Health care in New Orleans before and after Hurricane Katrina: The storm of 2005 exposed problems that had existed for years and made solutions more complex and difficult to obtain

Health Affairs

Volumn 25, Issue 5, 2006, Pages

  Rudowitz, Robin ^a   Rowland, Diane ^b,c   Shartzer, Adele ^c  

^a Kaiser Commission on Medicaid and the Uninsured   (United States)

^b HENRY J KAISER FAMILY FOUNDATION   (United States)

^c Kaiser Commission   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

COMMUNITY CARE; DISASTER; ECONOMICS; HEALTH CARE DELIVERY; HUMAN; ORGANIZATION AND MANAGEMENT; PATIENT; REVIEW; SAFETY; UNITED STATES;

COMMUNITY HEALTH SERVICES; DELIVERY OF HEALTH CARE; DISASTERS; HEALTH SERVICES ACCESSIBILITY; HUMANS; LOUISIANA; MEDICALLY UNINSURED; NATURAL DISASTERS; SAFETY;

EID: 33749345019     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.25.w393     Document Type: Review

References (53)

1. U.S. Census Bureau, "Special Population Estimates for Impacted Counties in the Gulf Coast Area," 6 June 2006, http://www.census.gov/Press- Release/www/emergencies/impacted_gulf_estimates.html (accessed 25 July 2006);
2. U.S. Census Bureau, Current Population Survey: Annual Demographic Supplement (Washington: Census Bureau, March 2004 and 2005);
3. Louisiana Department of Health and Hospitals, Bureau of Primary Care and Rural Health, Hurricane Recovery Plans (Baton Rouge: DHH, April 2006);
4. and Henry J. Kaiser Family Foundation, "Louisiana: Health Status, 2005," http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi?action= profile&area=Louisiana&welcome=1&category=Health+Status (accessed 23 May 2006).
5. Kaiser Family Foundation, "Louisiana: Health Insurance Coverage of Nonelderly 0-64, States (2003-2004), U.S. (2004)," http://www. statehealthfacts.org/cgi-bin/healthfacts.cgi?action=compare&category= Health+Coverage+%26+Uninsured&subcategory=Health+Insurance+Status&topic= Nonelderly+%280% 2d64%29 (accessed 10 August 2006).Data based on Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates, based on the Census Bureau's March 2004 and 2005 Current Population Survey.
6. "Louisiana: Health Insurance Coverage of Nonelderly 0-64, States (2003-2004), U.S. (2004)," Ibid.
7. Ruth Kennedy, deputy director, Louisiana Medicaid, presentation at the Kaiser Family Foundation's Reporter Teleconference Briefing on Health Coverage after Katrina, 9 September 2005, http://www.kff.org/medicaid/upload/ transcript090905.pdf (accessed 13 June 2006);
8. and DHH, Hurricane Recovery Plans.
9. Kaiser Family Foundation, "Health Coverage and Uninsured," see table titled "Health Insurance Coverage of the Total Population, 2003-2004" (URL in Note 2).
10. Kaiser Family Foundation, "Louisiana: Hospital Beds per 1,000 Population, 2004," http://www.state healthfacts.org/cgi-bin/healthfacts. cgi?action=profile&area=Louisiana&category= Providers+%26+Service+Use&subcategory=Hospitals&topic=Beds (accessed 17 July 2006).
11. PriceWaterhouseCoopers for the Louisiana Recovery Authority Support Foundation, Report on Louisiana Healthcare Delivery and Financing System, April 2006, http://www.lra.louisiana.gov/assets/PwChealthcarereport42706l.pdf (accessed 18 July 2006).
12. Uncompensated care cost data for 2003 provided to the authors by the Louisiana Hospital Association.
13. Ibid.
14. Kaiser Family Foundation, "Louisiana: Hospital Emergency Room Visits per 1,000 People, 2004," http://www.statehealthfacts.org/cgi-bin/ healthfacts.cgi?action=profile&area=Louisiana&category= Providers+%26+Service+Use&subcategory=Hospitals&topic= Emergency+Room+Visits (accessed 17 July 2006).
15. M. Brodie et al., "Experiences of Hurricane Katrina Evacuees in Houston Shelters: Implications for Future Planning," American Journal of Public Health 96, no. 8 (2006): 1402-1408.
16. Data provided to authors by Louisiana State University Health Care Services Division, 2005.
17. Kaiser Commission on Medicaid and the Uninsured, "State Medicaid Fact Sheets: Louisiana and the United States," http://www.kff.org/mfs/ medicaid.jsp?r1=LA&r2=US (accessed 13 June 2006).
18. State Medicaid Fact Sheets: Louisiana and the United States," Ibid.
19. National Association of Public Hospitals and Health Systems, Hospital Characteristics Data for 2003.
20. Hospital Characteristics Data for 2003. Ibid.
21. Louisiana Recovery Authority, 2006 Quarterly Report: February-May 2006, http://www.lra.louisiana.gov/assets/quarterlyreport/LRAQuarterlyReport060606pdf. pdf (accessed 25 July 2006).
22. Brodie et al., "Experiences of Hurricane Katrina Evacuees."
23. DHH, Hurricane Recovery Plans. The Census Bureau found even greater variation by parish using data extrapolated from the July 2005 Household Population Estimates and change-of-address files from the U.S. Postal Service.
24. See Census Bureau, "Special Population Estimates."
25. DHH, Hurricane Recovery Plans.
26. L.E. Fletcher et al., Rebuilding after Katrina: A Population-based Study of Labor and Human Rights in New Orleans, June 2006, http://www.hrcberkeley.org/ download/report_katrina.pdf (accessed 18 July 2006).
27. National Center for Disaster Preparedness, On the Edge: Children and Families Displaced by Hurricanes Katrina and Rita Face a Looming Medical and Mental Health Crisis, April 2006, http://www.ncdp.mailman.columbia.edu/ program_special.htm (accessed 10 August 2006).
28. J.Graham, "Storm Sweeps Away Health Insurance," Chicago Tribune, 29 December 2005; and Kristy Nichols, director, Bureau of Primary Care and Rural Health, DHH, personal communication, 16 May 2006. Given the difficult surveying conditions, only estimates of the rate of uninsurance are available. The DHH, in partnership with the CDC and other organizations, is fielding a population survey that will more precisely determine the number of uninsured people in the area, and results are anticipated in September 2006.
29. Fletcher et al., Rebuilding after Katrina.
30. D.C. Ross and V. Wachino, "Medicaid Categorical Eligibility Rules Are Proving a Major Obstacle to Getting Health Coverage to Impoverished Katrina Victims in Louisiana," September 2005, http://www.cbpp.org/9-26-05health. pdf (accessed 14 July 2006).
31. Kennedy, reporter teleconference briefing presentation, September 2005, based on e-mail correspondence with eligibility workers. The DHH used Medicaid presumptive eligibility to determine Medicaid eligibility based on disability criteria to obtain treatment for this person.
32. Louisiana Hospital Association, "Status of Hospitals in New Orleans and Surrounding Areas (as of 8/07/2006)" (Baton Rouge: LHA, August 2006). Periodic updates of the status reports are available on the LHA home page, http://www.lhaonline.org.
33. U.S. Government Accountability Office, Status of the Health Care System in New Orleans, Pub. no. GAO-06-576R (Washington: GAO, March 2006);
34. and authors' calculations based on data from Louisiana Public Health Institute, "NOLA Dashboard," 12 July 2006, http://www.noladashboard. org (accessed 18 July 2006).
35. Louisiana Healthcare Redesign Collaborative, "Region 1 Health Care Profile: A Healthcare Needs Assessment of Orleans, Jefferson, Plaquemines, and St. Bernard Parishes Post-Hurricane Katrina, July 2006" (slide presentation provided by Louisiana BPCRH);
36. and LPHI, "NOLA Dashboard."
37. Louisiana State University Health Care Services, "Request for Federal Assistance to Restore and Preserve Louisiana's Health Care Safety Net" (Baton Rouge: LSU, 16 November 2005).
38. DHH, Hurricane Recovery Plans;
39. and LPHI, "NOLA Dashboard."
40. T. Ricketts, "Hurricane Katrina Affects Nearly 20,000 Physicians - Up to 6,000 Patient Care Physicians Dislocated by Flooding," Press Release (Chapel Hill: University of North Carolina, 15 September 2005).
41. DHH, Hurricane Recovery Plans.
42. Ricketts, "Hurricane Katrina Affects Nearly 20,000 Physicians."
43. Accreditation Council for Graduate Medical Education, "ACGME Plan to Address a Disaster Significantly Altering the Residency Experience at One or More Residency Programs," February 2006, http://www.acgme.org/acWebsite/ downloads/RRC_prRev/pol_respDisaster06.pdf (accessed 17 July 2006).
44. PriceWaterhouseCoopers, Report on Louisiana Healthcare Delivery and Financing System.
45. Report on Louisiana Healthcare Delivery and Financing System. Ibid.
46. DHH, Hurricane Recovery Plans;
47. and LPHI, "Mental and Behavioral Health Services Clinic Operations Summary," on "NOLA Dashboard," 19 June 2006.
48. DHH, Hurricane Recovery Plans.
49. The Kaiser Family Foundation contracted with Lake Research Partners to conduct structured interviews with about fifty low-income Katrina survivors from New Orleans in January-February 2006; the findings were published in a KFF report in August 2006. The interviews focused on individuals' health challenges but also included questions about their general living situations. A video developed from the interview project, called "Voices of the Storm: Health Care after Katrina," is available online at http://www.kff.org/uninsured/ voices.cfm (accessed 25 July 2006).
50. U.S. Department of Health and Human Services, "HHS Releases First Round of Katrina Aid to Thirty-two States to Help with Evacuee Health Costs," Press Release, 24 March 2006, http://www.hhs.gov/news/press/ 2006pres/20060324.html (accessed 16 May 2006).
51. Senate Appropriations Committee, "Senate, House Conferees Approve Final Supplemental Spending Bill," Press Release, 8 June 2006, http://appropriations.senate.gov/subcommittees/record.cfm?id=256756 (accessed 10 August 2006).
52. Louisiana State University, "LSU-VA Partnership Advances toward New Orleans Hospital," Press Release, 14 June 2006, http://www.lsuhospitals. org/News/2006/June/va_press_release.htm (accessed 14 July 2006).
53. J. Moller, "Health Care Plan in Works to Offer Up Big Changes," New Orleans Times-Picayune, 13 June 2006.