COMPASS II-2.0 Health Key Findings

Emerging Issues

While health care issues have been a topic of debate for many years, the recently passed Health Care Reform Bill will likely change the landscape of health care and insurance for many Americans. Since the resident survey was conducted several months prior to the bill's debate and passage, data from the survey may not accurately reflect residents' current thoughts on some of these issues.

Alcohol and/or Drug Abuse

In 2003, 37% of residents indicated that alcohol and/or drug abuse was viewed as a critical problem in the community. In 2009, this percentage doubled to nearly 61%. Open-ended comments from respondents identified college students having problems with binge drinking and drug dealers coming in from out of town (NYC), as primary problems associated with alcohol and/or drug abuse.

On a household level, 7% of respondents in 2003 indicated that someone having an alcohol and/or drug problem was a problem which increased to 12% in 2009.

Stakeholder interviews indicate a significant increase in the number of clients seeking support for alcohol/drug abuse problems in recent years. While the problem affects all income and age levels, providers report that the average client age has been decreasing from mid-50's to 20's and 30's. Alcohol continues to be the main presenting problem, but an increase in opiate addictions has been observed by respondents.

Indicator data about alcohol and drug abuse from the NYS Department of Health shows that 16% of adults in Tompkins County engaged in binge drinking in a month's time. Additionally, Tompkins County has a higher rate of adult heavy drinking than NYS as a whole.

Mental Illness and/or Emotional Problems

In 2003, 25% of residents indicated that Mental Illness and/or Emotional Problems was a critical problem in their community. In 2009, this percentage more than doubled to 53.1%. Respondents commented frequently that the county has good services available, but that funding cuts and health insurance problems are leading to more difficulty in people receiving needed assistance.

On the household level, 29% of respondents said a lot of anxiety, stress or depression was a problem in their household in 2003; in 2009, this frequency increased to 45%. Comments indicated the perception of difficulties were primarily due to economic stressors for the majority of respondents.

Locally, the number of clients seen at the Tompkins County Mental Health Clinic has increased steadily over the past several years. Stakeholder interviews indicate that efforts to increase identification of clients with dual diagnoses of mental illness and substance abuse have been successful, leading to improved coordination of services and case management.

Children with behavioral and emotional issues were perceived as a critical problem for nearly 18% of residents. Stakeholder interviews indicate that a change in reporting requirements for evaluating children has resulted in earlier issue identification.

Lack of Affordable Primary Care/Lack of Affordable Specialized Care/Lack of Affordable Dental Care

The lack of affordable health and dental care was identified as a community problem by two-thirds of residents. On the household level, having enough money to pay for the doctor, prescription medicines, or the dentist was a critical problem for about one-third of respondents.

Respondents with low income were more likely to indicate difficulty related to health issues in their household. Additionally, 66% of low income and 30% of moderate income families indicated difficulty having enough money to pay the dentist.

The bulk of comments from respondents indicate that the lack of health care is due to a lack of insurance or financial constraints. Stakeholder information and indicator information suggest a lack of providers may be an additional issue related to availability of care.

Stakeholder interviews indicate that recruiting physicians has become increasingly difficult in most areas. In June 2006, the Association of American Medical Colleges called for increasing enrollment over the next decade by 30 percent over the 2002-03 level to address physician shortages projected by the year 2020. Cayuga Medical Center will be engaging a consultant in 2010 to perform a full needs assessment by specialty.

HIV/AIDS

Both the perception of HIV/AIDS as a problem in the county and the incidence of HIV/AIDS are low. Less than 25% of respondents indicated it was a critical problem in the community. The rate of persons living with HIV/AIDS in Tompkins County is just over 12 for every 10,000 population.

Underinsurance

Underinsurance was identified as a critical issue by nearly 72% of residents and 88% of key informants. Eighteen percent of residents surveyed indicated that at least one person in their household was uninsured. Respondents with low income were dramatically more likely to not have health insurance. On a positive note, the number of children with no insurance receiving care at Cayuga Medical Center has decreased significantly noted from data between 2002 and 2006.

Not surprisingly, uninsured respondents indicated an extremely high rate of not having enough money to pay the doctor (70%), pay for prescription medicine (66%), or pay the dentist (71%).

Assets

With a broad network of social services and a culture supporting positive health behaviors, Tompkins County is a relatively healthy community. The county has several agencies and organizations providing physical health, mental health, and substance abuse services. Cayuga Medical Center provides both inpatient and outpatient services to more than 150,000 patients each year through the center and two satellite locations. The Ithaca Free Clinic provided health services to more than 2,300 uninsured and underinsured clients in 2009. The Tompkins County Department of Mental Health provides both inpatient and outpatient clinical services to both adults and children in the county. Several agencies providing mental health services include Family & Children's Services, Suicide Prevention and Crisis Service, Lakeview Mental Health Services and the Mental Health Association. The Alcohol & Drug Council and Cayuga Addiction Recovery Services provide substance abuse services.

With the large number of health issues and organizations in the county, comprehensive planning is a vital component to effectively address challenges. The Health Planning Council of the Human Services Coalition has been a key component of the coordination by providing agency networking and collaboration opportunities, data collection and needs assessments, and the launching of several health initiatives including UrgentRx Prescription Program, "Getting Serious About Asthma Control", "Get Covered Info Line", and the Prescription Meds Access Program.

Resources
Health Planning Council of the Human Services Coalition
Tompkins County Health Department
Cayuga Medical Center
Ithaca Free Clinic
Tompkins County Dept. of Mental Health
Family & Children's Services
Mental Health Association
Lakeview Mental Health Services
Suicide Prevention & Crisis Services
Cayuga Addiction Recovery Services
Alcohol & Drug Council of Tompkins County
Planned Parenthood of Tompkins County
Southern Tier AIDS Program