Healthcare Case Study Schuylkill County, PA County Overview - Schuylkill County, Pennsylvania is located in the heart of the anthracite Coal region of Pennsylvania where the Schuylkill River originates. Pottsville is the county seat, and the county showed a population of just under 150,000 as of 2010 with a density of 190 persons per square mile. The total area of the county is 782 square miles, almost all land, less than 1/2 a per cent water. The county's history, likely due to large coal deposits, focused on the railroad and industrialization (Schuylkill Chamber of Commerce, 2011).

The county experienced the high point of its population during the 1920s and 1930s, and has been losing people ever since, most between 1950 and 1970, with about a 1-2% population loss since the turn of the century. This is likely due to the lack of appropriate jobs and opportunities within the county. Schuylkill County is one of the most heavily Lithuanian parts of the United States, but also had a number of Austrian, German and Polish immigrants during the early part of the 20th century, brought to the area with mining opportunities. Politically, Republicans have a slight edge (48% to 43%) (Election Statistics, 2010). Pottsville is the only city in the county, with 30 boroughs, and 36 townships. Partially due to the continual decline in population, the county has partnered with VISION, a non-profit organization that is based in Pottsville and dedicated to improving the quality of life in the county by partnering with other organizations that focus on modern concerns and community development -- typically in more of a strategic partnership paradigm (VISION - Strategic Plan, 2011)

Figure 1 -- Basic Demographic Overview of Schuylkill County, PA (U.S. average data listed for comparison only):

Component

Schuylkill County

U.S. Average

Household Size

2.29

2.60

Average Family Size

2.81

3.19

In labor force (over 16)

57.4

65

Median HH income

41,315

51,425

Per Capita Income (2009 adj.)

21,309

27,041

Individuals below poverty level

12%

13.5%

Median Age

42.6

36.5

Caucasian

95.3%

74.5%

Non-Caucasian

4.7%

25.5%

Owner Occupied Homes

77%

67%

Seniors 65 years and older

18.4%

12.5%

Figure 2 -- Demographic Statistics -- The County is not very diverse in terms of ethnicity, it is almost entirely Caucasian. This is quite different than the U.S. national average, and is also different than most of the major urban areas on the Eastern Seaboard. This preponderance of White middle class citizens has ramifications within the healthcare market. Income levels combined with expectations from historical trends, a somewhat depressed economy, and an area that is slowly losing population means that the healthcare market is growing in need as the population ages, but not necessarily in technology and size as income and economic indicators move downward. This mix also changes the level of services needed (continuing to trend towards more geriatric care, more cardio-pulmonary issues, diabetes, obesity control, etc.), but also the quality of those services and whether the area can attract certain types of physicians. That the income ranges seem lower than U.S. averages should not be too alarming, though. As a percentage, cost of living expenses in the county are less than in the major urban areas. We can also see some trends in issues involving education in the area, since as a community, less than 20 precent of the population has received a BA degree or above.

The county boasts a 71 precent religious affiliation as compared to 48 precent nationally. The primary religious affiliation is Catholic, 42 precent, double the national average. Eleven precent re Lutheran, and 12 precent other Christian, with the rest a small mix of protestant faiths. There is very little violent crime and property crime, 1/2 of the national average. Cost of living is 13 points below the national average, with food and utilities just slightly above. Overall, it costs about 13 precent less to live in the county. The unemployment rate is a bit higher than the national average, 9.6 precent compared to 9.1, and recent job growth is at a 2 precent loss. Income levels present some challenges, but as the chart below shows, it is not too far from the average American middle class (Schuylkill County, 2010):

The Schuylkill healthcare system is composed of two man medical centers located in Pottsville, four additional dental and other health clinics. The services are designed not just as medical centers, but as resource areas and educational facilities. In fact, in 2011 there have been several awards and national recognitions for the centers:

June 2011 -- a new Paediatric program with ties to the Children's hospital in Danvile announced a paediatric hospitalist who will dedicate their practice solely to treating children in a hospital setting -- from the ER through maternity and up to adolescence.

June 2011 -- The National League for Nursing Accrediting recognized the Schuylkill Health School of Nursing in Pottsville as a full-fledged member.

May 2011 -- The American Heart Association awarded the Schuylkill Medical Centers with Silver Performance Awards in heart disease prevention.

February 2011 -- The Schuylkill Rehabilitation Center was recognized nationally for its excellence in Physical Rehab Programs (Press Releases and Awards,...

There are a number of parks and recreational areas for activity, a fairly strong regional sport and recreation presence, and transportation services that include a small general aviation airport, a Trailways/Greyhound Bus Terminal, intercity bus service, but no rail service into Philadelphia or other major cities. There are two major highways that converge on Pottsville, PA Rout 61 and U.S. Rout 209. Educationally, there is a School of Business and Technology, a Satellite Campus of Alvernia University, and Penn State Schuylkill located quite near in Schuylkill Haven (Comprehensive Plan, 2010)
Like many cities of the same relative age and location, Pottsville's housing is a diverse mix of owner-occupied and rental units. The City (and County's) neighborhoods range from densely populated, heavily urbanized locations near the downtown corridor to stately mansions and suburban, low-density housing. Home ownership is consistent within the area, and no large scale conversion effort seems in place. However, the advanced age and condition of the housing units are a major challenge. About 60% of single family homes were build prior to 1940, and even though they were well constructed, they are nearing 70 plus years of age and have some deterioration. More often, certain micro-neighborhoods with housing issues are endemic with more of the modern social problems of substance abuse, unemployment, and violence. Subsidized housing accounts for about 13% of Pottsville's total housing stock. However, the City and County are well aware that there is a need to revitalize the neighborhoods in the areas. The City offers Block Grants up to $7,500 per home and there is HUD Home program funds up to $25,000 per year that are designed for larger projects that benefit more than a single family. The City has set some rather unique and optimistic goals trying to bring more funds, new home buyers, and professionals into the area:

Attract more market rate, owner-occupied housing construction.

Stabilize the housing stock of marginal, "borderline" neighborhoods.

Reduce blight and disinvestment in declining neighborhoods.

Ensure that municipal services fully complement the City's housing-related initiatives (Comprehensive Plan).

We have established some of the demographic and psychographic similarities and differences between Schuylkill County and the median data from the United States. Now, we will look in a more detailed manner at the major health issues within the county, and how they effect the population and are being mitigated by healthcare professionals. Some of the highlights of a specific healthcare overview are:

Natality and Prengnacy -- Crude birth rate is 10.6/1,000 with 13.3% receiving prenatal care and 8.7 having low weight at birth. The fertility rate is 60.1 and the percentage of birth to mothers under 18 years of age is 2.7. To contrast, in Philadelphia almost 40% of babies require prenatal care, and mothers under 18 jumps to about 8%.

Morbitidy -- Reported incidences per 100,000 of population; higher than average rate of Sexually Transmitted Diseases in the area, at least when dealing with national average.

Disease

Schuylkill

AIDS

27; Rate 6.1

Chlamydia

501; Rate 113.4

Gonorrhea

42; Rate 9.5

Hepatitis B (Chronic)

27; Rate 6.1

Varicella

43; Rate 9.7

Cancer -- In most areas of the country, cancer and heart disease are the top killers, table below shows incidence of cancer in county, rate, and % of population affected:

Type

Total

Rate

Percentile

All Types

2%

Prostate

.27

Breast (F)

.22

Lung

.18

Colon/Rectum

69.6

.11

Urinary

30.5

.08

Non-Hodgkin Lympohona

19.05

.07

Kidney

97

17.3

.07

Skin

23

.08

Mortality -- Heart Disease is the Number 1 cause of death county wide; Cancer 2nd, Stoke 3rd, Respitory Disease 4th. These are the same top killers in almost every location in the United States. By age group, however, we see a different paradigm:

< 5 years

5-24 years

25-44 years

45-64 years

>65 years

Birth Defects

Accidents

Accidents

Cancer

Heart Disease

Accidents

Suicide

Cancer

Heart Disease

Cancer

Suicide

Accidents

Stroke

Heart Disease

Respiratory

Respiratory

Respiratory

Stroke

Adult Behavioral Health Risks- Based on diagonsis, warning signs, and have been medically counseled on issues: Obesity (64%); Flu Shots (51%); Smoking (21%) HIV (37%); Asthma (10%; Alcoholism (6%).

Insurance Coverage -- About 22,000 are enrolled in insurance programs, or only 15% of the total population. Many consider this to be a high risk of morbidity due to individuals then only seeing physicians during emergency needs.

Hospitals/Nursing Homes -- 4…