madison county Health Care Profile
The cost for medical care services was consistently cited as the highest rated health care concern, by survey respondents in Madison County. Over seventy percent of Madison County respondents cited money needed for prescriptions as a major issue for the region. Over 67% of survey participants selected money for emergency medical care as a major issue, while 64.67% of respondents selected money for ongoing medical care, as major health care issues.
The relatively large percentage of Madison County residents who do not have health insurance is likely related to Madison County respondents' concerns over the cost of medical care services.
According to the Arkansas Department of Health (2002), 29.8% of Madison County residents do not have health insurance. This finding places Madison County 2 nd out of 75 counties in Arkansas , in terms of the percentage of residents who are without health care insurance. While survey respondents were able to accurately cite the significance of medical care costs as a major health care concern in their county, a multivariate analysis of salient demographic and sociocultural variables is needed in order to understand the reasons why such a high percentage of Madison County residents are without health care insurance. While there is suggestive evidence that the median household income of $27,855 per year (US Census Bureau, 2000), rather than the current rate of unemployment of 3.2%, (Arkansas Democrat Gazette, July 18, 2004), may be a contributing factor to the high percentage of Madison County residents who do not have health care insurance, the interrelationship of other factors (e.g. , rural nature of the county, unavailability of health care services, attitudes towards health care, types of businesses and services within the county, size of the workforce, etc. ), may also contribute to this problem. Further research is needed to better understand the factors that are associated with the high percentage of Madison County residents who do not have health insurance.
Madison County is predominately a rural county. According to the Arkansas Fact Finder (2000), 100% of Madison County 's population is considered to be rural. Given the rural nature of the county, the availability of basic health care services is somewhat limited. Madison County has only 4.2 primary care physicians per 10,000 population (Arkansas Department of Health, 2002). This finding places Madison County 9 th out of 75 counties in Arkansas , in terms of the fewest primary care physicians per population. Madison County also has limited access to medical specialty services and hospital services. It is therefore not surprising that 75.56% of Madison County survey respondents rated access to health care services as the most significant health care problem within their community. Similarly, 47.02% of the county's respondents selected access to tests and diagnostics as a major issue, while 43.2% of the survey participants selected adequate and timely access to physician services as a significant barrier in successfully accessing basic health care services. Employed survey respondents, as compared to unemployed adults, acknowledged somewhat greater concern over access to health care clinics, access to transportation and the availability of affordable and adequate assisted living facilities for the elderly.
Sixty-four and a half percent of Madison County respondents selected cancer as a major issue for the county, while 57.4% of survey participants identified cigarette smoking and/or second hand smoke as a major concern. Fifty-seven percent of the county's respondents selected weight problems, as a major physical health problem. While heart disease is the leading cause of death in Madison County (Arkansas Department of Health, 2002), deaths from cancer constitutes the second leading cause of death in the county (Arkansas Department of Health, 2002). It is of interest that while the overall rate of heart disease is declining in Madison County , the cancer rate is increasing (Arkansas Department of Health, 2002). While the reasons for the increasing rate of cancer in Madison County is not entirely clear, a number of different factors may be contributing to this phenomenon. Madison County has a high percentage of adults, aged 18 and older, who are smokers. Nearly 1 out of 3 adults residing in Madison County are smokers, (Arkansas Department of Health, 2002). Madison County is ranked 5 th out of 75 counties in Arkansas , in terms of the percentage of adults that smoke. In addition, 60.2% of adults in Madison County are considered to be obese, as measured by their Body Mass Index, (Arkansas Department of Health, 2002). Smoking and obesity are considered to be behavioral risk factors that are associated with the number of diseases, including; heart disease, cancer, diabetes, and hypertension. It therefore, appears reasonable to assume that the behavioral risk profile observed within Madison County , in combination with other factors, is likely contributing to the rising incidence of cancer cases within the county. These trends have been clearly noted by survey participants, as evidenced by their top rated responses to the physical health care items within the Health Needs Assessment Survey.
Middle age, race, household income, educational level, and insurance status all proved to be salient factors affecting Madison County respondent's perceptions of physical health care issues. More specifically, being 45-64 years of age, Caucasian, having an annual income between $29,000-$99,000, having at least some college education, having health insurance coverage all proved to influence the county respondents' choices. While it is beyond the scope of this current study, it would be of considerable interest to determine how these demographic variables contribute to the manner in which Madison County residents perceive and utilize health care services.
Just over 68% of Madison County respondents ranked substance abuse as a major concern, while 56.7% of the county's respondents ranked available and affordable substance abuse services as a major issue. Nearly 46% of survey participants ranked alcoholism as a major problem. While prevalence rates for substance abuse and alcoholism are not available for Madison County , the dramatic increase in methamphetamine abuse and other illicit substance, is a well-documented phenomenon in Northwest Arkansas. Survey respondents in Madison County clearly noted the significance of the perceived substance abuse and alcohol problem within their community. They also noted the need for available and affordable alcohol and substance abuse treatment facilities within their community. Compared to older adults (65 or older), younger and middle aged adults (18-64 years of age) were significantly more concerned about the problems related to substance abuse and alcohol, as well as the need for treatment facilities designed to treat these conditions. Indeed, substance abuse was the health care concern most frequently reported as being problematic, as compared to all of the other physical and mental health care items included in the survey. Surveyed respondents within Madison County have clearly identified concerns about substance abuse and the need for substance abuse treatment programs as a major health challenge within their community.
Just over 50% of Madison County respondents ranked cultural and/or language barriers to accessing health care services as a major multicultural health care issue. Slightly more than 31% of survey participants ranked access to affordable and available health care services as a major multicultural health care concern. While Madison County 's multicultural population is relatively small (5% of the total population, as cited by the Arkansas Department of Health), 42% of Arkansas ' Hispanic population resides within Northwest Arkansas , making Hispanics/Latinos the largest multicultural group in the region.
According to the Arkansas Democrat Gazette (Arkansas Democrat Gazette, July, 24, 2004). only North Carolina is experiencing a faster rate of growth for its' Hispanic residents, than Arkansas. Noting the rapid increase of multicultural residents within Northwest Arkansas (particularly of Hispanic descent), survey respondents within Madison County have clearly signified the need for health care services that are culturally and linguistically sensitive, accessible, and affordable for the county's multicultural population. The age of the survey respondent, their socioeconomic status and educational levels, also affected Madison County residents' perceptions in regard to multicultural health care issues.