Health care aftermath

Linda Benedict, Schafer, Mark J.  |  4/23/2008 3:25:04 AM

Table 1. Age structure shifts after 2005 hurricanes in affected parishes.

Makiko Hori and Mark Schafer

LSU AgCenter researchers analyzed data from the 2006 Louisiana Health and Population Survey pertaining to age demographics, health insurance coverage and health care access in 18 hurricane-affected parishes in Louisiana. See "Population dynamics in South Louisiana" for more about the survey.

Age demographics
Health care providers need detailed age-based demographic information to adequately supply doctors, nurses, hospital beds and other medical services to a given area. Table 1 shows that in addition to losing nearly 300,000 people, the most severely damaged parishes in Louisiana also saw a change in the age structure of the remaining populations in 2006. The percentage of children under 15 decreased by nearly 7 percent, while the percentage of working age population (age 25-64) increased by almost 6 percent. This indicates that fewer young children who evacuated these areas had returned. These regions saw an increase in the percentage of adults, likely fueled by the labor needs for debris removal and recovery. Somewhat surprisingly, the percentage of older children and elderly remained relatively unchanged.

Also curious is that the percentage of children in the receiving parishes declined significantly. New migrants to those regions had fewer younger children than the pre-storm residents, while the percentage of high school and college age children increased in receiving parishes. This trend may have been fueled by substantial labor opportunities for young adults in and around Baton Rouge and Lake Charles.

The age structure of the population living in the buffer parishes did not change dramatically despite the significant movement of people out of, into and within these parishes.

Severely damaged parishes include Orleans, Plaquemines, St. Bernard and Cameron. Receiving parishes include Ascension, East Baton Rouge, Iberia, Lafourche, Livingston, St. Charles, St. Helena, Tangipahoa, Terrebonne and Washington. Buffer parishes include Calcasieu, Jefferson, St. Tammany and Vermilion.

Health insurance
Insurance is a crucial health care issue. In this survey people were asked if they had some type of health insurance including private, Medicare, Medicaid, Medi-Gap, Louisiana Children’s Health Insurance Program, a state-sponsored health plan, military health insurance or other governmental program.

Among the 18 parishes, six parishes had high rates of people with no health insurance: St. Helena (24.1%), St. Bernard (21.4%), Cameron (21.4%), Vermilion (20.6%), Terrebonne (20.4%) and Orleans (20.1%).

Jefferson Parish had the largest uninsured population at 75,256, East Baton Rouge Parish had 63,049 and Orleans Parish had 43,367 uninsured individuals.

Meanwhile, St. Charles Parish had the lowest percentage of uninsured people in the parish population (8.5%), followed by Calcasieu Parish (13.0%), Iberia Parish (13.4%), St. Tammany Parish (13.7%) and Ascension Parish (13.9%). Overall, the estimated number of uninsured people in 18 parishes is 372,153, accounting for 16.4 percent of the population.

Under typical conditions, many factors contribute to lack or loss of insurance such as losing one’s job, inability to afford the cost of insurance or death of a spouse or parent. Natural disasters can greatly exacerbate these factors.

Among the 18 parishes, the most severely damaged parishes tended to have higher percentages of people who were uninsured because of the hurricanes: Orleans (28.7%), Plaquemines (24.5%), St. Bernard (32.3%) and Jefferson (20.9%). Surprisingly, the percentage of uninsured because of Hurricane Rita in Cameron Parish was not so high (13.5%).

Tangipahoa Parish had a relatively large percentage (20.1%) of uninsured because of the hurricanes followed by East Baton Rouge Parish at 15.5 percent. These results are a little puzzling because these parishes were not severely affected by the hurricanes. It is likely these parishes had many evacuees from severely damaged parishes who lost their health insurance.

Access to care
Both lack of insurance and displacement may result in difficulties accessing health care. Moreover, the closure of hospitals and doctors’ offices in affected parishes posed a challenge to individuals seeking health services there.

In both severely damaged and receiving parishes, there was a substantial decline in the percentages of respondents who typically accessed health care through doctors and HMOs — from 60 percent to 46 percent in severely damaged parishes and from 67 percent to 57 percent in receiving parishes.

In severely damaged parishes, there was a large increase in the percentages of respondents who reported using hospitals or other emergency care as their usual place of accessing health care after the hurricanes (increasing from 18 percent before to 31 percent after). Also, in both severely damaged and receiving parishes, the percentage of people who reported nowhere to go for health care increased after the hurricanes by about 3 percentage points. These results might indicate that people in damaged areas lost access to their family doctors after the storm and that those who relocated to receiving parishes had not yet acquired a new family doctor.

(This article was published in the winter 2008 issue of Louisiana Agriculture.)
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