Health Services Utilization
Those surveyed in the 2018 CASPER door-to-door assessment and the 2019 Sidney Health Center Community Health Needs Assessment largely agree that the health care services in Richland County are a positive aspect, and that local health care providers and services is important to the economic well-being of the area. Further, nearly three quarters of CASPER survey respondents agreed that they could get the health care they needed near their community.
Those surveyed by Sidney Health Center utilized hospital services in Sidney, followed by Billings, in the past three years, largely citing "closest to home" as their reason for selecting the hospital used. Of those surveyed, 73.2% had a primary care provider in Sidney, and 8.7% in Fairview. Only 18.1% had a primary care provider outside of the area.
Access to Care
Access to care, according to Healthy People 2020, in necessary for overall physical, social and mental health status; the prevention of disease; detection and treatment of illness; quality of life; preventable death; and life expectancy. The ability of an individual to access health care is dependent on a number of factors, including the cost of care, insurance coverage, and provider availability, among many other factors.
Surveyed residents accessing health care services at Sidney Health Center largely report insurance coverage through employer-sponsored plans. Notably, between 2013 and 2019, survey respondents reporting paying out of pocket decrease significantly, and those reporting "other" coverage increased significantly.
Inpatient admissions at Sidney Health Center by primary payer shows several important changes in health care coverage at Sidney Health Center. A stark decrease in the use of commercial health insurance occurred between 2014 and 2015, and an over 5000% increase in the use of "other/unknown" heath care coverage. Additionally notable is the decrease in the use of "self pay" to zero between 2014 and 2015.
Medicaid expansion was passed in late 2015, and became effective in Montana beginning January, 2016. This accounts for a 127% increase in Medicaid enrollees between 2010 and 2017 based on the primary payer for inpatient admissions at Sidney Health Center.
County Health Rankings data shows a decrease in the number of uninsured in Richland County residents overall in the past decade, as well as in both Montana and the United States. Despite increasing rates of health insurance coverage, 22% of CASPER respondents reported that they delayed seeking healthcare services in the past 12 months, 40% of which delayed services due to cost.
Nearly one quarter of those surveyed by Sidney Health Center in 2019 reported they were not aware of programs to assist with paying medical expenses. This decreased slightly from 2013. More than one quarter of 2019 respondents reported that they were aware of assistance programs, but did not qualify. This is slightly lower than those who reportedly did not qualify in 2013. Approximately 13% were not sure.
Those surveyed by Sidney Health Center who reported not being able to receive services or having to delay receiving health care services cited "too long to wait for an appointment" and "could not get an appointment" in 2019. Results were generally similar to responses from the 2018 CASPER assessment.
Richland County has a primary care physician availability rate of 33 per 100,000, or 1 primary care provider per 2,990 people, compared to 1 provider per 1,310 in Montana, according to the County Health Rankings. Sidney Health Center is designated as a Rural Health Clinic by the US Health Resources & Services Administration (HRSA), though Richland County is not considered a Medically Underserved Area.
Clinical Service Utilization
Preventative health screenings are key to effectively reducing death, disability and disease, according to Healthy People 2020. According to the CASPER door-to-door health assessment, those surveyed largely reported utilizing preventative services in the past 12 months. Of the options offered in the survey, more than 50% of respondents indicated having birthday lab work (an annual health blood screening), a cholesterol check, a dental visit, and/or a routine health check. According to the National Cancer Institutes, approximately 64% of women ages 40 and older had a mammogram in the last 2 years, compared to the national average of 73.7, and the Healthy People 2020 target of 81.1%. Approximately 55% of Richland County residents over 50 years of age had ever had a colorectal screening (sigmoidoscopy or colonoscopy), according to the National Cancer Institutes. The Healthy People 2020 target for colorectal screening is 70.5%. Approximately 66% of women in Richland County ages 18 and older had a pap smear in the last 3 years according to the National Cancer Institutes, compared to the baseline national average of 84.5% and the Healthy People 2020 target of 93.0%.
The largest users of the Sidney Health Center emergency department between 2010 and 2017 were ages 18-44 and ages 45-64. The most common primary diagnosis was injury and poisoning.
Those ages 65 and older accounted for the largest proportion of inpatient admissions at Sidney Health Center from 2010 to 2017.
Mental Health and Substance Abuse Services
Richland County has a mental health provider ratio of 880 people to 1 provider, compared to the state rate of 380:1. Eastern Montana is designated as a High Needs Geographic Health Professional Shortage Area in regard to mental health providers.
According to SAMHSA, 52% of Montanans with any diagnosed mental illness did not receive services between 2011 and 2015.
Nearly one quarter of CASPER respondents did not know where to refer someone for mental health services, and 25% of respondents would refer someone to the emergency room.
Similarly, 22% of CASPER survey respondents did not know where to refer someone for substance abuse services, and 20% would refer someone to the emergency room.