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OREGON AREAS OF UNMET HEALTH CARE NEED REPORT August 2020
The Oregon Office of Rural Health, in response to a mandate from the Oregon Legislature, developed the Areas of Unmet Health Care Need Report (AUHCN) in 1998 to measure medical underservice in rural areas. The report is published annually and is used:
• To qualify a practice site for loan repayment and forgiveness programs (OAR 409-036-0010 [25] [A]),
• As part of a risk assessment formula for rural hospitals to receive cost-based Medicaid reimbursement (SB 607, passed in 1991; HB 3650, passed in 2011), and
• As part of the determination of "medically underserved" geographic areas for the Oregon Governor’s Health Care Shortage Area Designation.
The report includes nine variables that measure access to primary physical, mental and oral health care. This report can be used by state partners to prioritize financial and technical assistance, and by community health care stakeholders to advocate for their unmet needs.
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CONTENTS WHAT IS CONSIDERED RURAL AND FRONTIER? .................................................................. 3
SUMMARY RESULTS .......................................................................................................... 4 Overview .................................................................................................................................. 4 Highlights ................................................................................................................................. 4 Figure 1. Overall Scores By Service Area ............................................................................................ 6 Figure 2. Ranked Service Area Scores (Highest Unmet Need to Lowest) ............................................ 7
METHODOLOGY .............................................................................................................. 11 Primary Care Service Areas...................................................................................................... 11 The Variables Used in the AUHCN Calculation .......................................................................... 12 CATEGORY ONE: AVAILABILITY OF PROVIDERS ................................................................................... 13
1) TRAVEL TIME TO NEAREST PATIENT CENTERED PRIMARY CARE HOME (PCPCH) ...................................... 13 Figure 3. Service Areas Above Average Travel Time to Nearest PCPCH .................................. 14 2) PRIMARY CARE CAPACITY (PERCENT OF PRIMARY CARE VISITS ABLE TO BE MET) ..................................... 15 Figure 4. Service Areas Below Oregon’s Primary Care Capacity Ratio ..................................... 21 3) DENTISTS PER 1,000 POPULATION ................................................................................................... 18 Figure 5. Service Areas Below Oregon’s Dentist Per 1,000 Population Rate ........................... 21 4) MENTAL HEALTH PROVIDERS PER 1,000 POPULATION ........................................................................ 20 Figure 6. Service Areas Below Oregon’s Mental Health Provider Per 1,000 Population Rate. 19
CATEGORY TWO: ABILITY TO AFFORD CARE ....................................................................................... 22 5) PERCENT OF POPULATION BETWEEN 138% AND 200% OF THE FEDERAL POVERTY LEVEL (FPL) ................. 22 Figure 7. Service Areas Above Oregon’s 138% - 200% FPL Rate ............................................... 23
CATEGORY THREE: UTILIZATION ...................................................................................................... 24 6) INADEQUATE PRENATAL CARE RATE PER 1,000 BIRTHS ....................................................................... 24 Figure 8. Service Areas Above Oregon’s Inadequate Prenatal Care Rate Per 1,000 Births ...... 25 7) AMBULATORY CARE SENSITIVE CONDITIONS (ACSC)/PREVENTABLE HOSPITALIZATIONS PER 1,000
POPULATION ................................................................................................................................ 26 Figure 9. Service Areas Above Oregon’s ACSC Rate Per 1,000 Population ............................... 27 8) EMERGENCY DEPARTMENT NON-TRAUMATIC DENTAL VISITS PER 1,000 POPULATION ............................. 28 Figure 10. Service Areas Above Oregon’s Non-Traumatic Emergency Department Dental Visit Rate Per 1,000 Population .............................................................................................. 29 9) EMERGENCY DEPARTMENT MENTAL HEALTH/SUBSTANCE ABUSE VISITS PER 1,000 POPULATION .............. 30
Figure 11. Service areas Above Oregon’s Emergency Department Mental Health/Substance Abuse Visit Rate Per 1,000 Population ................................................................................... 32
TOTAL SCORES ........................................................................................................................... 33
We welcome your feedback. If you have any questions or suggestions about this report, please contact Emerson Ong at [email protected].
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WHAT IS CONSIDERED RURAL AND FRONTIER? The Oregon Office of Rural Health defines rural as all geographic areas in Oregon ten or more miles from the centroid of a population center of 40,000 people or more. Frontier counties are defined as those with six or fewer people per square mile. Ten of Oregon’s 36 counties are frontier.
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SUMMARY RESULTS
Overview Nine variables are used to calculate Unmet Need scores for each of Oregon’s 128 primary care service areas. The lowest and worst score possible is 0. The highest and best score possible is 90. A lower score means greater unmet need. For 2020, scores in Oregon ranged from 25 (worst) to 79 (best). In 2019, it ranged from 27 to 73.
Rural and frontier service areas have greater unmet need (lower scores) than urban areas:
The mean (average) score for Oregon overall is 49.3. Half of the 128 service areas fall below that score. The number of service areas by geographic type with scores below the Oregon average include:
Urban: 2 out of 24 (8%) Rural (without Frontier): 53 out of 86 (62%) Rural (including Frontier): 62 out of 104 (60%) Frontier: 9 out of 18 (50%)
Greatest Unmet Need Areas 2020 2019
Least Unmet Need Areas 2020 2019
Cascade Locks 25 28 Portland SW 79 n/a* East Klamath 27 32 Lake Oswego 71 72
Swisshome/ Triangle Lake
27 31 Portland NE 70 n/a*
Drain/Yoncalla 28 28 Tigard 70 71 Chiloquin 30 30 Bend 69 67 Glendale 30 30 Eugene/University 69 64
Port Orford 30 29 Hood River 69 70 Powers 30 27 Oregon City 69 64 Yachats 31 33 Sisters 69 69
Blodgett-Eddyville; Shady Cove;
Warm Springs
34 34 34
31 33 36
Beaverton; Corvallis/Philomath
68 68
63 66
*Portland service areas were reconfigured in 2020 so there is no comparison score for 2019
Mean (Average) Score by Geographic Area 2020 2019 2018 Oregon 49.3 49.2 46.2
Urban 62.1 60.7 58.0 Rural (without Frontier) 45.9 45.6 42.5
Rural (including Frontier) 46.4 46.3 43.3 Frontier 48.4 49.6 47.2
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Highlights
1. The average travel time in Oregon to the nearest Patient Centered Primary Care Home (PCPCH) is 12.6 minutes. Twenty-two rural and frontier service areas do not have a PCPCH and the drive times for these areas average 25 minutes. (Pages 13-14)
2. The estimated ratio of primary care visits able to be met by existing providers in Oregon is 1.19. Rural and frontier service areas have lower ratios (0.94), meaning there is greater demand than supply. Ten rural and frontier primary care service areas have zero primary care provider FTE. (Pages 15-17)
3. Oregon has 0.49 dentist patient care FTE per 1,000 people. The average in rural and frontier areas is 0.33 FTE. Twenty-four rural and frontier primary care service areas have zero dentist FTE. (Pages 18-19)
4. There are 1.19 mental health care provider FTE per 1,000 people in Oregon. The average in rural and frontier is less than half of that at 0.54 FTE. Twenty-one rural and frontier service areas have zero mental health provider FTE. (Pages 20-21)
5. The percentage of the population that is above the Medicaid cut off of 138% Federal Poverty Level (FPL) but still below 200% of the FPL (and therefore unlikely able to afford health insurance unless provided by an employer) is 11% in Oregon. Fossil (22%), Chiloquin (24%), North Lake (26%), and Blodgett-Eddyville (26%) have rates double that or more. (Pages 22-23)
6. Oregon’s five-year (2014-2018) average inadequate prenatal care rate is 59.6 per 1,000 births per year. The average rate in frontier service areas is 97.1. Yachats (185.2) and Warm Springs (196.5) have over triple the state rate. (Pages 24-25)
7. Oregon’s three-year (2017-2019) average preventable hospitalization rate is 7.3 per 1,000 people per year. Rural and frontier service areas average 9.0 per 1,000. Wallowa/Enterprise (20.6), Reedsport (21.3) and Powers (24.8) have nearly triple the state rate. (Pages 26-27)
8. Oregon has a three-year (2017-2019) average non-traumatic dental Emergency Department (ED) visit rate of 4.0 per 1,000 people per year. The rate in rural Oregon is 5.2 per 1,000. Eleven rural and frontier service areas have double the state rate, and Warm Springs (14.9) has over triple the state rate. (Pages 28-29)
9. Oregon has a three-year (2017-2019) average mental health/substance abuse ED visit rate of 17.8 per 1,000 people per year. This is the only variable where rural and frontier (16.4), on average, do better than urban areas (18.5). However, Reedsport (25.7), Seaside (28.2), and Coos Bay (28.4) still have very high rates, and Warm Springs (53.4) has triple the state rate. These numbers have also been increasing statewide for the past three years. ED visits for suicide and intentional self-inflicted injury have increased 45% from 2016 (8,047) to 2019 (11,673). (Pages 30-32)
10. Oregon has an average Unmet Need Score of 49.3 out of 90. All but two of the 64 service areas that score lower than this mean are either rural or frontier. (Page 33)
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Figure 1. Overall Unmet Need Scores By
Service Area
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Figure 2. Ranked Service Area Scores (Highest Unmet Need to Lowest) The worst score in each column is darkest red and the best score is darkest green with graduated shading for the numbers in between the best and worst.
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Cascade Locks Rural 25 23 0.00 0.00 0.00 19% 87.0 10.7 9.4 16.1 East Klamath Rural 27 35 0.00 0.00 0.00 13% 80.5 11.5 7.6 16.6 Swisshome/Triangle Lake Rural 27 28 0.00 0.00 0.09 19% 96.2 8.8 4.9 14.8 Drain/Yoncalla Rural 28 22 0.15 0.00 0.00 19% 79.6 10.9 6.9 13.4 Chiloquin Rural 30 32 0.58 0.13 0.01 24% 119.5 9.8 4.7 15.4 Glendale Rural 30 23 0.00 0.00 0.00 16% 107.5 8.7 4.7 13.8 Port Orford Rural 30 32 0.63 0.00 0.00 11% 136.4 13.0 7.4 13.7 Powers Rural 30 31 0.00 0.00 0.00 13% 21.3 24.8 3.7 17.4 Yachats Rural 31 12 0.00 0.06 0.07 7% 185.2 12.2 6.1 15.7 Blodgett-Eddyville Rural 34 13 0.00 0.00 0.49 26% 42.9 5.7 4.6 16.6 Shady Cove Rural 34 10 0.23 0.17 0.00 15% 122.6 14.4 6.0 18.5 Warm Springs Rural 34 10 1.39 0.49 0.34 14% 196.5 16.1 14.9 53.4 Arlington Frontier 35 26 0.73 0.00 0.00 11% 113.6 9.5 5.3 11.4 North Lake Frontier 35 10 0.06 0.00 0.36 26% 97.1 12.2 2.5 13.3 Reedsport Rural 35 10 1.07 0.17 0.11 16% 121.2 21.3 7.3 25.7 Merrill Rural 36 27 0.00 0.00 0.00 16% 66.0 8.0 2.5 5.5 Myrtle Creek Rural 36 10 0.29 0.00 0.13 15% 70.0 9.1 7.9 16.0 Veneta Rural 36 27 0.40 0.13 0.05 17% 65.3 9.5 2.9 11.8 Clatskanie Rural 38 10 0.08 0.37 0.07 15% 95.5 15.6 5.0 14.1 Coquille/Myrtle Point Rural 38 10 0.64 0.20 0.12 18% 80.2 17.6 6.8 19.1 Canyonville Rural 39 10 0.80 0.00 0.29 19% 85.3 11.0 6.4 18.5 Cave Junction Rural 39 10 0.58 0.05 0.13 13% 106.2 13.2 5.0 19.4 Rogue River Rural 39 10 0.33 0.17 0.09 13% 72.8 12.0 4.9 17.8 Siletz Rural 39 13 0.77 0.73 0.29 19% 70.9 12.1 9.6 19.9 Sweet Home Rural 39 10 0.32 0.10 0.14 16% 63.2 10.6 6.5 15.2 Cloverdale Rural 40 16 0.55 0.12 0.05 14% 41.9 8.3 3.4 15.1 Waldport Rural 40 10 0.58 0.11 0.41 15% 116.9 12.3 7.0 17.9 Elgin Rural 41 10 0.48 0.08 0.00 15% 63.5 10.7 6.8 7.6 Jordan Valley Frontier 41 77 0.00 0.00 0.00 17% 31.3 0.0 0.0 2.1 McKenzie/Blue River Rural 41 10 0.35 0.00 0.21 7% 125.0 14.2 5.5 13.7 Mill City/Gates Rural 41 10 0.61 0.14 0.16 15% 76.1 13.2 6.0 16.1 Vernonia Rural 41 36 0.33 0.22 0.00 8% 61.5 8.6 4.2 14.9
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Scio Rural 42 12 0.15 0.02 0.00 12% 54.9 5.1 4.0 9.7 Wemme Rural 42 20 0.28 0.20 0.00 14% 58.3 6.0 2.1 12.6 Estacada Rural 43 10 0.27 0.07 0.13 13% 65.3 6.8 4.1 12.7 Milton-Freewater Rural 43 17 0.14 0.22 0.06 17% 70.4 10.1 0.3 1.1 Toledo Rural 43 10 0.41 0.17 0.31 14% 41.2 8.9 9.2 15.8 Union Rural 43 10 0.21 0.05 0.03 13% 61.5 7.8 4.4 6.9 Alsea Rural 44 10 0.52 0.00 0.13 16% 82.0 9.7 1.9 8.6 Eagle Point Rural 44 10 0.28 0.15 0.28 17% 47.1 9.4 3.9 12.6 Glide Rural 44 10 0.30 0.13 0.03 11% 42.4 7.3 7.7 12.1 Irrigon Frontier 44 10 0.85 0.00 0.00 10% 113.7 8.1 4.1 13.6 Monroe Rural 44 10 0.36 0.00 0.19 16% 60.2 5.0 3.1 12.3 Tillamook Rural 44 10 1.14 0.35 0.59 17% 56.3 12.8 5.5 22.8 Condon Frontier 45 23 1.45 0.22 0.00 19% 138.9 6.6 0.7 7.5 Eugene West Urban 45 10 0.73 0.23 0.37 14% 70.5 10.1 5.7 24.6 Lowell/Dexter Rural 45 10 0.33 0.00 0.41 12% 43.7 12.3 4.7 13.2 Prineville Rural 45 10 0.72 0.19 0.46 17% 45.3 10.3 9.5 22.8 Cottage Grove Rural 46 10 0.70 0.25 0.49 13% 67.8 11.9 9.8 18.7 Oakridge Rural 46 10 0.71 0.00 0.31 9% 90.1 13.1 6.1 12.5 Sutherlin Rural 46 10 0.22 0.34 0.00 14% 37.1 8.7 5.9 15.1 Vale Frontier 46 10 0.39 0.13 0.00 15% 83.3 3.3 4.0 7.9 Winston Rural 46 10 0.54 0.22 0.35 13% 45.9 10.3 7.8 16.2 Bandon Rural 47 10 1.09 0.47 0.36 21% 55.1 16.3 6.3 16.6 Gold Beach Rural 47 10 1.63 0.19 0.48 16% 109.3 13.7 6.7 20.6 Harrisburg Rural 47 10 0.00 0.00 0.07 8% 49.5 6.1 3.8 10.2 Willamina Rural 47 10 0.46 0.29 0.25 12% 68.0 10.1 6.9 17.3 Fossil Frontier 48 10 0.55 0.32 0.00 22% 72.7 10.2 0.7 7.2 John Day Frontier 48 10 1.43 0.27 0.35 14% 96.2 13.5 5.1 14.3 Lakeview Frontier 48 10 1.45 0.37 0.14 12% 87.5 12.6 7.0 16.6 Madras Rural 48 10 1.04 0.22 0.68 13% 97.8 9.4 8.9 19.8 Phoenix/Talent Urban 48 10 0.42 0.13 0.35 10% 47.2 8.7 3.9 17.2 Applegate/Williams Rural 49 12 0.17 0.25 0.17 6% 82.2 7.7 3.2 12.6 Maupin Rural 49 10 0.58 0.11 0.23 15% 49.5 9.3 3.0 9.7 Oregon 49.3 12.6 1.19 0.49 1.19 11% 59.6 7.3 4.0 17.8 Coos Bay Rural 50 10 1.36 0.51 0.95 11% 72.9 15.4 8.5 28.4 Florence Rural 50 10 0.99 0.30 0.46 13% 94.1 11.7 5.3 16.0 La Pine Rural 50 10 0.68 0.34 0.24 15% 63.4 11.5 3.8 13.9
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Lincoln City Rural 50 10 1.09 0.31 0.71 16% 59.6 10.5 8.5 19.4 Molalla Rural 50 10 0.28 0.31 0.08 12% 50.9 6.6 3.1 13.3 Moro/Grass Valley Frontier 50 10 1.76 0.00 0.00 21% 0.0 6.6 4.6 10.8 Seaside Rural 50 10 1.05 0.29 0.66 15% 72.1 11.8 6.4 28.2 Dallas Rural 51 10 0.51 0.22 0.32 11% 48.7 6.6 5.8 14.1 Springfield Urban 51 10 1.66 0.35 0.40 14% 72.9 11.3 7.3 21.4 Baker City Frontier 52 10 1.06 0.39 1.05 15% 73.9 8.2 8.9 15.5 Halfway Frontier 52 10 0.54 0.00 0.41 18% 35.7 8.8 1.6 5.8 Nyssa Frontier 52 10 0.52 0.54 0.00 12% 136.6 3.3 2.7 10.5 Portland East Urban 52 10 1.02 0.53 0.65 14% 102.1 8.2 5.2 22.4 Boardman Frontier 53 10 0.90 0.18 0.41 14% 120.9 4.3 2.7 10.6 Brownsville Rural 53 10 0.10 0.25 0.31 12% 45.5 5.6 3.4 9.4 Burns Frontier 53 10 1.24 0.17 0.67 16% 59.3 9.0 4.5 13.6 Grants Pass Rural 53 10 1.21 0.46 0.67 14% 72.3 11.1 4.8 22.3 Hermiston Rural 53 10 1.20 0.38 0.30 15% 76.7 7.1 4.5 13.0 Junction City Rural 53 10 0.37 0.26 0.58 10% 56.2 9.4 4.4 12.1 Lebanon Rural 53 10 0.99 0.31 0.30 13% 38.5 9.9 5.4 18.6 Nehalem Rural 53 10 0.60 0.00 0.63 10% 65.0 9.5 2.4 10.6 Sandy Rural 53 10 0.28 0.18 0.24 9% 48.7 7.0 2.6 12.5 Stayton Rural 53 10 1.15 0.29 0.08 9% 42.1 9.5 6.4 13.9 Heppner Frontier 54 10 1.36 0.05 0.67 15% 43.5 12.6 3.1 8.3 Klamath Falls Rural 54 10 1.75 0.46 0.71 14% 75.8 9.7 7.6 21.7 Astoria Rural 55 10 1.43 0.52 1.01 14% 52.3 11.4 5.4 22.8 Woodburn Rural 55 10 0.69 0.22 0.34 16% 52.4 5.1 2.1 9.6 Gresham Urban 56 10 0.80 0.48 0.65 12% 74.6 6.9 4.2 18.2 Medford Urban 56 10 1.70 0.64 1.35 16% 61.8 10.3 5.6 24.2 Pendleton Rural 56 10 1.35 0.38 0.89 13% 86.1 7.6 4.4 15.6 St. Helens Rural 56 10 0.60 0.25 0.32 12% 58.5 8.2 1.8 12.1 Albany Urban 57 10 0.84 0.42 0.79 13% 41.3 5.1 5.1 15.9 McMinnville Rural 57 10 0.89 0.45 0.75 12% 50.1 8.7 5.9 19.9 Roseburg Rural 57 10 1.69 0.55 1.26 15% 35.2 7.9 7.6 22.8 Salem North Urban 57 10 0.72 0.39 0.49 14% 53.1 7.1 3.3 14.2 Brookings Rural 58 10 1.16 0.41 0.40 15% 75.3 6.7 1.4 10.4 La Grande Rural 58 10 1.89 0.49 0.83 13% 68.8 8.6 8.1 11.1 Milwaukie Urban 58 10 0.58 0.50 1.06 10% 55.7 6.9 4.6 20.5 Newport Rural 58 10 1.81 0.72 2.34 10% 59.0 9.8 9.3 22.3
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Ontario Frontier 58 10 1.99 0.64 0.81 14% 132.1 5.2 6.3 19.8 The Dalles Rural 58 10 1.64 0.44 1.00 13% 54.0 8.4 6.8 18.1 Wallowa/Enterprise Frontier 58 10 1.90 0.49 0.78 14% 36.8 20.6 3.2 12.5 Canby Rural 59 10 0.69 0.32 0.31 10% 53.7 5.6 2.6 10.8 Eugene South Urban 59 10 0.45 0.45 0.81 11% 70.9 6.4 2.8 12.6 Redmond Rural 59 10 0.71 0.46 0.66 11% 41.9 6.5 4.0 16.1 Salem South Urban 60 10 1.59 0.64 1.84 13% 60.4 8.0 4.3 19.6 Portland SE Urban 63 10 0.52 0.46 2.23 9% 42.5 4.9 2.1 16.9 Ashland Rural 64 10 1.48 0.52 1.87 10% 57.6 4.4 3.5 15.9 Portland North Urban 64 10 1.90 0.31 2.09 9% 56.4 6.5 3.3 19.9 Silverton/Mt. Angel Rural 64 10 1.54 0.16 0.48 7% 35.1 5.4 2.6 10.2 Portland NW Urban 65 10 1.34 0.48 2.02 5% 43.1 5.9 2.1 36.9 Hillsboro/Forest Grove Urban 66 10 1.38 0.51 0.91 10% 48.7 4.7 2.8 13.8 Newberg Rural 66 10 1.26 0.36 0.83 9% 31.5 5.1 3.4 14.5 Beaverton Urban 68 10 1.28 0.67 1.13 10% 45.6 4.3 1.7 14.7 Corvallis/Philomath Urban 68 10 1.60 0.43 1.70 10% 41.0 3.1 1.9 15.5 Bend Urban 69 10 1.46 0.60 1.69 9% 34.6 4.9 2.6 15.0 Eugene/University Urban 69 10 2.53 1.02 4.77 10% 66.5 7.8 3.9 25.9 Hood River Rural 69 10 1.93 0.82 1.19 12% 43.2 4.9 2.2 10.6 Oregon City Urban 69 10 2.38 0.72 1.52 8% 65.4 5.4 3.6 16.7 Sisters Rural 69 10 1.05 0.29 0.77 8% 18.4 4.4 1.2 11.4 Portland NE Urban 70 10 1.93 0.65 3.01 7% 45.4 6.1 2.7 19.2 Tigard Urban 70 10 1.17 0.70 1.01 8% 39.8 4.6 1.7 12.9 Lake Oswego Urban 71 10 0.74 0.70 1.44 6% 39.6 4.2 1.2 10.1 Portland SW Urban 79 10 2.72 1.08 5.70 7% 40.4 4.8 1.3 20.5
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METHODOLOGY Primary Care Service Areas In most of the United States, county geographies are relatively small and homogenous, so in these areas, county-level data is widely used to analyze local information. Many of Oregon’s 36 counties, however, are quite large and vary greatly in geography and population distribution. Thus, sub-county geographies needed to be developed to more accurately represent community use of health care services. Among the established small geographic boundaries, only postal ZIP Code areas follow transportation and market patterns. ZIP Codes are also linked to a large amount of demographic, socioeconomic and health utilization information. The Oregon Office of Rural Health, with the help of other state and local agencies, chose ZIP Codes to be the building blocks of sub-county service areas and grouped all of Oregon’s 470+ ZIP Codes into Oregon "Primary Care Service Areas" using the following criteria:1 1) Health resources are generally located within 30 minutes travel time. 2) Defined areas are not smaller than a single ZIP Code and ZIP Codes used are geographically
contiguous and/or follow main roads. 3) Defined areas contain a population of at least 800 to 1,000 or more people. 4) Defined areas constitute a "rational" medical trade or market area considering topography,
social and political boundaries, and travel patterns. 5) Additional considerations for service areas are boundaries that:
a) Are congruent with existing special taxing districts (e.g., health or hospital districts); and b) Include a population that has a local perception that it constitutes a "community of need"
for primary health care services, or demonstrates demographic or socioeconomic homogeneity. The population should be large enough (800-1000 or more) to be financially capable of supporting at least a single midlevel health care provider.
These areas are updated when necessary according to changes in population and health utilization. In 2020, the service areas in Portland were reconfigured to follow, as closely as possible, the widely accepted “quadrant” system. The resulting groupings of Portland NW, SW, SE, NE, North, and East, reduced the number of service areas in the city from eight to six. There are 128 Oregon Primary Care Service Areas: Urban: 24 | Rural + Frontier2: 104 | Rural Only: 86 | Frontier Only: 18 Six-page demographic, socioeconomic, and health status profiles for each of the rural and frontier service areas are updated continuously and available for free. A sample profile, and more information, are available here.
1 Van Eck, Ethan; Bennett, Marge et. al. Strategic Plan for Primary Health Care in Rural Oregon, 1985-1990. September 30, 1985. (Available through the Office of Rural Health). 2 Using the Oregon Office of Rural Health’s definition, rural is a geographic area 10 or more miles from the centroid of a city of 40,000 or more. The Bureau of Primary Health Care (BPHC) defines frontier as counties with six or fewer people per square mile.
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The Variables Used in the AUHCN Calculation To determine the measures described in this report, The Oregon Office of Rural Health researched academic publications and collected studies from other State Offices of Rural Health. These findings were presented to a stakeholder group with knowledge of health utilization, hospital data, primary care, dental, and mental health services (see list of individuals and members below). Data Limitations:
• Data points must be available at the ZIP Code geographic level • Data must be updated annually, at minimum • Data must be available to the Oregon Office of Rural Health
The following nine variables were determined to be the best currently available measures of access to primary care, dental and mental health services for all ages. More detail on the sources and methodology for each variable is included in the following pages. Category One: Availability of Providers—Are needed providers available locally? 1) Travel Time to Nearest Patient Centered Primary Care Home (PCPCH) 2) Primary Care Capacity (Percent of Primary Care Visits Able to Be Met) 3) Dentists per 1,000 Population 4) Mental Health Providers per 1,000 Population
Category Two: Ability to Afford Care—Can the local population afford health care? 5) Percent of Population Between 138% and 200% of Federal Poverty Level (FPL)
Category Three: Utilization—Are primary physical, mental and oral health care being used? 6) Inadequate Prenatal Care Rate per 1,000 Births 7) Ambulatory Care Sensitive Conditions (ACSC)/ Preventable Hospitalizations per 1,000
Population 8) Emergency Department Non-Traumatic Dental Visits per 1,000 Population 9) Emergency Department Mental Health/Substance Abuse Visits per 1,000 Population
The Oregon Office of Rural Health would like to thank the stakeholder group for their participation: Greater Oregon Behavioral Health, Inc. Oregon Association of Hospitals & Health Systems Paul McGinnis, CCO Integration Director Katie Harris, Director of Rural Health & Federal Polity
Andy Van Pelt, Executive Vice President Oregon Health Authority Oregon Health & Science University Jackie Fabrick, Behavioral Health Policy Analyst Eli Schwarz, Chair of Department of Community Marc Overbeck, Primary Care Office Director Dentistry Amanda Peden, Health Policy Analyst Jeffery Scroggin, Policy Analyst
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CATEGORY ONE: AVAILABILITY OF PROVIDERS
1) TRAVEL TIME TO NEAREST PATIENT CENTERED PRIMARY CARE HOME (PCPCH) Description: A Patient Centered Primary Care Home (PCPCH) is a health care clinic that has been officially recognized by the Oregon Health Authority (OHA) for providing high quality, patient-centered care. All PCPCHs must posess a minimum set of 11 criteria3. For this report, three criteria were considered good indicators of community access to primary care, and to prevent misuse of the emergency room. These include screening and referral for mental health and substance abuse, 24/7 access to live clinical advice by telephone, and ongoing management of chronic diseases. Data Source: Patient-Centered Primary Care Home Program, Oregon Health Authority (July 2020) Methodology: Google Maps was used to determine driving times from the largest town in the Primary Care Service Area to the town where the nearest PCPCH is located. Locations that already have a PCPCH in the largest town are defaulted to a drive time of 10 minutes. V1 = Drive time in minutes Results: Average drive time to the nearest PCPCH for all 128 Primary Care Service Areas in Oregon is 12.6 minutes, which is nearly the same as last year’s average of 12.4 minutes. Cloverdale and Veneta both lost a PCPCH since last year. Twenty-two service areas, all rural, do not have a PCPCH, and drive times average 25 minutes to the nearest PCPCH for these areas.
Travel Time to Nearest PCPCH in Minutes (lower is better) 2020 2019
Oregon 12.6 12.4 Urban 10 10
Rural (without Frontier) 12.8 12.5 Rural (including Frontier) 13.2 13
Frontier 15.3 15.3
Five Longest Travel Times to PCPCH in Minutes 2020
Jordan Valley 77 Vernonia 36
East Klamath 35 Chiloquin 32
Port Orford 32
3 2017 Recognition Criteria Technical Specifications and Reporting Guide: https://www.oregon.gov/oha/HPA/dsi-pcpch/Documents/TA-Guide.pdf
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Figure 3. Shaded Areas Are Above the Average Oregon Travel Time to Nearest PCPCH of 12.6 Minutes
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2) PRIMARY CARE CAPACITY (PERCENT OF PRIMARY CARE VISITS ABLE TO BE MET) Description: This measure compares the estimated number of visits that primary care providers in the service area should be able to supply, with the estimated primary care visits needed by the demographic breakdown of the local population. The primary care providers in this variable include general and family physicians, pediatricians, obstetrician-gynecologists, internists, primary care physician assistants (PA), and primary care nurse practitioners (NP). Data Sources: Estimated Primary Care Visits Provided: Patient care FTE for all the providers listed above are from Oregon Health Authority’s (OHA) Health Care Workforce Reporting Program Database: licensure surveys4 using both primary and secondary work locations. The physician/PA survey contains renewals from 6/2019 to 3/2020, and the NP survey includes 11/2017 to 1/2020. Only providers renewing their licenses are required to fill out the surveys, so first-time licensees are not included in the FTE count. Estimated number of visits provided per year by primary care specialty is the average between the 2018 Health Resources and Services Administration (HRSA) Federally Qualified Health Center (FQHC) National5 Staffing and Utilization numbers, and the Oregon6 Staffing and Utilization numbers. Estimated Primary Care Visits Needed: Annually adjusted rates from the National Ambulatory Medical Care Survey: State and National Summary Tables, National Center for Health Statistics (2016)7 Local population data: Claritas (2020) Methodology:
a) Estimated Number of Primary Care Visits Provided Per Year = ([FTE of General and family physicians] x 2511) + ([FTE of Pediatricians] x 2499) + ([FTE of Obstetrician-gynecologists] x 2101) + ([FTE of Internists] x 2086) + ([FTE of Primary care physician assistants] x 2195) + ([FTE of Primary care nurse practitioners] x 2114)
b) Estimated Number of Primary Care Visits Needed = 0.88 x (([Female Population 0-14] x 2.5) + ([Female Population 15-24] x 1.9) +
4 https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/Health-Care-Workforce-Reporting.aspx Data from the OHA’s Health Care Workforce Reporting Program Database was used to produce this product. Statements contained herein are solely those of the authors and the OHA assumes no responsibility for the accuracy and completeness of the analyses contained in the product. 5 https://bphc.hrsa.gov/uds/datacenter.aspx?q=t5&year=2018&state= 6 https://bphc.hrsa.gov/uds/datacenter.aspx?q=t5&year=2018&state=OR 7 https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2016_namcs_web_tables.pdf 8 All multipliers are from the National Ambulatory Medical Care Survey; which estimates visits to all types of physicians. Since primary care from all providers in rural areas accounts for 80% of those visits, the calculation here is multiplied by 0.8.
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([Female Population 25-44] x 2.8) + ([Female Population 45-64] x 3.4) + ([Female Population 65-74] x 4.7) + ([Female Population 75+] x 5.5) + ([Male Population 0-14] x 2.7) + ([Male Population 15-24] x 1.1) + ([Male Population 25-44] x 1.3) + ([Male Population 45-64] x 2.6) + ([Male Population 65-74] x 4.6) + ([Male Population 75+] x 5.4))
c) Estimated visits provided is divided by the estimated number of primary care visits needed. The final variable is a ratio of need being met, using the following formula: V2 = Estimated Visits Provided
Estimated Primary Care Visits Needed Results: The ratio of estimated primary care visits able to be met for the state of Oregon is 1.19. A ratio of 1.00 means that supply should be equal to demand, if access and affordability were equal for everyone. A lower ratio means more demand. A higher ratio means more supply. Rural and frontier service areas have a lower ratio of 0.94. There are 10 service areas, all rural, that do not have any primary care provider FTE, while the highest ratios are located in urban areas: Portland SW (2.7), Eugene/University (2.5), and Oregon City (2.4). Primary Care Service Areas with no primary care provider FTE: Blodgett-Eddyville, Cascade Locks, East Klamath, Glendale, Harrisburg, Jordan Valley, Merrill, Powers, Swisshome/Triangle Lake, and Yachats
Primary Care Capacity Ratio (higher is better) 2020 2019
Oregon 1.19 1.24 Urban 1.33 1.40
Rural (without Frontier) 0.92 0.93 Rural (including Frontier) 0.94 0.95
Frontier 1.26 1.37
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Figure 4. Shaded Areas Are Below Oregon’s Primary Care
Capacity Ratio of 1.19
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3) DENTISTS PER 1,000 POPULATION Description: Patient care FTE of local dentists compared to local population. Data Sources: Dentist patient care FTE: Oregon Health Authority’s Health Care Workforce Reporting Program: licensure survey (1/2018 to 1/2020) for both primary and secondary work locations. Only providers renewing their licenses are required to fill out the surveys, so first-time licensees are not included in the FTE count. Local population: Claritas (2020) Methodology: V3 = Dentist patient care FTE x 1,000 Local population Results: Oregon has 0.49 dentist patient care FTE per 1,000 people, which is unchanged from last year. Twenty-four primary care service areas (all rural or frontier) have no dentist FTE. The urban areas of Portland SW (1.08) and Eugene/University (1.02) have the highest numbers of dentists per 1,000 people. Primary Care Service Areas with no dentists: Alsea, Arlington, Blodgett-Eddyville, Canyonville, Cascade Locks, Drain/Yoncalla, East Klamath, Glendale, Halfway, Harrisburg, Irrigon, Jordan Valley, Lowell/Dexter, McKenzie/Blue River, Merrill, Monroe, Moro/Grass Valley, Myrtle Creek, Nehalem, North Lake, Oakridge, Port Orford, Powers, Swisshome/Triangle Lake
Dentists per 1,000 Population (higher is better) 2020 2019
Oregon 0.49 0.49 Urban 0.57 0.58
Rural (without Frontier) 0.33 0.33 Rural (including Frontier) 0.33 0.34
Frontier 0.35 0.39
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Figure 5. Shaded Areas Are Below Oregon’s Rate of 0.49
Dentist FTE Per 1,000 Population
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4) MENTAL HEALTH PROVIDERS PER 1,000 POPULATION Description: Count of all Psychiatrist FTE, Psychologist FTE, Licensed Professional Counselor/Marriage and Family Therapist FTE, Clinical Social Worker FTE, Psychiatric Nurse Practitioner FTE, and Psychiatric Physician Assistant FTE compared to the local population. Data Sources: All providers’ patient care FTE numbers are from Oregon Health Authority’s Health Care Workforce Reporting Program: licensure surveys for both primary and secondary work locations as follows: Psychiatrists and Psychiatric Physician Assistants (6/2019 to 3/2020) Psychologists (12/2018 to 1/2020) Licensed Professional Counselors/Marriage and Family Therapists (12/2018 to 1/2020) Clinical Social Workers (12/2017 to 1/2020) Psychiatric Nurse Practitioners (11/2017 to 1/2020) Only providers renewing their licenses are required to fill out the surveys, so first-time licensees are not included in the FTE count. Local population data: Claritas (2020) Methodology: V4 = Sum of mental health provider FTE x 1000 Local population Results: There are 1.19 mental health provider FTE per 1,000 people in Oregon. Twenty-one of 128 service areas (all rural or frontier) have no mental health providers. The highest FTE per 1,000 are in the urban areas of Portland SW (5.7), Eugene/University (4.8) and Portland NE (3.0). Primary Care Service Areas with no mental health providers: Arlington, Cascade Locks, Condon, Drain/Yoncalla, East Klamath, Elgin, Fossil, Glendale, Irrigon, Jordan Valley, Merrill, Moro/Grass Valley, Nyssa, Port Orford, Powers, Scio, Shady Cove, Sutherlin, Vale, Vernonia, and Wemme
Mental Health Providers per 1,000 Population (higher is better) 2020 2019
Oregon 1.19 1.19 Urban 1.54 1.53
Rural (without Frontier) 0.54 0.55 Rural (including Frontier) 0.54 0.54
Frontier 0.51 0.50
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Figure 6. Shaded Areas Are Below Oregon’s Rate of 1.19 Mental
Health Provider FTE per 1,000 Population
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CATEGORY TWO: ABILITY TO AFFORD CARE
5) PERCENT OF POPULATION BETWEEN 138% AND 200% OF THE FEDERAL POVERTY LEVEL Description: The percentage of the local population that is above the Medicaid cutoff of 138% of Federal Poverty Level (FPL), but still too poor to afford health insurance on their own (unless health insurance is provided by their employer). Data Source: American Community Survey (2014-2018)9 Methodology: V5 = 200% FPL – 138% FPL Results: Approximately 11% of Oregonians are between 138% and 200% of the Federal Poverty Level. The rate ranges from a low of 5% in Portland NW and 6% in Lake Oswego, to over a quarter of the population in North Lake and Blodgett-Eddyville.
Percent 138-200% Federal Poverty Level (lower is better) 2020 2019
Oregon 11% 12% Urban 11% 11%
Rural (without Frontier) 13% 13% Rural (including Frontier) 13% 13%
Frontier 15% 14%
Five Highest 138-200% Federal Poverty Level Rates 2020
Blodgett-Eddyville 26% North Lake 26%
Chiloquin 24% Fossil 22%
Bandon 21% Moro/Grass Valley 21%
9 Because American Community Survey data is based on samples, they are subject to a margin of error, particularly in places with a low population, and are best regarded as estimates.
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Figure 7. Shaded Areas Are Above Oregon’s 138% - 200% Federal
Poverty Level Rate of 11%
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CATEGORY THREE: UTILIZATION
6) INADEQUATE PRENATAL CARE RATE PER 1,000 BIRTHS Description: In Oregon, inadequate prenatal care is defined as care that did not begin until the third trimester, or consisted of fewer than five prenatal visits. This is a good indicator of how often required primary care is utilized, as inadequate prenatal care results in higher rates of low-birthweight babies.10 Data Sources: Most recent five years (2014-2018) of inadequate prenatal care data by ZIP Code from Oregon Health Authority Center for Health Statistics. Methodology: V6 = 5 years of inadequate prenatal care births x 1000 5 years of total births Results: For years 2014-2018, Oregon’s average inadequate prenatal care rate was 59.6 per 1,000 births per year, compared to 58.1 for years 2013-2017. Moro/Grass Valley and Jordan Valley show no instances of inadequate prenatal care in the last five years, likely because of the few births that occurred (11 per year average in Moro/Grass Valley, and six per year average in Jordan Valley). Yachats (185.2) and Warm Springs (196.5) have inadequate prenatal care rates over three times the state average.
Inadequate Prenatal Care per 1,000 Births (lower is better) 2020 2019
Oregon 59.6 58.1 Urban 57.5 55.7
Rural (without Frontier) 60.4 59.4 Rural (including Frontier) 62.9 62.2
Frontier 97.1 98.1
Five Highest Inadequate Prenatal Care Rates 2020 2019 Warm Springs 196.5 167.1
Yachats 185.2 140.4 Condon 138.9 105.3
Nyssa 136.6 139.2 Port Orford 136.4 157.9
10 Oregon Vital Statistics Report 2017, Volume 1. Oregon Health Authority, Public Health Division. 2-10 https://www.oregon.gov/oha/PH/BIRTHDEATHCERTIFICATES/VITALSTATISTICS/ANNUALREPORTS/VOLUME1/Documents/2017/Chapter2Narrative.pdf
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Figure 8. Shaded Areas Are Above Oregon’s Inadequate Prenatal
Care Rate of 59.6 per 1000 Births
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7) AMBULATORY CARE SENSITIVE CONDITIONS/PREVENTABLE HOSPITALIZATIONS PER 1,000 Description: Ambulatory Care Sensitive Conditions (ACSC), also known as preventable hospitalizations, are a set of inpatient discharges that may have been preventable had they been treated with timely and effective primary care. These include common conditions such as asthma, diabetes, hypertension, and pneumonia. Data Sources: All Oregon (2017-2019) and Washington (2016-2018) hospital inpatient discharges for the latest three full calendar years from Apprise Health Insights. Primary diagnoses filtered using the ACSC ICD-10 codes introduced and updated by John Billings.11-12 Local population: Claritas (2020) Methodology: V7 = 3 Years of ACSC Discharges/ 3 x 1000 Local population Results: Oregon has an average ACSC rate of 7.3 per 1,000 people per year, compared to last year’s rate of 7.8. Because only Oregon and Washington hospital data are collected, Oregon residents who go to a hospital in another state are not counted in this calculation. For a few communities near the Oregon border where the closest hospital is in Idaho or California, this means that their total hospital usage is not being captured, and their ACSC rate is most likely higher than reported here. This affects places such as Jordan Valley (0.0)—the lowest result—and Brookings (6.7). While places such as Powers (24.8) and Wallowa/Enterprise (20.6) continue to have high ACSC rates, the number of preventable hospitalizations in Oregon hospitals overall has been declining for the past three years: 2016: 34,525 | 2017: 32,118 | 2018: 30,527 | 2019: 28,739
ACSC per 1,000 (lower is better) 2020 2019 Oregon 7.3 7.8
Urban 6.4 6.8 Rural (without Frontier) 9.0 9.7
Rural (including Frontier) 9.0 9.7 Frontier 8.7 9.5
Five Highest ACSC Rates 2020 2019
Powers 24.8 22.7 Reedsport 21.3 19.9
Wallowa/Enterprise 20.6 21.1 Coquille/Myrtle Point 17.6 17.1
Bandon 16.3 15.0
11 Introduced: Billings J., Zeitel L., Lukomnik J., et al. Impact of socioeconomic status on hospital use in New York City. Health Affairs (Spring 1993): 162-173. 12 Updated ICD-10 list available at: https://wagner.nyu.edu/faculty/billings/acs-algorithm
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Figure 9. Shaded Areas Are Above Oregon’s Ambulatory Care
Sensitive Conditions (ACSC) Rate of 7.3 per 1000 Population
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8) EMERGENCY DEPARTMENT NON-TRAUMATIC DENTAL VISITS PER 1,000 POPULATION Description: Visits to the Emergency Department (ED) with a principal diagnosis of dental problems that are not a result of trauma. Visits to the ED for non-traumatic oral health conditions are often the result of limited access to a primary dental provider.13 Often these visits result in opioid and antibiotic prescriptions, rather than definitive dental care.14 Data Sources: All Oregon hospital inpatient and outpatient ED visits for the latest three calendar years (2017-2019) from Apprise Health Insights. Principal diagnoses are filtered using the non-traumatic dental codes from the published article: “Emergency Department Visits for Non traumatic Dental Problems: A Mixed-Methods Study.”15 ICD-9 codes used in the study were updated to ICD-10. Local population: Claritas (2020) Methodology: V8 = 3 Years of Non-Traumatic Dental ED Visits/ 3 x 1000 Local Population Results: Oregon has an average non-traumatic dental ED visit rate of 4.0 per 1,000 per year, compared to 4.3 last year. Because only Oregon hospital data is collected, Oregon residents who go to a hospital in another state are not counted in this calculation. For a few communities near the Oregon border where the closest hospital is in an adjacent state, this means that their total hospital usage is not being captured, and is most likely higher than reported here. This applies to places such as Jordan Valley (0.0), Milton-Freewater (0.3)—the two best results—and Brookings (1.4). The number of statewide non-traumatic dental visits to the ED has been declining for the past three years: 2016: 19,926 | 2017: 17,857 | 2018: 17,205 | 2019: 16,130
ED Dental Visits per 1,000 (lower is better) 2020 2019 Oregon 4.0 4.3
Urban 3.4 3.7 Rural (without Frontier) 5.2 5.6
Rural (including Frontier) 5.2 5.6 Frontier 5.2 5.1
Five Highest ED Dental Visit Rates 2020 2019
Warm Springs 14.9 18.1 Cottage Grove 9.8 10.8
Siletz 9.6 9.5 Prineville 9.5 9.6
Cascade Locks 9.4 9.4 13 Sun BC, Chi DL, Schwarz E, et al. Emergency Department Visits for Non traumatic Dental Problems: A Mixed-Methods Study. American Journal of Public Health. 2015;105(5):947-955. doi:10.2105/AJPH.2014.302398. 14 Ibid. 15 Ibid.
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Figure 10. Shaded Areas Are Above Oregon’s Non-Traumatic Emergency
Dept Dental Visit Rate of 4.0 Per 1,000 Population
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9) EMERGENCY DEPARTMENT MENTAL HEALTH/SUBSTANCE ABUSE VISITS PER 1,000 POPULATION Description: Visits to the Emergency Department (ED) with a principal diagnosis of mood disorders, anxiety disorders, alcohol, drug use, schizophrenia and other psychoses, suicide attempts and suicidal ideations. Visits to the ED for Mental Health/Substance Abuse (MHSA) conditions are potentially preventable with adequate primary care.16 They are more than twice as likely to result in a hospital admission17, and the increasing rate of MHSA ED visits in the past few years is highest among low-income populations.18 In the Mental Health America 2020 survey, Oregon has the highest prevalence of mental illness of all 50 states.19 Data Sources: All Oregon hospital inpatient and outpatient ED visits for the latest three calendar years (2017-2019) from Apprise Health Insights. Principal diagnoses are filtered for the top six Clinical Classification Software (CCS) diagnosis groups used in the article “Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, 2007.”20 (CCS 651, 657, 659, 660, 661, 662) Local population: Claritas (2020) Methodology: V9 = 3 Years of ED Mental Health/Substance Abuse Visits/ 3 x 1000 Local Population Results: Oregon’s current average mental health/substance abuse ED visit rate is 17.8 per 1,000 population per year, compared to the 2019 rate of 17.5. This is the only variable where rural areas as a whole perform better than urban areas, although the worst performing service area, Warm Springs (53.4), has triple the state’s rate. Only Oregon hospital data is collected, so Oregon residents who go to hospitals in other states are not counted in this calculation. For a few communities near the Oregon border where the closest hospital is in an adjacent state, this means that only part of their hospital usage is captured, and is most likely higher than reported here. This applies to places like Milton-Freewater (1.1), Jordan Valley (2.1)—the two best results—and Brookings (10.4).
16 Rockett IRH, Putnam SL, Jia H, Chang C, Smith GS. Unmet substance abuse treatment need, health services utilization, and cost: a population-based emergency department study. Annals of Emergency Medicine. 2005; 45(2):118–27. 17 Owens PL, Mutter R, Stocks C. Mental Health and Substance Abuse-Related Emergency Department Visits Among Adults, 2007. HCUP Statistical Brief #92. July 2010. Agency for Healthcare Research and Quality, Rockville, MD. 18 Weiss AJ, Barrett ML, Heslin KC, Stocks C. Trends in Emergency Department Visits Involving Mental and Substance Use Disorders, 2006–2013. HCUP Statistical Brief #216. 2016. Agency for Healthcare Research and Quality, Rockville, MD. 19 https://mhanational.org/issues/mental-health-america-prevalence-data 20 Owens PL, et al. Mental Health and Substance Abuse-Related Emergency Department Visits Among Adults, 2007.
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The number of statewide outpatient mental health/substance abuse visits to the ED has been increasing for the past three years:
2016: 64,003 2017: 65,582 2018: 69,633 2019: 70,685
The number of outpatient ED visits for the ICD-10 diagnosis code for Suicidal Ideation alone (R45.851) has more than doubled from 2016 to 2019:
2016: 3259 2017: 4774 2018: 6401 2019: 6601
ED MHSA Visits per 1,000
(lower is better) 2020 2019 Oregon 17.8 17.5
Urban 18.5 18.2 Rural (without Frontier) 16.6 16.5
Rural (including Frontier) 16.4 16.3 Frontier 14.0 13.1
Five Highest ED MHSA Rates 2020 2019
Warm Springs 53.4 59.3 Portland NW 36.9 n/a
Coos Bay 28.4 30.0 Seaside 28.2 28.7
Eugene/University 25.9 24.4
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Figure 11. Shaded Areas Are Above Oregon’s Emergency Dept Mental
Health/Substance Abuse Visit Rate of 17.8 Per 1,000 Population
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TOTAL SCORES
Methodology: A score of between 0 (worst) and 10 (best) is calculated for each of the variables, depending on the variances of the lowest and highest numbers from the mean. The scores are added together to produce a final Unmet Need Total Score: V1 + V2 + V3 + V4 + V5 + V6 + V7 + V8 + V9 = Unmet Need Total Score (0 to 90) Results: The highest scoring primary care service area is Portland SW (79 out of 90), and the highest scoring rural service area is Sisters (69). Cascade Locks has the lowest score of 25, followed by Swisshome/Triangle Lake, with 27. Rural and frontier areas comprise all but two of the 64 service areas that fall below the mean score of 49.3 for the state. Only three of the 15 highest scoring service areas are rural. See the full list of scores starting on page 7 of this report. While it is encouraging to see that Preventable Hospitalizations and Non-Traumatic Dental ED Visits are declining statewide year over year (perhaps due to Oregon’s health system transformation), the continued increase of ED Visits due to mental health and substance abuse issues is a cause for concern. One caveat about the ranking is that all three of the hospital utilization variables (ACSC, ED Dental, and ED Mental) utilize data from Oregon and Washington hospitals only (ACSC), or Oregon hospitals only (ED Dental and Mental). Three rural service areas—Brookings (58), Jordan Valley (41), and Milton-Freewater (43)—mainly use hospitals that are located in adjacent states. As a result, their visit numbers for these variables are incomplete and may give the impression that these communities have better access to and utilization of health care services than they actually do. Their total scores and rankings should be interpreted with this in mind.
Mean (Average) Score by Geographic Area 2020 2019 Oregon 49.3 49.2
Urban 62.1 60.7 Rural (without Frontier) 45.9 45.6
Rural (including Frontier) 46.4 46.3 Frontier 48.4 49.6
Top 10 Areas With the Lowest Total Scores 2020 2019
Cascade Locks 25 28 East Klamath 27 32
Swisshome/Triangle Lake 27 31 Drain/Yoncalla 28 28
Chiloquin 30 30 Glendale 30 30
Port Orford 30 29 Powers 30 27 Yachats 31 33
Blodgett-Eddyville; Shady Cove;
Warm Springs
34 34 34
31 33 36
