Can voter-approved tax levies provide fiscal advantages and stability for local public health agencies?

CONTEXT: Major funding cuts have occurred throughout the United States public health system during the past several years. Funding for local public health agency (LPHA) services and programs is obtained through a patchwork of sources that vary both within and among states. Even though local city and county sources provide a significant proportion of funding for LPHAs, information available in the literature about these revenues is sparse and is not clearly described. OBJECTIVE: This study focused on a single specific revenue stream included in the local sources (local city and county) category: funds voted on directly by the public. The primary purpose of this study was to examine whether this type of funding source provided fiscal advantages for LPHAs. Specifically, we wanted to see how sensitive levy votes were to changing general economic conditions. METHODS: A questionnaire to collect LPHA levy data was developed, approved, and mailed to county boards of elections in Ohio (n = 88). Elections officials were asked to provide voting results for all LPHA levy ballot attempts since 1994 regardless of outcome. RESULTS: In the study period (1994 through 2011), 250 LPHA property tax levies were placed on election ballots in Ohio. LPHAs were successful in 155 (62.0%) and unsuccessful in 95 (38.0%) attempts. Over the 18-year period, the most noteworthy outcome was a 94.6% pass rate for renewal levies. CONCLUSION: Our study demonstrated that voter-approved tax levies provide some fiscal advantages for LPHAs: higher per capita revenues than those who have to rely on other sources of income and predictable revenue streams. This translates into more funds being available for public health programs and services. Property tax levies allow citizens to make direct investments in their local health departments.

Reducing barriers for migratory agricultural workers to receive oral health care services.

Between one and two million migratory agricultural workers leave their homes each year to plant, cultivate, harvest and pack fruits, vegetables and nuts in the United States. While in the United States, most lack dental insurance and have no regular dentist. The primary purpose of this study was to describe issues associated with barriers to access and receiving oral health care from the perspective of migratory agricultural workers rather than the perspective of providers. Views and experiences regarding their use of oral health care services were collected from focus groups. Information from focus groups was used to design a questionnaire. Among the 157 respondents the most significant barriers hampering access to oral health care services were crop demands, travel distance, and transportation. Cost and the lack of an interpreter were ranked as the top two barriers to receiving oral health care. The most convenient times for respondents to visit a dentist were between 1 and 6 p.m. The most convenient day was Monday, followed by Sunday and Saturday.

Reducing barriers associated with delivering health care services to migratory agricultural workers.

INTRODUCTION: Between one and two million migratory agricultural workers (MAWs), primarily from Mexico and Central America, leave their homes each year to plant, cultivate, harvest and pack fruits, vegetables, and nuts in the USA. While in the USA, most lack health insurance, a permanent residence, and a regular healthcare provider. Publications over the past two decades in the USA have reported that a majority of MAWs encounter barriers to receiving medical services. Migratory agricultural workers experience high rates of occupational illness and injury. Poor access to medical care continues to exacerbate health problems among members of this population related to their working environments. In most studies concerning healthcare access issues for this population, researchers collected their information from healthcare service providers; rarely have they included input from migratory agricultural workers. This study was different in that opinions about healthcare access issues were collected directly from MAWs. The primary purpose of this study was to describe issues related to barriers associated with the delivery of healthcare services to migratory agricultural workers. A secondary purpose was to suggest strategies for reducing these barriers. METHODS: In this study, data from focus group sessions were used to develop a survey questionnaire. Four certified bilingual interpreters were trained to administer the questionnaire. A total of 157 usable questionnaires were returned from MAWs living in employer-provided camps in Northwest Ohio. The statistical analyses were primarily descriptive. RESULTS: The most significant barriers hampering access to medical services among the 157 respondents were cost (n=113; 72.0%), crop demands (n=102; 65.0%), the lack of an interpreter (n=98; 62.4%), travel distance (n=88; 56.1%) and transportation (n=82; 52.2%). Approximately half (n=82; 52.2%) said that they had access to transportation for traveling to a medical clinic. As a group, respondents were willing to travel an average of 29.1 km (18.1 miles) (range 0-129 km [0-80 miles]) to obtain medical services. Female heads of households had significantly less access to transportation compared with male heads of households (t=2.35; df=74; p<0.05). CONCLUSIONS: Three general categories of barriers to health care for MAWs surfaced in this study: (1) work environment; (2) migratory agricultural worker resources; and (3) healthcare clinic practices. Work environment issues relate mostly to the employers. Resources are barriers for MAWs because they are poor and have limited funds for the cost of transportation to clinics and the fees associated with accessing health care. Most of the barriers identified related to healthcare clinic practices. Some strategies to address healthcare clinic practice barriers were developed by the group conducting the study. By listening to what MAWs described as barriers to health care, providers can help improve access which can reduce the use of high cost hospital emergency room care.

A model program to reduce patient failure to keep scheduled medical appointments.

Community health center clinics that rely on scheduled appointments lose revenue and time when patients do not keep their appointments. Various approaches have been used to improve the rate of patient appointments kept. This article provides a model intervention program developed by a quality improvement committee at a Northwest Ohio community health center that is credited with significantly reducing rates of patient failure to keep scheduled medical and dental clinic appointments. The approach of this intervention program is different from others in that it was primarily designed to help patients learn how to become part of the solution to the problem. Community health center staff accomplishes this through engaging patients in a respectful and courteous manner and helping them understand the importance of their involvement in maintaining an efficient scheduling process to benefit all patients. Data collected from outpatient appointment records before and after implementation of the program indicate that missed appointments dropped to less than half the pre-intervention rate.

Communications between local health departments and the public during emergencies: the importance of standardized web sites.

Of the 2790 local health departments (LHDs) in the United States, Internet homepages were located for 1986. We reviewed each homepage to document the presence of 9 elements deemed to be critical for effective communications during emergency or disaster situations. LHD Web site homepages had a mean of 4.1 (±1.4) elements. Among the findings, this review revealed that 4 of 5 (80.5%) of the LHDs included the agency phone number, half (49.4%) provided links to emergency information, and about 1 in 5 (19.6%) listed an agency e-mail address. Fewer than 1 in 20 (4.3%) of the LHD homepages reviewed allowed visitors to sign up for automatic alerts or notifications. We suggest that these results be used as a starting point in developing a standardized template containing the 9 homepage elements. Such a template complements National Incident Management System protocols and can provide a recognizable source of consistent and reliable information for people during a public health emergency or disaster.

Creating a regional dental center serving six rural county health districts.

People with Medicaid or no dental insurance have a difficult time accessing dentists in private practice. The problem of access is more profound in rural than urban areas. Safety net dental clinics operated by small rural local health districts are difficult to start up, operate, and maintain. The number of these facilities in the United States is small and not evenly distributed to meet needs. This article describes how a full-service dental clinic was established to serve six rural county health districts in Northwest Ohio. Retired volunteer dentists were instrumental in the success of creating the clinic, starting with a field-type operation in 2001 serving 316 persons and building into a full-time regional dental center that served 1,306 individuals in 2007.