1. Pam Beringer, Erin Burdi, Debra Francik , and Ashley Jacobson
Lack of Health Care Providers In Mecosta County
A Community Health Nursing Plan of Care
Pam Beringer, Erin Burdi, Debra Francik , and Ashley Jacobson

2. Epidemiological Concepts
Assessment & Analysis
Epidemiological Concepts
Host: Due to the “rural” classification of Mecosta County, residents of this community are at an increased risk for a shortage of Health Care Providers (HCP’s) .

3. Assessment & Analysis: Epidemiological Hosts
Rural areas (also referred to as "the country," and/or "the countryside") are settled places outside towns and cities (Farlex, 2010, para 1).
According to the US Census Bureau, the classification of “rural” includes all territories, populations, and housing units located outside of an Urbanized Area (UA) or Urban Cluster (UC) (2000).

4. Assessment & Analysis: Epidemiological Host
In the year 2000, the Mecosta County total population census was 40,553 (MSUE,2007).
The rural population of Mecosta County was 28,780 residents or 70.6% of the total population (US Census Bureau, 2000)
*27,642 (96% )of these residents lived in Non-Farm areas & 1,138, (4%) of residents lived in farm areas (MSUE, 2007, p.5)

5. Assessment & Analysis Rural Population Comparison
Percentage of Population
Rural Population Census
Total Population
United States 21% 59,061, ,421,906
Michigan 25.3% 2, 518, ,938,444
Mecosta % , ,553
*According to Census Data, Mecosta County has a greater percentage of rural resident population than both the State & National census combined! (US Census Bureau, 2000)

6. Vulnerable Groups
“To be considered vulnerable, a person or group generally has aggravating factors that place them at greater risks for ongoing poor health status then other at-risk persons” (Fisher, pg. 533).
An example : “ A middle-aged obese man with a sedentary lifestyle and hypertension would be considered at risk for cardiac problems. If that man also had an income below the poverty level, no health insurance, and stressors related to living conditions, he would be more likely to be vulnerable to ongoing poor health status then a man with similar risk factors but with an adequate income and health insurance. The man in poverty would be more likely to experience difficulties obtaining and maintaining a relationship with a primary care provider, would have problems accessing tests and procedures for diagnosis and ongoing monitoring, and would have difficulty obtaining and paying for the appropriate medications”(Fisher, pg

7. Specific groups this especially effects
According to Fisher, “A vulnerable population is a group or groups that are more likely to develop health-related problems, have more difficulty accessing health care to address those health problems, and are more likely to experience a poor outcome or a shorter life span because of those health conditions” (Fisher, pg. 533).
Characteristics, traits , and different circumstances enhance the potential for poor health (Fisher, pg. 533).
“Department of Health and Human Services, had identified certain groups as more vulnerable to health risks, including the poor, the homeless, disabled, the severely mentally ill, the very young, and the very old” (Fisher, pg. 533).
Not all people at risk for poor health are considered vulnerable

8. Assessment & Analysis Community Groups of Interest
“What is it like to live in a small rural town? What do nurses know about rural populations and their nursing needs? Although each community is unique, the experience of living in a small town is similar in all 50 states” (Fisher, pg ).
The typical rural lifestyle is characterized by the following:
Greater spatial distances between people and services
An economic orientation toward the land and nature
Work and recreational activities that are cyclic and seasonal
Social interaction that facilitate informal, face-to-face negotiations, because most, if not all, residents are either related or acquainted (Fisher, pg. 821)

9. Assessment & Analysis Community Groups of Interest
“There is increasing evidence that community members who are informed and active in planning their health care system are more likely to use and support that system” (Fisher, pg. 825).
The community decision making model helps to identify a problem and try to come up with a solution. The steps in the model are:
1. Identify the problem.
2. Assess the community’s perspective
3. Analyze the data
4. Develop a long-range plan
5. Take action
6.Evaluate the program

10. Assessment & Analysis Existing Health Resources in Mecosta
“There is ongoing debate as to whether anything is unique about rural nursing practice, because nursing care is similar regardless of the setting” (Fisher, pg. 822).
There is little information in periodical and in nursing texts on what actually makes community/public health nursing different in rural settings (Fisher, pg 824).

11. Assessment & Analysis Community Groups of Interest
“In brief, for rural residents, a small town is the center of trade for a region, and its churches and schools usually are the centers for socialization” (Fisher, pg. 821).
This helps for planning and implicating public health and community nursing programs for rural clients (Fisher, pg. 821).

12. Assessment & Analysis Community Groups of Interest
Community Groups that might be interested in helping are:
Churches
Nursing Students
Volunteers
Nurses
Community Centers
American Red Cross

13. Assessment & Analysis: Epidemiological Environment
There are Three Major Factors that Influence Rural Health
Availability of Services
Accessibility of Services
Acceptability of Services
(Maurer & Smith, 2009, p.815)

14. Assessment & Analysis: Rural Health Influences
Availability of Services
“refers to the existence of services and sufficient personnel to provide those services”
(Maurer & Smith, 2009, p.815)

15. Assessment & Analysis: Rural Health Influences
Acceptability of Services
“refers to the degree to which a particular is offered in a manner congruent with the values of a target population”
(Maurer & Smith, 2009, p.816)

16. Assessment & Analysis: Rural Health Influences
Barriers to Acceptability
Traditions of Handling personal problems without professional Help
Beliefs about the Cause of a Disorder & the Appropriate Healer
Knowledge Deficit
Specific Conditions
and Value of Prevention and Treatment
Confidentiality & Anonymity in a “Everybody knows Everyone” community setting .
Urban Orientation of most HCP’s
(Maurer & Smith, 2009, p.816)

17. Assessment & Analysis Rural Health Influences
Accessibility of Services
“ refers to the ability of a person to obtain and afford needed services” (Maurer & Smith, 2009, p.815)
Common Barriers to Accessibility Include:
Long Travel Distances
Lack of Public Transportation
Lack of Telephone Services
Shortage of Health Care Providers
Inequitable Reimbursement policies
Unpredictable Weather Conditions
Inability to Obtain Entitlements
(Maurer & Smith, 2009, p.815)

18. Multiple factors also affect specific groups
Lower socioeconomic status
Lifestyle behaviors
The psychological impact of poverty
Genetic inheritance
Race
Ethnicity
Gender
Poor education
Poor health
Sudden change in financial situation (Fisher, pf. 541)

19. Health Professional shortage areas
“Concerns about rural health care services, especially in regions with insufficient numbers of all types of health care providers,(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990’s” (Fisher, pg. 809).
“The U.S. Bureau of the Census estimates that there are 54 million people living in rural areas of the United States. They make about 1/5 (20%) of the total population but are spread out across 4/5 (80%) of the land area” (Fisher, pg. 809).

20. Assessment & Analysis Shortage of Health Care Providers
As of 2005, in the State of Michigan there are 25,146 active physicians*
with a State Population of 10,120,860
That’s a 1:420
Physician –Patient Ratio!
*(excluding physicians with unknown addresses, inactive statuses, and osteopathy)
As of 2005, Mecosta County had only 34 Practicing Physicians located in Big Rapids area to care for a Population of 42,391
That ‘s a 1 : Physician-Patient Ratio!!!

21. Assessment & Analysis: Epidemiological Agents
Major Health Problems for Rural Areas
Accidents & Trauma
Chronic Illness
Suicide & Homicide
Alcohol & Drug Abuse

22. Assessment & Analysis: Epidemiological Agents
Top Ten Causes of Death in Mecosta County
1. Heart Disease
2. Cancer
3. Chronic Lower Respiratory Disease
4. Stroke
5. Unintentional Injuries
6. Diabetes Mellitus
7. Alzheimer’s Disease
8. Pneumonia/Influenza
9. Kidney Disease
10. Intentional Self Harm
(Michigan Surgeon General’s Health Status Report., 2010)

23. Assessment & Analysis Epidemiological Agents
The Top Ten Causes of Morbidity/ Mortality for the State of Michigan where nearly identical to those of Mecosta County with only a slight difference in numerical order
Mecosta County
1. Heart Disease
2. Cancer
3. Stroke
4. Chronic Lower Respiratory Disease
5. Unintentional Injuries
6. Diabetes Mellitus
7. Alzheimer’s Disease
8. Pneumonia/Influenza
9. Kidney Disease
10. Intentional Self Harm
State of Michigan
1. Heart Disease
2. Cancer
3. Chronic Lower Respiratory Disease
4. Stroke
5. Unintentional Injuries
6. Diabetes Mellitus
7. Alzheimer’s Disease
8. Pneumonia/Influenza
9. Kidney Disease
10. Intentional Self Harm
(Michigan Surgeon General’s Health Status Report., 2010)

24. Nursing Diagnosis
Risk for Increased Mortality & Morbidity in Mecosta County related to Lack of Health Care Providers.

25. Plan
Increase the availability of preventative health resources and measures to citizens of Mecosta County to decrease the burden on current Health Care Providers (HCP).
Rationale: If Residents of Mecosta County have Access to Preventative Care & become Proactively Involved with Personal Health, the Over-all Community will Benefit from Improved Health & Reduction of Health Services Required.

26. Michigan Center for Rural Health
“Supporting and engaging rural Michigan communities and their residents in eating healthy, being physically active, and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life. Collaborative efforts involving communities, schools, worksites, families, and others are needed to create environments that support sustainable healthy behaviors.”
(Michigan Center for Rural Health, 2008, pg.23)

27. Primary Prevention
“Primary prevention is aimed at altering the susceptibility or reducing the exposure of persons who are at risk for developing a specific disease” (Fisher, Pg. 170).
“Primary prevention includes general health promotion and specific protective measures in the pathogenesis stage, which are designed to improve the health and well-being of the population” (Fisher, pg 170).

28. Plan: Primary Prevention
Sources for Volunteers & Community Venues
Volunteers
*Professors & Nursing Students from Ferris State University located in Big Rapids
*Health Care Personnel from Local Mecosta County Hospital & Private Practices
* Church Volunteers
Venues
*Churches
*Community Centers
*County Hospital
*Urgent Care Centers

29. Plan: Primary Community Prevention
Utilize Local Volunteers & Venues to Educate & Encourage Preventative Health Measures & Provide Free Health Screenings that Target Top 10 Causes of Morbidity & Mortality in Mecosta County.
*For the purpose of this power point we will only show examples for the top three causes of morbidity & mortality in Mecosta.

30. Plan: Primary Prevention Services
Heart Disease
Provide Free Blood Pressure Screenings
Free Cholesterol Quick Tests
Free Risk Factor Assessment
Education
Proper Exercise & Nutrition According to American Heart Association Guidelines
Stress Reduction
Early Signs & Symptoms of Heart Attack

31. Plan: Primary Prevention Services
Cancer
Assessment of Risk Factors
(Genetics, Lifestyle, & Environmental)
Education
Different Types of Cancer
Nutrition
Exercise
Early Detection: Signs & Symptoms
Self Screening Tools
(Self-Breast & Testicular Exams)
Smoking Cessation

32. Plan: Primary Prevention Services
Stroke
Risk Assessment
(Genetics, Lifestyle, Environmental)
Education
Nutrition & Exercise
Smoking Cessation
Stress Reduction
Early Detection-Signs & Symptoms!!
Slurrred Speech
Dysphasia
Hemi-paresis
Numbness &Tingling
Facial Droop
Blurred Vision

33. Plan: Secondary Prevention
“Secondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression, thereby preventing disability or complications” (Fisher, pg. 171).
Examples:
1.Preventing transmission of a communicable disease
2. Preventing or slowing of a disease
3. Preventing complications from a disease
(Fisher, pg. 171)

34. Plan: Tertiary Prevention
“ Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for person’s who have experienced a loss of function resulting from a disease process or injury” (Fisher, pg. 171).
We need to provide:
Education to people
Nursing Care
Referrals
Resources

35. Plan
Offer Incentives for Future HCP’s to Practice in the Mecosta County area.
Rationale: Through offering Incentives for HCP’s to practice in the Mecosta area, one can increase the number of HCP’s to residents.

36. Reason Healthcare Providers Avoid Practicing in Rural Areas
“The reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilities” (Health Professions Resource Center, 2006).

37. Plan: Recruitment & Retention
Recruitment and Retention of HCP’s is a challenge for rural areas.
Nationally, there is a projected provider shortage along with a projected increase in demand for
services, as the baby-boomer population reaches retirement age.
Recruitment and Retention was identified as an issue in all three components of the rural community health assessment
(Michigan Center for Rural Health, 2008, pg.23)

38. (Michigan Center for Rural Health, 2008, pg.29-30)
Plan: Recruitment & Retention The Michigan Center for Rural Health
The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan
Increase by 20% the number of rural health sites approved as Michigan State Loan Repayment sites.
Increase by 10% the number of rural providers participating in the State Loan Repayment Program. (MSLRP).
Increase by 20% the number of rural health sites approved as
National Health Service Corps sites; from 127 to 152.
Increase by 10% the number of National Health Service Corps
provider placements at rural sites.
Develop a retention model to assist rural hospitals, certified rural health clinics and federally qualified health centers in their retention planning efforts.
Develop a rural component to the “Practice Michigan” campaign to promote the benefits and positive aspects of rural practice.
(Michigan Center for Rural Health, 2008, pg.29-30)

39. Measurable Outcomes
Increased number of HCP’s in Mecosta County Decrease in HCP to Patient Ratio. Attendance Rate of > 60% to Local Prevention Seminars & Screenings. Less admissions into the hospital.

40. The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures.

41. The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions.
(Beringer, 2010)

42. Intervention
“An intervention is an interference so as to modify a process or situation.”
“An intervention is designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patient.”
(Farlex, 2010)

43. (Michigan Center for Rural Health, 2008, pp. 1-2)
The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan.
The approved goals by the Advisory Group for rural residents are:
Access to dental care
Access to mental health
Access to primary care & specialty care
Practicing health professionals
Targeted education & training opportunities
The number of applications and admissions into health professions & training programs
The rate of obesity
The activity level of the population
The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas
Healthy eating in the community
(Michigan Center for Rural Health, 2008, pp. 1-2)

44. Available Services In Mecosta County
34 Physicians
EMS Services:
Spiritual care
Hospice care
Grief support
Nursing Care
Respite care
Social services
Home care aide or homemaker services
Volunteer care
Physical, occupational, and/or speech therapy
(Jacobson, 2010)

45. Recruitment & Retention in Mecosta County
☼Evaluating the ratio of health care providers to the number of patients
☼Recognize the shortage of health care providers
☼Showcase the environment to draw health care workers to the area
☼Describe the different religious organization
☼Illustrate the different cultural groups in the area
☼Highlight the civic activates and cultural arts available in the area
☼Offer incentives for relocation
☼Illustrate the recreation activities that are offered in the area

46. Health Care Providers
Mecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids
Mecosta County Medical Center provides services in:
●Maternity
●Cardiopulmonary & Rehabilitation
●Critical Care Unit
●Emergency Care
●Home Health Care
●Inpatient Medical Rehabilitation
●Laboratory Services
●Medical Imaging
●Nutrition and Dietary Services
●Occupational Medicine
●Outpatient Physical Rehabilitation
●Pharmacy
●Specialty Clinics
●Surgical Services
Mecosta County Medical Center. (2010)

47. Mecosta County is classed as a Micropolitan area with two Rural areas bordering it.
There are no free clinics located in the county or surrounding counties.
(Michigan, 2010)

48. The shortage of Health Care Providers is an issue with today’s economy
The shortage of Health Care Providers is an issue with today’s economy. Extending care and services suffer due to cut back in the budgets. The existing care institutions needs to reach out to communities and other business’s to facilitate the growing need for health care providers and facilities. Community involvement can increase awareness of services in the community.

49. Showcasing Mecosta County
Mecosta County offers diverse terrain
Rolling hills
Northern woods for stunning color
Marsh land for wild life
(Ertman, 2010)

50. The Congregations In Mecosta County Allows For Varied Religious Practice
United Methodist Church - 9
Lutheran Church - 2
United Church of Christ - 1
The Wesleyan Church - 3
Evangelical Lutheran Church in America - 1
Evangelical Free Church of America - 1
Free Methodist Church of North America - 4
Christian Churches and Churches of Christ - 3
Wisconsin Evangelical Lutheran Synod - 2
Church of Jesus Christ of Latter-day Saints - 1
Episcopal Church - 1
Presbyterian Church - 1
Church of God – 3
Old Order Amish - 3
Christian Reformed Church in North -America - 1
General Association of Regular Baptist Churches - 1
Assemblies of God - 2
Church of God (Cleveland, Tennessee) - 1
Conservative Baptist Association of America - 1
Church of the Nazarene - 1
Community Church of Christ - 1
Seventh-Day Adventist Church - 1
Sothern Baptist Convention - 1
Churches of Christy - 1
Baha’i – 15 members (no congregations)
Salvation Army - 1
Buddhists - 1
(Rousseau, 2010)

51. Population Affiliation Percentage in Mecosta County
Lutheran Church (11%)
Other (37%)
United Methodist Church (14%)
United Church of Christ (5%)
The Wesleyan Church (5%)
Catholic Church (28%)
(Rousseau, 2010)

52. Mecosta County Is The Home To Many Different Cultures
Mecosta County Is The Home To Many Different Cultures And The Most Common Reported Are:
German (26%)
English (11%)
United States or American (10%)
Irish (9%)
Polish (5%)
Dutch (4%)
French (except Basque) (4%)
Amish also reside in the area
(Dixon, 2010)

53. Highlighting The Activities That Are Provided In The Community
Can Enhance The Benefits Of Living In A Small Rural Area
Showing the activities that are monthly & annually gives a feel of community closeness
Monthly Rise ‘N’ Shine’s
Monthly Business After Hours
Mecosta County Community and Family EXPO!
Pioneer Group Chamber Open
Annual Morley Free Festival / Bike Show
Annual Labor Day Arts and Crafts Festival
Bulldog Bonanza
Annual Mecosta County Community Holiday Gala
( Rousseau, 2010)

54. ▪Repaying student loans
Offering Incentives For Relocation Can Draw New Health Care Providers To An Area
▪Institutions sometimes offer incentives with signed contracts that will insure a bonus after so many years of service.
▪Repaying student loans
▪Health care workers that work in the more remote areas receive higher pay
(Shinohara, 2010)

55. ☺Ferris State Racquet & Fitness Center
Mecosta County Offers A Wide Range Of Recreation For Everyone
☺City Parks - 14
☺Lakes and Rivers - 5
☺Hiking
☺Ferris State Racquet & Fitness Center
☺Mountain Biking – x4 different areas
☺Camping – x3 local areas
☺Hunting
☺Snowmobiling
☺Cross Country Skiing
Francik, 2010

56. Promotion Of Healthy Lifestyle Decreases The Work Load Of Health Care Providers
Interventions are needed to promote good health in the community
Primary, secondary, and tertiary preventive care is ideal, but the services that provide this care may be hard for rural areas to access.
Ways to reach out and help other people
⌂ Reaching out to the local venues for participation
⌂ Provide health fairs
⌂ Promote community physical activities
⌂ Provide screening services in different areas of the community
⌂ Provide workshops on good nutrition
⌂ Provide stress management classes
⌂ Provide information on social support in the community
(Pender, 2006)

57. (Michigan Center for Rural Health, 2008)
Primary Medical Care Providers
Eight counties in the northern part of Michigan have no hospitals. Out-patient
clinics is the only available health care facility
Health departments are shared with other larger districts
53 free clinics are located in Michigan with only 10 located in the northern
part of Michigan
There are 7 sites of Federally Qualified health Centers located in Micropolitan areas with 36 sites in rural areas in Michigan
There are three Rural Health Clinics in Mecosta County and 156 in the state
Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers
Provide primary care that is reimbursed by health care payers
(Michigan Center for Rural Health, 2008)

58. (Michigan Center for Rural Health, 2008)
Objectives
◘ Form a committee to target healthy eating and fitness to decease heart disease
Encourage school participation by:
Replacing vending machine with water & health alternatives
Encourage the use of healthy models when preparing lunches
Have healthy eating seminars for families
Encourage the local farmers and markets to form a partnership with school for lower rates for food purchases
Develop exercise programs that include the whole family at affordable rates
Encourage a partnership with Ferris State Racquet and Fitness Center
(Michigan Center for Rural Health, 2008)
Decreasing health problems decreases the work load of HCP’s

59. Increase Education
◘ Provide adequate educational material to the community
Increase awareness of eating healthy and eating fruits and vegetables
Provide educational means at different times of the day and week to facilitate
the whole community
Develop web resources with learning material, premade meal planning, quick and
easy to follow recipes, tips on sales and coupons, and interactive games on
healthy living for the family
Advertise with healthy eating commercials on television and the radio
Provide links on the web site to state-wide nutritional sites
Provide informational hotlines for the community to call
(Michigan Center for Rural Health, 2008)

60. ◘ Identify vulnerable members of the community
Form a committee to identify the vulnerable members of the community
Identify the members that are elderly, handicapped, poverty stricken, and
people with lack of transportation
Provide information on Meals on Wheels, Women Infant and Children (WIC),
and transportation alternatives schedules
Encourage local venues to assist with transportation, shopping, and
companionship,
(Michigan Center for Rural Health, 2008)

61. Evaluation
An evaluation is a critical appraisal or assessment; a judgment of the value, worth, character or effectiveness of that which is being assessed (Farlex, 2010).

62. Evaluations are needed in every plan of care to see if the plan is working
There are five steps in the evaluation process
► Plan the evaluation
► Collect evaluation data
► Analyze the data
► Report the evaluation
► Implement the results

63. The plan is evaluated periodically (depending on the time set in the beginning) during the course of the process.
Our evaluation would consist of:
∆ Did the number of HCP’s increase during the time frame?
∆ If the number of HCP’s increased did the work load decrease?
∆ Did attendance increase at the screenings, seminars, and other events held?
∆ Did the hospital admissions decrease and was it due to our interventions?

64. Outcomes Did the number of HCP’s increase during the time frame?
●If the number of HCP’s did not increase, different means of recruiting, incentives and advertising may be needed.
If the number of HCP’s increased, did the work load decrease?
●This is based on the increase of the HCP’s. If the number of HCP’s did not increase the work load would not decrease
●If the number of HCP’s increased, did the work load decrease?
Did attendance increase at the screenings, seminars, and events held?
●If the attendance increased and was above 60% as planned, what was more beneficial the screenings, seminars, and/or the events held?
●If the attendance was below 60%, reevaluation of the area held in, time held, and type of screening, seminar, or event was held.
Did the hospital admissions decrease and was it due to our interventions?
●Did hospital admission drop and what type of admission have decreased.
●If hospital admissions did not drop, what type of patients continue to get admitted?

65. & Conclusions and Recommendations Conclusions from the data would
be formed with all involved parties
&
Recommendations are made and changes are made if needed

66. Federal Authority in Health Care
Responsible for protecting the health of its population. Regulates, interprets the law, and administers services mandated by law. Responsible for supervision and compliance with health law regulations. Involved indirect services.
Maurer & Smith, 2009, p. 64

67. State Authority in Health Care
Finances care of the poor and disabled. Manages Medicaid programs. Operates state mental health hospitals. Oversees licensure and regulation of health providers and facilities. Attempts to control health care costs. Regulates insurance companies.
Maurer & Smith, 2009, p. 68

68. County Authority
Health department Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) State Children's Health Insurance Program (SCHIP) School health programs Mental health programs Community health education
Maurer & Smith, 2009, p. 69

69. Hypothetical State Superagency Incorporating the Health Department
Maurer & Smith, 2009, p. 69

70. Increase the Number of People with Health Insurance
83 percent of persons under age 65 years were covered by health insurance in 1997.
Note: Age adjusted to the year 2000 standard population
(Healthy, 2010)

71. Increase the Number of People with Health Insurance Female vs. Male
(Healthy, 2010)
83 percent of persons under age 65 years were covered by health insurance in 1997.
Note: Age adjusted to the year 2000 standard population

72. Increase the Number of People with Health Insurance at the Family Level
83 percent of persons under age 65 years were covered by health insurance in 1997.
Note: Age adjusted to the year 2000 standard population
(Healthy, 2010)

73. Percentage of Uninsured Rises In USA
(Wolf, 2010)

74. Uninsured Increase Cost to Area Hospitals in 2000
Name
Uninsured Patient Pay Costs
Uninsured State
Costs
Total Uninsured Costs
Uninsured Payments
Net
Uninsured Costs
Mecosta County General Hospital
809,784
15,455
794,329
Memorial Medical Center of West Michigan
958,577
1,123,980
953,934
170,046
Metropolitan Hospital, Grand Rapids Michigan
7,861,364
8,604,570
1,028,514
7,576,056
(Citizens, 2000)

75. Public Policy Implications
Form a committee/coalition to work with local agencies to support the recruitment of primary care providers.
Offer incentives to attract primary health care providers.
Increase the availability of free health clinics.
Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness.

76. Support Groups
Healthy People 2010 American Nurses Association (ANA) Institute of Medicine State Children’s Health Insurance Program (SCHIP) American College of Health Care Executives

77. Healthy People 2010 Supports Access to Quality Health Care
Founded on data that enable progress and trends to be tracked, Healthy People 2010 provides a set of 10-year evidence-based objectives for improving the health of all Americans. The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life. The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population.
(Healthy, 2010)

78. American Nurses Association
ANA believes health care is a basic human right that should be provided to all individuals. ANA believes that the health care system must ensure access, which means health care services must be affordable, available and acceptable. ANA believes that all individuals should have access to a standard package of essential health care services. ANA believes the health care system must be redirected from the overuse of more expensive, technology‐driven, hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services. ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine – safe, effective, patient‐centered, timely, efficient and equitable. (New Hampshire Nurses Association, 2010)

79. Institute of Medicine
Mission Statement is to serve as adviser to the nation to improve health.
The IOM asks and answers the nation’s most pressing questions about health and health care. Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely. Each year, more than 2,000 individuals, members, and nonmembers volunteer their time, knowledge, and expertise to advance the nation’s health through the work of the IOM.
Many of the studies that the IOM undertakes begin as specific mandates from Congress; still others are requested by federal agencies and independent organizations. While our expert, consensus committees are vital to our advisory role, the IOM also convenes a series of forums, roundtables, and standing committees, as well as other activities, to facilitate discussion, discovery, and critical, cross-disciplinary thinking. (National Academy of Sciences, 2010)
(National Academy of Science, 2010)

80. State Children’s Health Insurance Program
The State Children's Health Insurance Program, or SCHIP, was established by the federal government ten years ago to provide health insurance to children in families at or below 200 percent of the federal poverty line.
(National Center for Public Policy Research, 2010)

81. American College of Healthcare Executives
An important role for healthcare executives has always been to translate social values into workable healthcare programs. In keeping with this role, healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay. (American College of Healthcare Executives, 2008)

82. Healthcare Executives
Developing and communicating access-to-care policies within their organizations and to the community.
Managing their organizations efficiently to help underwrite healthcare costs associated with uncompensated and undercompensated care.
Collaborating with other healthcare providers in their community to develop shared approaches to ensure access to care.
Encouraging and assisting trade and other professional associations to take proactive roles in access-to-care issues.
Promoting shared leadership and funding responsibilities among government, healthcare organizations, employers, private insurers and consumers.
Organizing grassroots advocacy efforts to secure needed funding from local, state and federal government bodies.
Organizing or participating in local, state and regional initiatives to resolve access problems.
Spearheading discussions with key decision makers (e.g., legislators) and key stakeholders (e.g., public agencies) to identify community health priorities so available resources can be allocated equitably and effectively. (American College of Healthcare Executives, 2008).

83. Recommendations
Based on the provider responses, some possible ways to increase the supply of health care professionals in rural areas include:
• Increasing the interest of high school students in medical professions, especially in the rural areas, because providers who were raised in a rural area appear more likely to practice in a rural area.
• Retaining students as they progress along the education pipeline from high school through residency.
• Providing more incentives such as loan repayment.
• Providing incentives specifically targeted to those who will practice in rural areas.
• Increasing awareness of the need in rural areas among healthcare providers from other places.
• Promoting and advertising the positive aspects of living and working in rural areas, including greater purchasing power.2
• Providing funds to upgrade the facilities and equipment in rural areas.
• Providing more opportunities for resident training.
(Health Professionals Resource Center, 2006)

84. Unsupportive Groups
Adding health care providers can change the cost of providing services to a community causes conflict due to over stretched budgets and lack of increased government assistance.
The following may object to changes that will bring health care providers to the community:
Consumers who have private insurance and do not want there taxes increased to support those who lack health care.
Providers who may have to care for the uninsured without proper compensation.
Maurer & Smith, 2009, p. 74

85. References
●American Nurses Association. (2010, July). Nursing Agenda Fro Health Care Reform. Retrieved November 20, 2010, from ●Barnes, J., Barnett, L., Wightman, T., Emge, A., Johnson, S. (2008). Michigan strategic opportunities for rural health improvement. Michigan Center for Rural Health, April. Retrieved from ●Beringer, P,.(2010). Mecosta county assessment people: demographics: population and trends per race, ages, and genders, including levels of education.. Ferris State University. ●Boughton, B. (2009). Improving Healthcare Access, Quality, and Efficiency: An Expert Interview with Public Policy Analyst Robert Doherty. Retrieved November 19, 2010, from Medscape Medical News: htt:// ● Citizens Research Council of Michigan. (2000). Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System. Retrieved November 21, 2010, from CRC Online Almanac: ●Dixon, B., (2010). Mecosta county assessment people: culture. Ferris State University. ●Ertman, H., (2010). Environment: environmental quality. Ferris State University. ●Farlex. (2010). The free dictionary. Retrieved November 24, 2010, from dictionary.thefreedictionary.com/evaluation ●Francik, D., (2010). Mecosta county recreation. Ferris State University. ●Health People (2010). Healthy People. Retrieved November 20, 2010, from ●Health Professions Resource Center. (2006, September). Recruitment and Retention of Health Care Providers in Texas. Retrieved November 19, 2010, from ●Jacobson, A., (2010) Social systems: types of health care providers. Ferris State University. ●Maurer, F. A. (2009). Community/Public Health nursing practice: Health for families and populations (4th ed.). St. Louis, MO: Elsevier Saunders. ●Mecosta County Medical Center. (2010). Advance care with a personal touch. Retrieved November 23, 2010, from

86. ●National Academy of Sciences. (2010, October 10)
●National Academy of Sciences. (2010, October 10). Institute of Medicene. Retrieved November 20, 2010, from
●National Center for Public Policy Research. (2007). SCHIP Information Center. Retrieved November 20, 2010, from
●New Hampshire Nursing Association. (2010, July). Nursing Agenda For Health Care Reform. Retrieved November 20, 2010, from
●Wolf, R. (2010, September 17). Number of uninsured Americans rises to 50.7 million. Retrieved November 19, 2010, from USA Today: from
●Michigan Surgeon General’s Health Status Report. (2010). Healthy Michigan Retrieved from:
●Michigan State University Extension Team . (2007, January 27). Mecosta County Profile. Retrieved from
●Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2006). Health Promotion in Nursing Practice. Upper Saddler River: Pearson Education, Inc.
●Rousseau, S., (2010). Mecosta county religious system. Ferris State University.
●US Census Bureau . (2002, April 30). Census 2000 Urban and Rural Classification. Retrieved from
●US Census Bureau. (2007, April). United States Summary: Population and Housing Unit Counts. Retrieved from
●Shinohara, R. (2010, February 15). Group advocates incentive to lure health care workers. Anchorage Daily News. Retrieved from