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Many Chatham County residents perceive barriers that prevent them from getting care when they need and want it. Responses from county residents about access are described (in order of frequency): 1. Transportation difficulties The location of providers influences the ease with which Chatham County residents can obtain health care services. Resources are primarily concentrated in Pittsboro and Siler City, and to a lesser extent in Moncure. County residents see the distance between towns, the conditions of roads, and the lack of transportation services as important barriers that keeps people from accessing health services. Residents and public safety professionals express concern about the time it takes for EMS to reach the southern communities in the county. The Climb Aboard Resource Van has proven that health care outreach into neighborhoods is well-utilized and well-received by Chatham residents. “For people in the south end of the county.... we’re sort of out there in limbo. An ambulance can take as long as 30 minutes. I have a two year old and I am most concerned. We used to have an EMS station in Moncure. It would be nice to have more MD’s in our part of the county.” “Why has this community been left alone for so long? Do they not care that there are so many problems here?” (Moncure) 2. High cost of health care (poverty and lack of insurance) An estimated 15% of the Chatham County population lives in poverty, compared to 14% for the state. Physicians, dentists and other health care providers generally require some level of payment at the time that services are rendered, which 16.3% of residents surveyed by telephone reported as keeping them out of the doctor’s office until the condition becomes very serious. Lack of insurance or incomplete coverage has been identified by Chatham County residents as one of the top four most important issues impacting the health and well being of the population. An estimated 6,342 Chatham County residents have no insurance, and 15,206 have incomplete coverage. This represents 50% of Chatham’s population, above North Carolina’s uninsured/underinsured rate of 45%. Among the population living in poverty, 27% in Chatham have no health insurance; this exceeds the statewide uninsured rate among the poor of 13.8%. “There really needs to be something done about the medicine - the prices.” 3. Language barriers Health care providers described their feelings of helplessness in assisting Hispanic clients due to language barriers. While there are a handful of Spanish translators in the county who work at the Chatham County Health Department, the Family Resource Center, and Piedmont Health Services, few health care providers speak Spanish, including personnel at OPC Mental Health and at the Chatham Hospital. Latino youth mentioned language barriers as a critical issue. Latino adult residents did not mention language barriers as frequently as did health care providers and other community members. 4. Lack of understanding of how to get into and use the health care system Latino residents repeatedly did describe frustration and helplessness in seeking health care with unfamiliar health care systems. For example, the cost of medical and dental care is generally far lower in their home country, and health insurance is not needed. Preventive checkups for medical and dental health are not customary. For this reason, many of the recently immigrated residents of Chatham, even though offered a health insurance benefit by their employer, choose not to receive employer subsidized health insurance since they do not see it as beneficial as having a partially higher take-home pay. “Access for some people means a combination of language barriers, education, and how to use the health care system.” 5. Hours of operation inconvenient Many residents described need for evening and weekend services. This was particularly true for youth, persons with young children, and shift-workers. Primary care providers suggested that since children are already at school that considering school-based programs would address transportation and hours of service barriers to health care. 6. Need for specific programs and services Chatham residents described needs for specific health care programs and services, including (in order of frequency of responses): |
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7. Not sure of services available Lack of information about available resources was recognized as a leading barrier that prevents Chatham County residents from obtaining necessary care. 8. Lack of a “whole view” of a person and lack of humanity in health care “Health service educators need to retrofit the system. Go back to treating people, not just diagnosing them. Treating disease is totally inappropriate when you are not considering the family situation, the environment, etc. Treat the whole person.” 9. Acceptability For some Chatham resdidents, pride may reduce access to publicly funded, safety net programs. “Access means acceptability. Acceptable means different things to different people. Some people in the Southeast area wouldn’t go to the Moncure clinic - it’s for ‘poor folks’ though its a great service down there.” 10. Coordination between providers, primary, and specialty providers Residents and health care providers alike spoke out about lack of coordination between many agencies as a barrier to accessing services. “Access means linkages between local providers of primary, secondary and tertiary care. It means communication between churches, doctors, employers, and teachers.” 11. Lack of sensitivity to the family and social context Several residents described feeling frustrated with not being able to get out to services due to lack of ability to cope with adding one more thing to their day to day life. According to Terry Stevens, Program Coordinator for Climb Aboard, the mobile unit overcomes many of the obvious barriers to health care access, particularly transportation problems, and work and/or child care problems. Additionally, Stevens sees the social and family context issues that may make visits to a health care provider insurmountable. Stevens reports that by going into homes, daycares, and schools, the Mobile Unit has served families that would otherwise have fallen through the cracks. When asked about the future, Stevens hopes to eventually be able to reach the community as a whole, including teens, adults, and persons of all ages. “Smart Start has given us a great start to see the broader issues within the whole community -- the context that people live in really opens your eyes. The housing has been quite an education to me - it’s deplorable - you’ll find three or four families living in the same place. Trust is a critical issue, people begin to really trust you and know you’re there to help them when you’re on their ground and in their homes. The power shifts, they offer you tea and open up on all issues. They really tell you about their lives, and what they think the community needs”. |
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