Many Oregon children face a combination of serious illness plus family or other social problems, such as parental incarceration, domestic violence, mental illness or drug and alcohol abuse, says a new study that will be presented to the Oregon Health Policy Board on Tuesday.
The combination of what experts call “medical complexity” – serious health problems – and “social complexity” – serious social setbacks – is summed up as “health complexity,” in the report by Dana Hargunani, the Oregon Health Authority’s chief medical officer.
The study said the findings intensify the need to focus on the “social determinants of health,” in addition to the provision of specific health care services.
Medical experts increasingly have warned that social factors play a big role in either exacerbating or lessening medical problems, and that simply providing health care services isn’t a viable strategy for improving overall health.
Virtually all Oregon children are covered by health insurance plans, either through their parents’ insurance or through the Oregon Health Plan, Oregon’s Medicaid system, which covers all children who are not on commercial insurance.
The study found that of the roughly 391,000 publicly insured children statewide, 6 percent, or nearly 24,000, had “complex chronic disease,” and 18 percent, or nearly 72,000 had “non-complex chronic disease.”
The study also found that many tens of thousands of Oregon children were subject to “social complexity” problems. These range from “poverty,” to parental death or incarceration to “limited English proficiency.”
The study found that of the publicly insured children in the state, nearly 41 percent were in poverty, 33 percent had received mental health services, 13 percent were in foster care, 29 percent had a parent who was receiving substance abuse treatment, 21 percent were in a family with limited English proficiency, and 19 percent had a parent who was incarcerated.
The study found that of the children on public health insurance, only 19 percent had no “social complexity” factors. Large numbers of children had one or two “social complexity” factors, and 39 percent – or 152,000 children - had three or more such factors.
There were 256 children who had a total of 10 or 11 social complexity factors.
The study will help the Oregon Health Authority work more closely with local health agencies, including coordinated care organizations, which administer the Oregon Health Plan, to “serve children with health complexity,” the OHA said.
Also, the study highlights that health advocates need to continue exploring “value-based payment models,” in which care providers are paid for overall improvement in a patient’s health, instead of for the provision of specific health care services.
The health board meeting runs 8:30 a.m. to noon, at the Portland State Office Building, 800 NE Oregon St., Portland.
The meetings are livestreamed. For more information, including the “health complexity” report, visit the board's webpage.
Christian Wihtol can be reached at [email protected].