I'm sure I speak for all the members of the Healthcare Community when I say we're grateful for the work that is being done by the partnership sponsored by the United Way in determining where the problems are in healthcare and hopefully as a team, we will be able to address those problems and overcome some of them and I will speak to that point at the end of my remarks. The problem of adequate physical health care is defined in the survey. Looking at the shortage. And affordability or lack of affordability of healthcare generally dental care Physician Office Care Nursing Home Care Home Health Care in medical rehabilitation. Further defined by looking at the quality of healthcare General generally the lack of or inadequacy or affordability of medical insurance. lack of services for people with AIDS Lack of prevention advocacy and Public Information Services, the questions regarding problems all revolved around those specific issues. The telephone household survey results. Show do that 42% of those surveyed believe that physical health care was a major or moderate Community problem. 13% at had a physical Healthcare problem during the past year and that ranked number 3 on the 17 problem areas and this represents 4934 households in the greater Duluth area. 4% of the households. We're currently experiencing a problem and that ranked number three in the 17 not problem areas and that represented 1645 households in the greater st. Louis area. I'm the next overhead shows the specific physical health care problems that were experienced and there are five listed here. Actually the top four are the ones that showed up consistently and all of the surveys. Affordability of healthcare lack of medical insurance affordability of medical insurance or inadequate medical insurance. So the cost and availability medical insurance stands out in this survey is a very medical major problem and will see that as true in the other surveys. Also the reasons that the individuals contacted in the telephone survey gave for not being helped where a lack of information about services or that eventually the responding solved the problem him or herself. The reasons for not getting help for eligibility restrictions the lack of information again about the services the responded solve the problem or there was no service in existence to meet that particular problem. Those are the major points from the telephone survey. The non telephone household survey many of whom were homeless and poor and I think there were approximately 50 persons in that survey. So it was smaller and number 42% believe physical health care was a major or moderate Community problem. That was exactly the same percent as we had in the telephone survey 20% had had a physical health care problem during the past year. 13% was the number from the telephone survey in this ranked number seven in the 17 problems. 13% we're currently experiencing a problem that compared to 4% in the telephone survey and this ranked number four of the none of the people in the non telephone survey. The specific types of problems in the non telephone survey where the same affordability of healthcare generally lack of medical insurance in inadequate medical insurance and shortage of healthcare. Generally. The rank order wasn't exactly the same, but they were in the top for the special groups that were affected. We're low income elderly people over 60 and the homeless in the most common reasons for not getting care and the non telephone survey where eligibility restrictions and lack of Transportation. Next week, we'll talk about the key informant survey and this was a survey of persons who had knowledge of Human Service problems based on their work in agencies dealing with this in the city of Duluth. 33% of the responses from the key informant survey indicated that physical health care was a very important Community problem. And this compared with 42% that said it was moderate or major in the telephone surveys and telephone and on Telephone surveys of the of the public. So in the can for mint physical health care is a problem ranked number 5 out of the 17 groups 54% of the response has indicated. The problem was not being addressed. Well, and that ranked number one of the 17. The percentage that the index for this is 6 and that put physical health care ranking number 1 equal with employment unemployment and the key informant survey. The ranked higher there than it had in the telephone survey. The four top-ranked specific problems were the same as what we saw in the telephone and then on Telephone surveys looking at the affordability of medical insurance lack of medical insurance portability of healthcare or inadequate medical insurance. The specific groups affected for all of these problems. We're low income in the under or unemployed. The Homeless was included in three of two of the groups in the elderly in one but the low income in the under underemployed the barriers cost of services. lack of resources an eligibility restrictions and those barriers consistently showed up for each of the problems a service provider survey was conducted to see how many clients were being served and if people were waiting for care The organization's included in the service providers survey where the American Health Heart Association the arrowhead epilepsy League the arrowhead parent parents of hearing impaired the association for retarded citizens Birthright of Duluth Duluth Community Health Center Lake Superior Life Care Center, Minnesota services for the blind Polinsky medical rehab center natural Family Planning Planned Parenthood of Northeastern, Minnesota Regional service center for hearing impaired the American Cancer Society senior citizen Coalition of Northeastern Minnesota services for children with handicaps UMD speech language and hearing Clinic st. Louis County Health Department American Red Cross in St. Luke's Home Health Care. Those were the agencies surveyed in the service provider and you can see from this Slide the number of clients served. and the number waiting and these agencies reported that and their records there were no clients waiting doesn't exactly jibe with some of the information that we received from the telephone surveys in the key informant service. But you can see the the different categories. They are Physician Office Care Home Health financial assistance medical to so forth. Are the last part of the data is related from the existing data committee related to death rates looking at the death rate by age groups. the death rate per 1000 population We're right on in the younger age group with the state. But again higher in the 25 to 44 year group in the 45 to 64 your group in the 65-plus as well as in the infant group. So these are all things that big questions in our minds and hopefully this data and the rest of the day. That we have. Discovered in the survey will lead us to some appropriate ways to try to find answers for why? One answer that I think will be somewhat helpful and I hopefully very successful in terms of the major problem that we've seen consistently which related to the lack of health insurance soda and affordability of health insurance is being addressed by the health insurance coalition. And that is a private nonprofit organization that was established in 1987 to design and Implement a demonstration project which would make low cost health insurance available to low-income in uninsured people in northeastern, Minnesota. This group which is made up of small business owners and is represented by consumers Health Care Providers labor health insurance industry local government and is kind of coming under the general way under the auspices of the air DC. The group is determined that lack of personal health insurance is really the most significant barrier for people and receiving adequate Healthcare & The Spa specifically the low-income population. So the goal of the Coalition is to design a program that will provide access to healthcare for unemployed persons who cannot afford and who currently lack health insurance. This particular project is looking more at employed persons than unemployed. But has found that the majority of persons who do not have health insurance unemployed. The northern part of Minnesota has been harder hit than other parts of the country as we all know by unemployment. And we find that even though unemployment is fine and affects the lack of health insurance. That is also affected by the kinds of jobs that are increasing in the state and they're more service-sector jobs as opposed to industrial jobs, and those are our lower-paying jobs. And there's a growing number of small businesses as opposed to large businesses and it is many of the small businesses that have the fewer worker benefits and do not provide health insurance health insurance Coalition started out by doing a survey of Northeastern Minnesota and they surveyed 4,500 of the Region's employers and they found that 4 out of 10 did not provide any health insurance coverage and that's that's a large number. So this is the problem is being addressed by the health insurance Coalition. And the first thing they need to do and addressing it is to reduce the premiums that have to be paid so that the employers and the employees can afford to purchase the insurance. Join us by attempting to reduce those premiums and getting some help from the state of Minnesota and legislature has funded this project with $200,000 and that would be used to cover all the administrative expenses of administering the health insurance plan as well as the marketing and other overhead type expense it. The hope is that the employees in the employers could could pay the cost for actually providing the health benefits. and to do this the cross that they would pay would have to be approximately half of what the standard insurance premiums are. No. And that may be unrealistic but they're also as part of the plan is to encourage a healthy living and there will be a lot of effort on decreasing health problems because of Lifestyle. the goal is to have a health insurance for all low-income persons in this region. And the goal is to implement this project as of June 1989 and we're looking forward to to this as a unique approach in northeastern Minnesota. And this was started before the healthspan health insurance building program was put before the legislature and it appears that that will not make it this year. But we are hoping that the health insurance Coalition which is being looked at as a pilot project in northeastern Minnesota that that will be successful and maybe a better way regionally to provide access to health insurance than that. Then what the state has put forth in the healthspan bill. That would conclude my remarks on physical health care problems. Thank you.