uninsured). When the same question is posed for
dependents, over 90% of dependents are reported as being insured,
nearly 6% are periodically uninsured (less than one year), and one
percent are chronically uninsured (greater than one year). For
other adults living in the household, 90.6% are considered
insured, whereas 8.6% are periodically uninsured, and less than
one percent are chronically uninsured. A small number of the
uninsured believe that they may qualify for Medicaid (12.5%).
The 1996 and 2001 CHAP Telephone
Surveys assessed insurance status using slightly different
methodologies. In order to make direct comparisons to another
current Kansas insurance study, survey items assessing insurance
status were adapted in the 2001 CHAP. These changes may account
for the differences in reported insurance status between the 2001
and 1996 telephone survey results. In addition, it appears that
the 1995 and 2001 samples are different as well. Comparisons of
1996 and 2001 CHAP Telephone Survey responses of those aged 18-64
years old indicate a statistically significant improvement in
insurance status for the county as a whole. In 2001 14.0% of
those surveyed reported being uninsured, compared with 28.0% in
1996. A larger percentage of adults are insured in 2001 versus
1996, 86.6% vs.76.6%, respectively. The percentage of
periodically uninsured adults was also smaller (10.9% vs. 16.6%),
and finally the proportion of chronically uninsured adults was
reduced (2.5% vs. 6.6%). In 2001, among those respondents with
health insurance at the time of the interview, most had some type
of commercial insurance (71.8%). Only about four percent of
survey respondents reported having Medicaid.
The 1998-99 Sedgwick County BRFSS
data is similar to the 2001 CHAP data. When asked, “Do you have
any kind of health care coverage?” 89.0% of Sedgwick County
residents responded yes. Sedgwick County health insurance
coverage rates are comparable to national and Kansas’s rates of
87.6% and 89.6%, respectively. BRFSS data also shows the majority
of Sedgwick County residents health insurance coverage is gained
through their employer (66.3%) or other employer (21.0%). Less
than one percent of Sedgwick County BRFSS respondents indicate
Medicaid as their health insurance, somewhat lower than the four
percent reported in the 2001 CHAP telephone survey. National
statistics for Medicaid coverage (2.7%) are higher than for Kansas
(1.1%) or Sedgwick County (0.9%). Approximately seven percent of
Sedgwick County residents bought their own health insurance (not
through their employer), which is comparable to national
statistics (7.6%) but lower than Kansas’s rates (8.6%).
Description of the Uninsured in Sedgwick County
The uninsured are similar to
insured Sedgwick County residents in terms of education and
minority status, however the two groups are demographically
dissimilar in terms of income and age. Education was measured and
compared categorically in three strata, less than high school
education, high school education, and more than high school
education. There were nonsignificant differences in the numbers
of respondents in each level of education, which suggests that in
this sample, level of education is not associated with having or
not having insurance. Less than five percent of the uninsured had
a high school education or less. In the 2001 survey, the
ethnicity of the overall sample is predominantly White (85%);
therefore, it is not surprising that the uninsured are
predominantly White as well. Due to small sample among
minorities, ethnic status was collapsed into minority versus
non-minority groups to assess group differences. The insured
versus uninsured are similar in terms of minority and non-minority
representation. In addition, nearly 70% of the uninsured group
was female, which may be related to the high representation of
women in the sample.
With respect to income, 16% of the
uninsured earned more than $50,000 and less than 7.0 % earned less
than $25,000 annually, whereas 20% of the insured earned $50,000
or more, and 23% earned less than $25,000. In terms of
employment, approximately 15% of the uninsured work full-time, and
12% work part-time. Respondents who were uninsured were younger
than those adults who were insured. The average age of uninsured
respondents was 34 years (SD=10.5) while insured respondents had a
mean age of 42 years (SD=10.5). The majority of the uninsured
were 18-44 years old (86.7%) and more than 50% are between 18-34
years old. This finding is consistent with the 1996 survey
results.
The original 1996 CHAP Report is
still available through the Sedgwick County Internet Web page. By
October the updated 2001 CHAP will be available with multiple
graphs and figures visually describing portions of the 2001
analysis. The Internet continues to be an effective way to
communicate the results of the study. The Web page has three
areas including: 1) the full CHAP report (morbidity, mortality,
GIS maps, community health perceptions), 2) a listing of
community-based coalitions, and 3) links to other health and
health statistics sites at the local, regional and national
levels. Since the report was posted on the web, we have received
nearly 1,500 hits at the CHAP/CHIP Web site. Web site visitors
may email questions to the CHIP Coordinator. We have maintained
the link between United Way of the Plains Service Directory,
CareLink, and the CHAP Web page. It continues to serve the
purpose to connect the public with information about public and
private health and social service resources in the community.
Funding Activities
The majority of our time this
year has focused on supporting the efforts of Project Access and
collaborating with the United Way of the Plains in community
health assessment and planning. All four grant submissions this
year were successful, three of which support the continued growth
and development of Project Access and community health planning.
- Improving Access to Health
Care for The Uninsured in Wichita/Sedgwick County, Medical
Society of Sedgwick County. (PI, MSSC), $ 150,000.
- Enhancing The Project Access
System Of Care In Wichita/Sedgwick County, Kansas. The Robert
Wood Johnson Foundation, Communities in Charge, Phase II
Application. (Medical Society of Sedgwick County, PI) $700,000.
- Enhancing The Project Access
System Of Care In Wichita/Sedgwick County, Kansas. Health
Services and Resources Administration. Medical Society of
Sedgwick County, PI, $950,000
- Robert Wood Johnson Foundation
Community Health Leadership Award, Nomination of Arneatha
Martin, RN, MSN and the Center for Health and Wellness.
$100,000.
Improve CHIP Identified
Health Problems
Access to Health Care Resources in Wichita:
Project Access is a program designed to assist
the low income uninsured to access to medical care. The work
group of community organizations included local health clinics,
physicians, school nurses, pharmacists, hospitals and social
service agencies. Project Access will connect those needing
medical care to physicians volunteering their time to see
patients. City and county government are providing funds to
purchase medications for Project Access patients and local
pharmacists are filling the prescriptions at cost. The Department
of Social and Rehabilitation Services is helping patients with the
application process. The details of both the one-year planning
grant and the Phase II RWJF application have been described
earlier.
Dental Health:
Once again, the City Council failed to pass an
ordinance to fluoridate the city water supply. The
Wichita/Sedgwick County Department of Community Health and Board
of Health continue to pursue this goal and to formulate strategies
to influence the City Council members to support fluoridation of
the water supply. Results of the 2001 CHAP survey indicate that
access to dental care remains a problem in our community.
Community Health Assessment
Unit
Our
collaborative effort with the United Way of the Plains has made
great progress. Not only has the United Way of the Plains,
Community Planning Committee, continued to meet, but also the long
awaited Community Indicators project is nearly ready to go live.
Social and health indicators were reviewed, selected and
prioritized by a subcommittee in 2000. Wichita State University
been in the process of developing a web site that will
interactively provide information on the selected indicators,
allow the user to build charts, and even allow the download of
data in an Excel spreadsheet format for the individual to use.
The site contains information on the following topics:
Children, Crime, Demographic, Economic,
Education, Health, and Seniors. The Web site may be
accessed at
http://kronos.niar.twsu.edu/CID/.
In summary, the self-reported
health status of Sedgwick County residents has remained stable in
the past five years. Although the findings of the 2001 CHAP
suggest an improvement in insurance status for the general
population, there has been a slight increase in the perceived
difficulty in accessing certain medical care services for a small
percentage of the population. It is also possible that vulnerable
portions of the population were not included in the survey due to
biases associated with telephone surveys.
There are two valuable
contributions the 1996 and 2001 Community Health Assessments, one
is county-specific data analysis, and the second is the
community-based relationship building that has occurred during the
past five years. The CHAP reports made rich, descriptive data
available to local health and human service agencies to document
community need for their grant submissions. Moreover, the reports
have been used in organizational and community planning projects.
For example, data from the 1997 Sedgwick County CHAP was
instrumental in documenting problems associated with infant
mortality in Sedgwick County, and played a role in bringing
Healthy Start Initiative funding to our community. Furthermore,
Sedgwick County government has increased its funding for maternal
child programs at the Health Department as well. Data from the
1997 CHAP report was also used extensively in the preparation of
all grant submissions for Project Access. At least four million
dollars in grant funding have been brought into Sedgwick County,
in part, as a result of the CHAP data.
A final major benefit of the
community health improvement process is the dialogue and
relationship building that has resulted among health care
providers, local government, human services agencies, education
and the community around issues critical to community health.
Although not all of the 1997 CHAP recommendations have been
realized, we believe progress has been made in improving the
health of Sedgwick County residents, and we remain supportive of
those goals.
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