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Example 3: Needs Assessment: The Ottawa County Public Health Department

The Kansas Department of Health and Environment has set as one of its goals to assure access to complete public health services to all the citizens of Kansas. Public health services are listed below under three broad categories:

ENVIRONMENTAL AND SANITATION SERVICES 

  • Well water and septic system inspections
  • Restaurant inspections
  • Licensing of child care facilities

PREVENTIVE SERVICES 

  • Immunizations
  • Communicable disease control
  • Health screening
  • Women's health services
  • Women, Infants, and Children (WIC) program
  • Periodic Screening, Diagnosis, and Treatment (EPSDT) programs

 

HEALTH PROMOTION AND EDUCATION SERVICES 

  • School health services
  • Acquired Immune Deficiency Syndrome (AIDS) education
  • Community health fairs
  • Environmental health education
  • Community health assessment analysis and planning for health needs.

In urban areas, these types of services have traditionally been performed by public health departments. In smaller rural communities, services such as clinical services, health screening, women's health, EPSDT, immunizations, and the like, are often carried out in the primary care clinic. While the regulatory, educational, and planning components of the public health mission are the domain of the public health department, the entire community should be a part of the planning and decision-making process concerning these activities.

This model assumes that economies of scale are the primary variable in service delivery and does not take into consideration factors such as geography or the ability (or necessity) to perform traditional public health department functions through alternative mechanisms. In rural areas, which do not have a large population base, these alternative mechanisms are often critical.

OTTAWA COUNTY SERVICES:

The Ottawa County Public Health Department provides a range of public health services. This agency is tax supported and located in Minneapolis. The Public Health Department employed a total of 15 people in 4.1 full time equivalent positions in 1994. In addition to the services provided by employees, some services are offered through contract. The services which are provided are listed in Table 21.

Utilization:

Table 21 Public Health Visits by Program

Health Department Services

Number of Visits

Percent of Total

School Health

2,027

41.3%

Adult Health

1,715

35.0%

Early Intervention

389

7.9%

Immunization

383

7.8%

Infant & Child

233

4.7%

Maternal Health

51

1.0%

Other

48

1.0%

EPSDT

46

0.9%

High Risk Infant

6

0.1%

Family Planning

5

0.1%

Communicable Disease

3

0.1%

Total

4,906

100.0%

The department made a total of 4,906 visits in the last fiscal year. The largest program was school health with 2,027 visits, followed by Adult Health visits at 1,715. The age break down of those who have used public health services (excluding home health) is listed in Chart 3.

With the exception of its school health service, this department primarily serves the very young and the elderly in the county.

The Public Health Department is primarily funded through public sources: over 50 percent of its 1994 revenue came from a single mil of county funds and over 20 percent from grants, many of which come from state and federal programs. The sources of funds are listed in Table 22.

Table 22 1994 Ottawa County Public Health Department Revenue and Visits by Payor 

Payor Source

1994 Revenue

% Total Revenue

Visits By Payor

% of Total Visits

Medicare

0

0.0%

0

0.0%

Commercial

0

0.0%

0

0.0%

Medicaid

$3,630

5.0%

86

1.8%

Self Pay/Not Insured

$3,590

5.0%

2500

51.0%

Other

$12,400

17.1%

2320

47.3%

Grant Funds

$16,400

22.6%

 

 

 

 

Tax Revenue

$36,480

50.3%

 

 

 

 

Total

$72,500

100.0%

4,906

100.0%

Table 22 also shows how local tax dollars support the services of the Public Health Department. As federal and state sources of grant funds become more difficult to obtain, this department will depend to an even greater extent on local dollars to provide needed services.

WHAT WE LEARNED FROM THE DATA:

  • Next to School Health, Adult Health visits constitute the second most frequent type of patient care for the Ottawa County Public Health Department.
  • With the exception of School Health, this agency primarily serves the very young and the elderly in the county.
  • Over 50% of the 1994 revenue for the health department came from public funds in the form of the county mil levy.
  • 20% of the 1994 revenues came from grants - many of which also come from the state and federal governments.
  • The only other source of funds for this agency in 1994 was the Medicaid program and what fees could be collected from clients who were not covered by categorical grants or the Medicaid program.

WHAT WE LEARNED FROM COMMUNITY INTERVIEWS:

  • The Ottawa County Public Health Department was commended for its services and the caring attitude of its personnel. This was particularly evident in the communities outside Minneapolis.
  • The health department was described by other providers as cooperative and in need of additional resources.
  • The Hospice program of the health department was described as an important community resource.
  • Ottawa County is under served with rural water districts, which means many of the rural residents are on private wells.
  • Some areas of the county are remote and distant from access to health services - they are only served by the health department.
  • The county has a high teenage pregnancy rate.
  • Low income families that are not eligible for public funds do not access care when they should and when they do, the care they need is more costly.
  • Broaden the county-wide immunization program to more sites in smaller communities.
  • Medicare certification for Hospice is very important for the community.
  • More information on AIDs prevention and care including a support system for those people in the community caring for AIDs patients is needed.
  • Develop an immunization tracking system so records in various immunization sites can be coordinated (i.e., MD Offices and the Health Department).
  • Dispel the myth that the Health Department is part of SRS.
  • Community education on immunizations and adequate nutrition for kids is needed.
  • The pregnancy issues of unmarried or adolescent women need to be addressed.
  • Unsafe water supplies and improper septic waste disposal are threats to the local system of health care.