Perceptions of Health in Monroe County
A key goal of Community Voices for Health in Monroe County was to listen to and elevate community voices regarding health resources, concerns, and needs in Monroe County and to inform future health policies, programs, and services with the ultimate goal of creating a lasting model for equitable engagement practices.
Beginning in June 2020, the Community Voices for Health in Monroe County team hosted small group discussions and personal interviews with more than 150 community members to enhance our understanding of community perspectives on health in Monroe County. Below is a summary of these results, in an abbreviated form.
Health Insurance
The importance of insurance
I
nsurance makes healthcare treatments, particularly medicines, exams, and hospital visits more affordable
Termination of health insurance benefits can have potential health impacts
Willingness to pay for insurance that meets the needs of their family while being able to afford other
living expenses, suggesting trade-offs exist between insurance costs and potential health
improvements
Likelihood of seeking healthcare regularly increases with insurance coverage
Difficult choices have to be made about health insurance coverage and ability to pay for other living
expenses
Concerns about ability to get and maintain health insurance
Health insurance is not available to all community members
Concerns about high costs of health insurance
Desire for universal healthcare or insurance with costs based on income level
Challenges with switching back and forth between the Healthy Indiana Plan (HIP) and marketplace
insurance due to changes in income
Medicaid recipients, particularly individuals with disabilities, have challenges maintaining Medicaid coverage due to $2,000 limit on liquid assets
HIP coverage can be difficult to maintain due to mailing address requirements, particularly for individuals who are housing insecure
Desire for healthcare to be more inclusive of undocumented individuals
U.S. health system is perceived to be behind those of other countries because of barriers to
receiving care
Limited coverage of health insurance
Concerns with coverage limits of some health insurance plans
Specific concerns about coverage of x-rays, dental, and vision care
Need for broader health insurance coverage
Desire for more equitable care for all insurance policies (e.g., Medicaid patients are forced to choose
from previously used eyeglass frames that may not hold up as well as new ones)
Challenging processes for the use of insurance, obtaining and keeping insurance
Limitations on what health care facilities IU students can use, especially if covered under out-of- state plan from parents’ policy
Challenging to sort through different insurance options, including COBRA, marketplace options, Medicare
Separate policies for medical and dental insurance
Challenges finding doctors that accept Medicaid
Concerns that care can be interrupted suddenly when accepted insurance plans change, particularly
with Medicaid
Gaps in healthcare for children between end of Women Infants and Children (WIC) coverage and
beginning of elementary school
Documentation requirements for gender affirming coverage treatments for transgender individuals
Challenges understanding the benefits of Medicare Part D (drug coverage)
Insurance companies make choices that consumers and doctors might wish to make
Desire for greater empowerment and choice
Concerns with complicated billing processes that affect how charges may be covered
Desire for insurance coverage that may be used across state lines
Quality of Health Services
Timeliness of health services
Concerns regarding timeliness of appointments, specifically transportation time to specialist appointments and delays in scheduling care
Strict rules about late and missed appointments
Transgender individuals shared challenges finding local healthcare providers familiar with their health
needs, resulting in long drive times to qualified provider
Concerns about waiting times in doctors’ offices
Skills of healthcare providers
Concerns about ability of local healthcare providers to serve groups with special needs
Desire for providers to avoid making assumptions and listen more carefully to patients
Fears lead to a need to feel guarded around healthcare providers
Desire for more privacy in teaching hospital with student training
Concerns regarding ability to provide equitable care to underrepresented groups, particularly individuals with disabilities, non-English speakers, immigrants, transgender, and low-income individuals
Individuals with disability expressed specific concerns, highlighting the need for doctors to learn to cope with behaviors that may prove challenging, to learn to recognize non-verbal signs of pain, to provide compassionate crisis care, and to set aside implicit bias to provide the best quality healthcare to individuals with disabilities
Participants who spoke Spanish shared their experiences with healthcare staff not always treating patients with accents very well and providing inequitable care to individuals born outside the United States
Concerns about the lack of use of interpretation services at Monroe County health organizations
Desire for equitable treatment regardless of insurance coverage
Concerns about requirements for upfront payment for surgery by individuals without insurance
Individuals experiencing housing insecurity, addiction issues, and mental health issues shared they
have felt judged by healthcare providers
Transgender individuals expressed desire for additional training for local healthcare providers,
highlighting concerns about the trauma of frequent misgendering, doctors declining service because of their lack of experience with transgender care, and that these actions are allowed based on religious beliefs
Social and Economic Barriers to a Healthy Community
Costs of healthcare
Concerns about costs of healthcare and need for trade-offs between paying for healthcare and paying for other basic needs
Desire for greater certainty in costs prior to treatment
Concerns about billing from use of emergency room, when it is particularly difficult to tell whether the
healthcare professional treating you is covered by your insurance plan
Fears about going into debt to pay medical bills
Challenging processes to navigate, receive, and maintain social services and benefits
Concerns about challenging processes to receive and maintain social services and the trauma these systems create for low-income individuals
Frustrations regarding number of repeated calls to ensure paperwork is processed correctly
Long wait times with telephone and fax glitches in making contact with Family and Social Services
Administration
Desire for low-income individuals to have better awareness of social services available to them
Long wait list to receive Area 10 Agency on Aging housekeeping and transportation services
Social service providers are overwhelmed due to long wait times residents are experiencing with
benefits
Concerns that staff members lack first-hand experiences with health challenges and daily trauma that
other community members face, resulting in treating people without compassion
Desire for advocates to help people obtain needed medical treatments and social services
Wish for health and social service benefits to carry over with move across state lines
Employment opportunities
Residents need opportunities to earn income
Concerns that income opportunities decreased with COVID-19 pandemic
Health issues can limit ability to work, particularly for elderly and individuals with disabilities
Inability to work results in residents not having income to purchase things that support health
Housing issues
Concerns about availability and conditions of housing Monroe County
Particular concerns expressed about conditions of rural housing
Individuals with disabilities shared experience with inability to shower in current housing
Addiction issues are challenging to address unless housing issues are addressed first
Food insecurity
Concerns about food insecurity, particularly during COVID
High costs of purchasing healthy food
Existence of food deserts
Transportation
Concerns with using public transportation during COVID-19 pandemic due to health concerns
Elderly patients have poor nutrition due to transportation challenges
Public transportation and Rural Transit are difficult to use with mobility issues
Rideshare services are not affordable to many residents
Desire to have more affordable transportation, particularly outside city limits
Conflict in areas of coverage for those going between City and County
Decision makers are not fully aware of issues
Concerns that decision makers lack first-hand experiences with health challenges and daily trauma that other community members face
Desire for decision makers to have education around poverty and empathy
Lack of healthcare education
Concerns about health education provided in schools
Desire for PCPs to spend appointment time to provide preventative health information
Stigmas around mental health
Desire to discuss mental health without judgment
Concerns about the burden people feel seeking mental healthcare
Shame, discrimination, and stigma occur in healthcare and lead patients to lose hope for receiving care
Inequity, discrimination, and implicit bias
Concerns with inequitable care from local healthcare providers
Instances of implicit biases and overt racism that goes overlooked within the Monroe County Community
School Corporation
Commitment to seeing all community members obtain healthcare, food, and stable housing
Inequities that exist impact others’ own sense of well-being and quality of life
Concerns with physical and emotional safety
Black residents shared concerns about physical and emotional safety in the community
Residents provided examples of over-policing and targeting of Black people and feeling unwelcome
and unsafe in public spaces in outdoor recreation