Quality of Life Indicators

public health spending -- new 2/28/11

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According to the Nevada Cancer Coalition's, State of Nevada Comprehensive Cancer Plan, 2011-2015:

• Despite growing proff in evidence of the relationship between comparatively modest public health investments and significant reductions in mortality from the leading preventable causes of death, Nevada ranks last among all states in per capita health expenditures
• Nevada spends $4 per capita on public health services
• Nevada spent on 11% of the minimum CDC recommended amount for tobacco control and prevention in 2010, despite 1:5 adults smoking, as tobacco settlement dollars are earmarked for other programs (education, corrections other revenue streams)
• Worsening trend in the number of Nevada residents ho are obese
• Increased number of indigent residents

According to America’s Health Rankings, Nevada ranks 50th on per capita state funding ($38.62 per person) dedicated to public health, including federal funding directed to Nevada for 2010. In comparison, Idaho ranked 7th ($123.31 per person), California ranked 11th ($112.76 per person), Utah ranked 33rd ($64.67 per person), Oregon ranked 38th ($55.56 per person), and Arizona ranked 43rd ($47.96 per person).

Nevada Check Up -- updated 11/13/11

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Uninsured children ages birth to 18, from families with incomes that are too high for Medicaid and too low to afford private health-insurance coverage, can be covered by Nevada Check Up. Families with income levels up to 200 percent of the federal poverty level may qualify. Program quarterly premiums are based on income and family size.

oral health prevalence -- updated 5/17/12

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As employers eliminate dental insurance, families may delay regular dental visits due to the costs incurred. Visiting a dentist on a regular basis, helps prevent tooth decay and gum disease. Poor oral health impacts overall health and can be especially dangerous for children.

emergency room visits -- updated 7/10

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Nevada moved from rank 43rd in the nation with 53 medical school graduates in 2005, to 44th in 2009 with only 51 graduates.

medical school graduates -- new 7/10

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According to State Health Facts, Nevada moved from rank 43rd in the nation with 53 medical school graduates in 2005, to 44th in 2009 with only 51 graduates.

cost of living - health care -- updated 3/3/11

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Healthy communities take a broad view of health. They focus on wellness, prevention and access to quality medical care. When health care is hard to find or expensive, people may delay treatment, often making their health and economic problems worse. Nationally, health care expenses, even among those who have jobs, cause over half of all bankruptcies.

A large percentage of Nevada’s population is without health insurance; the costs for health care are especially important for these families and individuals. Health care costs in the Reno area have started to decline although it remains unclear how the federal healthcare reform will impact local costs before many of the requirements are enacted in 2014.

inpatient hospital costs per day -- new 7/10

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Inpatient hospital adjusted expenses per day in Nevada averaged $1,685 in 2005, vs. $1,522 average for the US; by 2008 this increased to $1,990/day in Nevada vs. $1,792 for the US.

uninsured adults & children -- partial data updated 5/15/12

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As the number of persons without health insurance rises, the economic impact on healthcare providers, and the health care industry across Nevada, declines significantly. Although the percentage of Washoe County uninsured has remained slightly below the state percentages, little improvement has been achieved. As unemployment remains high in northern Nevada, families can't afford to pay for COBRA to continue their health insurance and are resorting to Medicaid. Working families without health benefits have even less options. Monthly premium estimates for an average family of four are estimated at more than $1,000 per month, while the average unemployment check is $1,300 per month, leaving little for basic needs, let alone health insurance. This is a complex problem since the healthier the workforce, the lower the employer paid insurance premiums. 84.5% of Washoe County adults reported "having any kind of health care coverage, in the CDC's National Center for Chronic Disease Prevention and Health Promotion 2009 Behavioral Risk Factor Surveillance System. This was a 5.2% increase over the 2008 behavioral survey. 81.8% of Washoe County adults aged 18-64 reported having any kind of health care coverage in 2009; this was a 5.9% increase over 2008.

According to 2007 and 2009 reports from Great Basin Primary Care Association, in July 2008, almost 72,000 people in Washoe County did not have health insurance (17,810 were aged 18 and under). Great Basin Primary Care Associates offers possible reasons for Nevada’s high rate of uninsured--Nevada is 51st in the nation for per capita expenditures over the last decade on Medicaid (Health Care State Rankings). We spend less on Medicaid than any other state in the country, yet we have one of the highest uninsured rates in the country. At the same time, fewer people than the national average are participating in Medicaid and Nevada Check-Up. Eligible people have not enrolled in these programs, either because of the complicated enrollment process or simply a lack of awareness. Small businesses today are less likely to provide health insurance benefits than in the past. Businesses with fewer than 50 employees make up the vast majority of Nevada businesses and employ more than half of Nevada’s workers. According to the Reno-Sparks Chamber of Commerce (2/2/07), only 39% of employers with 50 or fewer workers offer insurance.

According to the Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2006 and 2007 Current Population Survey (CPS: Annual Social and Economic Supplements), 21% of Nevada’s non-elderly workers were uninsured 2005-2006, compared to 18% in the U.S. 2006. State Health Facts

According to TMT’s December 2007 community survey of Washoe County residents, 28.2% reported being retired; 8.2% reported not being employed; 42.2% responded that their employer provided them with health insurance vs. 13.2% reporting their employer did not provide health insurance; and 3.8% reported being covered with health insurance outside their employer.

infant mortality -- updated 3/22/11

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Infant mortality reflects the overall status of maternal health, plus healthcare availability to pregnant women an their infants. The National Kids Count program data are reported for infant deaths <1-year per 1,000 live births (by place of residence, and not place of death). Nevada ranked 29th in the country with a -2% change in the infant mortality rate from 2000-2006. Washoe County continues to be higher than the national Healthy People 2010 goal of less than 4.5 deaths per 1,000 live births.

workers with insurance -- updated 1/17/11

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According to a State Health Access Data Center at the University of Minnesota study reported in the Las Vegas Sun, 19.8% of Nevada workers ages 19-64 had no health insurance coverage for the years 2006-07 (higher than the 18.4% national average). According to the Reno-Sparks Chamber of Commerce, only 39% of employers with 50 or fewer workers offer insurance (2/2/07). Consistent, reliable data for this data measure isn’t available for Washoe Count.

workforce wellness programs

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According to the Wellness Councils of America, the Washoe County School District reports a return of $15.10 for every dollar spent on their wellness program. http://www.welcoa.org/news.php?entryid=220

The WCSD Good Health Incentive Wellness Program won the 2006 national large employer (greater than 500 employees) award (one of nine given among seven categories) for STEPS to a HealthierUS, a Department of Health & Human Services initiative that advances helping Americans live longer, better, and healthier lives. To be considered, programs must address at least one of the following risk factors: obesity, physical activity, and/or nutrition. The WCSD Wellness Program targets all of the employees, retirees, and spouses covered under the District's health plan. Preventative Medicine research shows a $15.60 ROI for these programs. [Financial impact of a comprehensive multisite workplace health promotion program, Preventive Medicine, Volume 40, Issue 2, February 2005, Pages 131-137, Steven G. Aldana, Ray M. Merrill, Kristine Price, Aaron Hardy, and Ron Hager]

A 2003 analysis showed that wellness participants were 26% more likely to be in the lowest quartile of healthcare costs. The most recent analysis from 2001 through 2004 indicated a 7% reduction in the average dollar claim and fewer overall claims for wellness participants. http://www.prevent.org/content/view/120/144//#hwle2

According to WellnessProposals, "...employers get an average of $3.48 back in reduced health care costs and $5.82 in lower absenteeism cost for every dollar spent on employee wellness. Employers who live more healthy lifestyles have reduced sick leave, improved work performance, decrease health insurance costs, increased productivity and reduced overall costs."

According to TMT’s November 2007 business eSurvey, 54% of respondents reported that they did not offer a wellness program or wellness incentive for employees, and 69% of these businesses also had not considered quantifying the financial benefit of such a wellness program.

TMT will track additional metrics as they become available. Additional business survey questions include:

• The type of employee wellness programs?
• Gym memberships or discounts
• Nutrition or diet advice or consultation
• Medical screenings
• Wellness classes – diet, exercise, stress reduction, disease prevention
• Substance abuse treatment
• Smoking cessation
• Other

Percent of employees participating in some aspect of the wellness program?

Quantified financial benefit of the business wellness program for every $1 invested?

prenatal care in the first trimester -- updated 5/17/12

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According the NSHD, Office of Health Statistics & Surveillance, preliminary data indicate that 8.8% of Nevada births occurred in 2008 where the mother did not receive prenatal care until the third trimester or received no prenatal care. Prenatal care is crucial to the health of mother and child and has been shown to reduce low birth weight babies and infant deaths. A study by the American Medical Association showed that well-educated and low risk women are getting more early care while low-income and high risk women are getting less care than is optimal. The percent of women receiving pre-natal care in the first trimester is dropping in Washoe County. This indicator may reflect that fewer women have access to health insurance. Women without access to early prenatal healthcare have an increased risk of low birth weight babies, premature births, and infant mortality. This is particularly important because screening for risk factors associated with adverse pregnancy outcomes can reveal pre-existing health issues and most fetal organs form in the first trimester. Washoe County District Health participates in the Test4baby free mobile program with messages critical to maternal and health health.

number of doctors, nurses, dentists per capita -- updated 7/10

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In 2008, according to State Health Facts, Nevada had 2.3 nonfederal physicians (5,954) per 1,000 population, compared to 3.2 for the US; and 0.9 nonfederal primary care doctors (2,396 or 40% of licensed physicians/ranked 49th in the US), compared to 1.2 for the US. In 2004, Nevada ranked 49th in the United States with 1.89 doctors per 1,000 people (compared to 3 per 1,000 people nationally). Nevada was projected to have 20 physician assistants per 1,000 population in December 2008, compared to 24 physician assistants for the US.

In 2008, Nevada had 613 registered nurses per 100,000 population, compared to 836 for the US; 49th among states in the number of registered nurses per capita. As of December 2008, Nevada has 20 physician assistants per 1,000 population, compared to 24 for the US. Nevada has 0.7 dentists per 100,000 population in 2008, compared to 0.8 dentists for the US.

Highlights from the National Center for Health Workforce Analysis by the U.S. Department of Health & Human Services are listed below. Source: http://bhpr.hrsa.gov/healthworkforce/reports/statesummaries/nevada.htm

• Nevada ranked the lowest among the states in per capita health services employment and percent health services employment.
• In 1999, Nevada was above the national rates of deaths due to cancer and heart disease. Nevada had the highest rate of deaths due to firearms in the country.
• In 2000, Nevada ranked 49th in the country in the number of hospital beds per 100,000 population and in 1999 ranked 48th in the country in the number of nursing home beds per 1,000 population 65 and over.
• In 2000, Nevada ranked last in registered nurses per capita, ranked 42nd in the number of LPNs employed, had one of the lowest ratios of nurse practitioners per capita in the nation, and had one of the lowest ratios of nurse anesthetists per capita in the nation.
• Nevada had 0.7 certified nurse midwives per 100,000 population, well below the national rate of 2.9. Nevada ranked 49th among states in certified nurse midwives per capita.
• Nevada ranked 48th in the nation in dentists per capita. The per capita ratio of dental hygienists was also lower than the national rate.

licensed alcohol, drug & gambling counselors per 100,000 population -- 3/3/12

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