| context There have been major changes in San Mateo
County since 1995 when the last Community Needs Assessment was completed. These changes
range from industry changes such as transfers of hospital ownership and mergers, to
changes in government programs, and the Healthy Families Program. Meanwhile, consumer
interest and demand are bringing about new approaches to health care and health
information.
San Mateo County is served by eight acute
care hospitals. During the last year, consolidation of ownership has resulted in these
hospitals being owned and managed by four non-profit health care systems.
- One district hospital became part of a non-profit system.
- Two hospitals merged their licenses and medical staff and
are owned and managed by a not-for-profit system.
- The county hospital was replaced with a new facility which
incorporated an acute rehabilitation center.
- The county health clinic system added four additional
sites.
- Trauma care is being provided at trauma centers outside the
county.
- Ambulance services is being provided through a joint
venture with a private ambulance company and fire departments within the county.
- Managed care coverage continues to expand within the
county.
- Growth of medical groups, especially specialty groups,
continues. At the same time, many such groups are struggling to provide the administrative
and quality oversight promised by their collaboration.
local implementation of state & federal
programs
- Medicare is offering persons over 65 the option of
assigning their Medicare coverage to a senior health maintenance organization. Several
such health plans cover seniors in the county, while other older adults have opted to
retain traditional Medicare.
- Since 1987, the Medi-Cal program (the California version of
the federal Medicaid program) in San Mateo County has been administered by the Health Plan
of San Mateo. The Health Plan of San Mateo is a county organized health system providing
Medi-Cal coverage to nearly all Medi-Cal beneficiaries in San Mateo County.
- Federal legislation in 1996 created the Personal
Responsibility and Work Opportunity Act which significantly reformed the welfare system in
the United States. An increased emphasis on work and short-term assistance have led to
large reductions in the numbers of families receiving cash assistance.
- The Medi-Cal program has been affected by welfare reform
and changes in Medi-Cal eligibility requirements, which have reduced the numbers of
persons receiving general assistance or temporary assistance to needy families (TANF).
- Federal legislation in 1997 created the state
Children’s Health Insurance Program to cover uninsured children in low-wage, working
families. In California, this program is known as the Healthy Families Program.
- The fall 1998 California election included passage of
Proposition 10, the "tobacco tax initiative" that raises the price of cigarettes
and other tobacco products. The intent is that monies raised will fund health and social
programs for young children and other at risk individuals. A local commission in the
county will be formed to administer San Mateo County’s portion of the projected $300
million new fund.
new approaches in health care & health
information
- Increased interest in alternative/complementary medicine
from both consumers and professionals is reflected in popular and clinical literature;
national studies show that one out of four American adults are using traditional therapies
such as acupuncture and herbology, as well as chiropractic approaches, vitamin
supplements, and massage therapy. Locally, health plans are beginning to cover some of
these non-mainstream therapies. This interest in examining the various approaches to
health and healing has led to the development of integrative medicine clinics within some
of the hospitals in the county.
- The availability of health and medical information on the
Internet, as well as interactive websites and online support groups, has dramatically
increased during the last three years. Some studies indicate that over a third of people
online are there for health and medical information. While online, some searchers receive
excellent assistance from both major and lesser known sites; other studies point out the
unreliability of information available even from reputable sites and that some Internet
searchers are unsophisticated about website authors and agendas. Some health care
providers and institutions are using the Internet as a new personal communication tool
with patients, a trend that many feel will expand dramatically as technology and
experience continue to improve.
economic growth
- Rapid economic growth has led to several significant
quality-of-life issues, including the highest housing prices in the country and a marked
increase in traffic congestion.
- It is becoming more difficult to recruit qualified workers
into the county.
- The disparity between the poor and working poor and those
participating in the economic growth continues to widen.
other local efforts
- Throughout the county, there are many local efforts
currently underway to address health and quality of life issues. Many of the issues
outlined in this report, in fact, are currently being addressed at some level in San Mateo
County. The Collaborative wishes to recognize these efforts, and hopes that this
assessment will help to further define direction and encourage collaboration in these
areas.
next steps
This community assessment is designed to
identify areas of opportunity for improving health and quality of life in San Mateo
County. Understanding the state of and changes in the local health care environment as
described above is essential when identifying priorities for action and designing
initiatives to promote community wellness. It is also important to recognize that, while
some needs will show potential for short-term impact through community initiative and
intervention, others (e.g., racism, poverty) define the realm within which we operate and
demand a more long-term approach. The most hopeful strategy is to find opportunities to
address these broader issues in the long-term, while working to remedy some of their
consequences in the lives of San Mateo County residents. |