Community Meeting on Healthcare in Monterey County

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A Summary of Supervisor Jane Parker’s Community Meeting on Health Care

Introduction

This report summarizes the discussion that took place on September 20, 2009 at the third Community Meeting hosted by Monterey County Supervisor Jane Parker. The topic of the meeting was Healthcare in Monterey County featuring guest speakers from the Health Department and Natividad Medical Center. 

Thirty-five people shared their personal experiences and ideas for improving healthcare in Monterey County. Participants included insured and uninsured, publicly and privately covered, healthcare providers, and business owners. Many had been following federal health reform efforts and nearly everyone expressed deep concern about our country’s current healthcare system. 

Following a presentation by Supervisor Parker about the roles and responsibilities of the County to deliver healthcare services, the Director of the Health Department, Len Foster, and the CEO of Natividad Medical Center, Harry Weis, spoke about their respective functions. Small discussion groups were formed to explore a series of questions about the most significant health problems that exist in Monterey County and ideas for solving those problems. 

This report will be shared with the County Chief Administrative Officer, Health Department Director, and Natividad CEO, and Board of Supervisors. It will also be made available to the public online at www.janeparker.org. Supervisor Parker and her staff will reference the feedback documented in this report in their work to implement health care system improvements in Monterey County. 


The Role of Government in Health Care - Jane Parker, County Supervisor 

Supervisor Parker explained that Counties have a very important role to play in the delivery of safety net health care services. The history of funding for local health and mental health programs is incredibly complex. As a result, no two counties have organized their health care systems in the same way. 

The California Healthcare Foundation has summarized an overview of “The Crucial Role of Counties in the Health of Californians”. This report can be accessed on their website at http://www.chcf.org


Monterey County Health Department - Len Foster, Director 

Len Foster provided examples of the many ways that the Health Department touches the lives of Monterey County residents, noting that many of these services are invisible to the public. Restaurant inspections and tap water monitoring are two examples of Health department responsibilities that protect the lives of nearly every County resident on a daily basis. Issuing birth certificates and death certificates are another Health Department responsibility. The Health Department administers a wide range of State and Federal programs, including the federal Women, Infant, and Children (WIC) program in which 2 of 3 children born in Monterey County are enrolled. While not a mandated service, our Health Department fills a critical community health need by operating the largest primary care medical group in the County with over 40 physicians who provide a medical home for 1 in 12 County residents. The Health Department also manages the largest behavioral health and substance abuse treatment network in Monterey County. 

The Monterey County Health department has a $120 million annual budget, primarily comprised of state and federal funding sources. Health Department priorities are largely dictated by the state and federal funding streams. 



Natividad Medical Center (NMC) - Harry Weis, CEO 

Natividad Medical Center began providing health care services in 1886, prior to the existence of public or private health insurance. The history of NMC is especially relevant as we prepare for significant changes with healthcare reform in the coming years. Harry Weis noted that regardless of the changes we are facing, it is important to recognize the power of our vision for health services in our County. Natividad is committed to providing the highest quality services to improve the health status of all residents of Monterey County, regardless of socio-economic status. 

Mr. Weis noted that there are only 10 other counties who have a County-owned hospital and that these hospitals operate at an average loss of $103 million annually. It is impressive to recognize the recent achievements made by NMC to manage its current budget without any financial subsidy from the County. 

With a long-standing affiliation to the University of San Francisco School of Medicine for the Family Practice Residency Program, NMC offers a three-year, post graduate Family Practice Training Program for physicians that is widely recognized as one of the finest physician teaching programs in the county. 



Small Group Discussions 

Following the presentation on the Role of Government in Health Care, people were asked to split into small groups and discuss the following questions: 

What are the most significant health problems in Monterey County? 

What obstacles exist that prevent health problems from being addressed or solved? 

What ideas do you have to help ensure that as many Monterey County residents as possible have access to affordable quality health care? 



Small Group Feedback 

When asked about the most significant health problems in Monterey County constituents listed prevalent health problems and significant barriers to quality health care. Prevalent health problems included mental health, improper nutrition, and drug and alcohol abuse among adolescents. A lack of health literacy was cited as a barrier to addressing many of the chronic health problems facing our community. The lack of access to health care services was a concern shared by most participants. Geographic and cultural restraints, cost and insurance restrictions, and an inadequate supply of primary care providers are all factors negatively impacting access. Additional concerns about a lack of access to specific health services including pre-natal, ante-natal, post partum care, and private mental health services were also raised. 

Problems inherent in the current health care system were cited as barriers to accessing health care. Many people lack a medical “home base.” There are substantial disparities in access and support for healthy lifestyle choices and a lack of emphasis on prevention. Many participants expressed concern that the profit motive in our health care system is incompatible with the goal to keep people healthy, and that the profit motive of health insurance companies fundamentally undermines any effort to improve the health care system. 

Other basic inefficiencies in the health care system were cited as obstacles to better treatment. Waste and inefficiency within the entire health care system was cited as a pervasive problem. Some felt that the health care system lacks standards to promote accuracy in records and billing. Fear of malpractice claims have led many doctors to practice defensive medicine. Participants also noted the dis-jointed nature of the healthcare system as a significant barrier to quality coordinated care. 

The participants identified that some of the obstacles to improving health care are related directly our unique community. Linguistic and cultural differences are a barrier for some people to seek out medical treatment. It was felt that our county lacks the capacity to accommodate a mobile and migratory workforce. We need to work harder to cultivate a health care system that is culturally sensitive with providers and support staff who are bi-lingual. 

Many people also referenced personal challenges in maintaining health insurance coverage, leading to periods of being uninsured. Employer-sponsored health insurance failed to meet the needs of a handful of participants who were unable to continue working following an illness. “Pre-existing conditions” then prevented these individuals from qualifying for individual insurance when they lost their employer-sponsored coverage. 

Communication with and between health care providers was also identified as a barrier to quality health care. Participants cited many examples of not being ‘listened to” by their doctor, not having enough time during appointments to talk to their doctor, or problems with doctors failing to follow up in an appropriate manner. 

When solutions were offered for improving health care in our county, prevention ranked high on the list of priorities. Community capacity building that relied on peer-led health literacy campaigns to promote healthy lifestyles was suggested by multiple groups. We need to find ways to encourage people to make better nutritional choices and promote regular activity. The formation of walking groups to encourage parents to walk their children to school, development of a local health savings account, and increased healthy living education efforts in schools were specifically proposed. Some participants suggested that the County health delivery programs would benefit from stricter auditing procedures and oversight by the Board of Supervisors. A few participants suggested that midwives could be used at the County Clinics and Hospital to improve birthing outcomes and provide continuity of care for pregnant patients. One of the only ideas about how to fund health care solutions was to levy a tax on fast food restaurants and other unhealthy foods. 

There was general agreement that the local health care system desperately needed to be better integrated so that patients could successfully navigate their way through the maze of health providers, insurance providers, pharmaceutical options, and medical choices. One idea was to develop a standard of excellence for care in Monterey County that would define, measure, and report on a set of criteria specific to the needs of our residents. 

National healthcare reform, specifically a single payer model, was also discussed as a solution to many of our local health care problems. Some suggested that federal health reform could include a provision for medical school tuition to be waived or reduced for those who work in public health care for a period of time following graduation. 


Individual Comments that were otherwise not addressed in the small group feedback

Trouble finding a specialist in the area 

Trouble finding a doctor who accepted MediCare 

Inability to pay medical bills, even with insurance coverage 

Inability to purchase individual health care during unemployment 

High cost of mental health care that is not covered by insurance 

Expense of pharmaceuticals 

Little access to diagnostics 

No healthcare for migrant population & non-citizen population 

Employers have a problem paying for employee insurance 

Over-medication prescribed / mistakes with prescriptions 

Little support for maternal health and breastfeeding 

Perceived unfairness of inmates at the jail and prison have access to free medical care. Might an individual who cannot otherwise afford needed medical care choose to ‘visit’ the jail in order to receive needed care? 


Conclusion 

Despite the significant healthcare concerns that are currently facing our nation and our county, there is a strong local interest to discuss and explore solutions. The County of Monterey, through Natividad Medical Center and Health Department, have demonstrated a legacy of leadership in identifying and meeting unmet health needs. The Board of Supervisors has demonstrated a commitment to further strengthen the integration of county-wide health systems with their 2010 Strategic Plan Initiatives. Community advocacy for ongoing and increased investments in prevention will be necessary, especially in the wake of our current economic crisis. 

The challenges are indeed great, however many of the ideas and solutions discussed at this Community Meeting could be achievable and positively impact the health of many Monterey County residents. Supervisor Parker and her staff will reference this report in their work to implement health care system improvements, however many of these ideas will require action from the participants and the community as well. 


If you were not able to join the discussion on September 20th, you can still voice your concerns and ideas by completing this form

Additional Resources:
California Healthcare Foundation: The Crucial Role of Counties in the Health of Californian
Healthy People 2010: Leading Health Indicators
Healthy San Francisco: a County Healthcare Access Model


A Snapshot - Natividad Medical Center 

http://www.natividad.com
Primary Address: 1441 Constitution Boulevard, Salinas CA
Primary Phone Number: (831) 755-4111 

Natividad Medical Center is a 172-bed acute care medical center owned and operated by Monterey County. A Board of Trustees appointed by the Board of Supervisors works with Administration on day-to-day operations of the medical center. 

Natividad Medical Center is a public community hospital emphasizing the care of women, children and families. Fully Accredited by the Joint Commission on Accreditation of Hospitals and Healthcare Organizations, Natividad Medical Center is a modern medical center campus offering comprehensive inpatient, outpatient, diagnostic and specialty care. 

The Natividad Medical Staff consists of more than 268 physicians representing 44 specialties who are attracted to Natividad’s academic environment. Natividad has been affiliated with the University of California at San Francisco School of Medicine for the Family Practice Residency Program since 1974. Natividad Medical Center offers a three-year, post graduate Family Practice Training Program for physicians that is recognized as one of the finest physician teaching programs in the country. 

In addition to the main inpatient facility, the Natividad campus includes outpatient primary clinics operated by the Monterey County Health department and specialty clinics operated by NMC. Outpatient Clinics and the Emergency Department combined have approximately 48,000 outpatient visits annually. 

Our services combine the most highly trained clinicians and the best technology available today. In many cases, our programs and services have been the first and only one of its kind in Monterey County. 

If you would like to tour the Natividad campus in person, simply call the Public Relations office at 831-755-4189. 



A Snapshot - Monterey County Health Department 

http://www.co.monterey.ca.us/health/
Primary Address: 1270 Natividad Road, Salinas CA
Primary Phone Number: (831) 755-4500 

The Monterey County Health Department is responsible for protecting the health of the entire community. This is done through programs that include Public Health, Environmental Health, Behavioral Health, Clinic Services, Public Administrator/Public Guardian, Emergency Medical Services, and Animal Services. The Department offers a variety of medical care and client services, but also enforces laws and regulations to protect health. It educates the community about health threats and issues, and works in collaboration with other agencies and organizations to assure the health of the public. 

The Department is organized into the following six (6) operational bureaus plus an administrative support unit. 

Administration: Consists of the Finance, Human Resources, Risk Management, and Facilities. 

Animal Services: Committed to effective animal and rabies control 

Behavioral Health: Offers a variety of mental health and alcohol and drug services. 

Clinic Services Division: Provides efficient and cost effective primary care to eligible members of our community. 

Community Health Division: Helps people stay healthy for as long as possible. 

Emergency Medical Services: Plans, coordinates, and evaluates the county-wide EMS system. 

Environmental Health: Protects the public and resources from environmental hazards. 

Office of the Health Officer: Assures a healthier community through access to needed services and protection from threats to public health. 

Public Guardian / Conservator: Safeguards and protects individuals in our community who cannot longer care for themselves.




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Jane Parker,
Mar 10, 2010, 7:47 PM
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