All Is Not Well:

Citizens Speak Out About Health Care in Daviess County

A report on 52 community health forums

September 2002



Table of Contents


Summary of findings

Citizens' concerns, solutions


Survey results

The voices: who participated




The People's Health Project involved the citizens of Owensboro-Daviess County, Kentucky, in discussions of health care access at 52 moderated forums in 2001-02. The forums were structured to cover seven issues that were among the greatest concerns local citizens expressed in a University of Kentucky Health Needs Assessment released in August 2000:

  1. People without a medical home. Nearly one-fourth of Daviess County adults do not have a regular doctor.
  2. Gaps in the system. Nearly 5,000 Daviess County adults are uninsured, and many more are underinsured.
  3. Shortage of doctors. Of the 15 most populated Kentucky counties, Daviess ranks 13th in the percentage of primary care physicians.
  4. Lack of fairness/courtesy. Uninsured Daviess Countians, as well as those with Medicaid and Medicare coverage, feel they are treated differently.
  5. Inconvenience and intimidation. Delays in getting an apointment, paperwork, approvals and transportation problems can complicate care.
  6. High costs. Nearly 13,000 Daviess County adults (or someone in their family) did not see a doctor last year because of costs.
  7. Prescription drug costs. Because of costs, nearly 11,000 Daviess County adults did not fill a prescription last year.

Forum moderators introduced participants to the findings from the health needs assessment and other relevant data. Through two-hour discussions and follow-up questionnaires, they were asked to share impressions and personal experiences, and to select or provide their own ideas for community strategies.

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Summary of findings

The dominant theme of the forum discussions was this:

Many Daviess Countians, particularly those with low incomes, have a hard time coping with medical conditions and bills, and many have significant difficulties getting and affording the health care they need.

Here is what forum participants said regarding the seven access issues targeted by the People's Health Project:

1. Health care costs, including prescription drug costs, are too high.
High costs were the overarching concern of forum participants. Cost affects everyone, but women more directly than men, according to UK's analysis of surveys filled out by forum participants. Citizens believe costs are unjustly high, and that the reasons include:

2. Everyone needs a doctor.
Citizens agreed that primary care is critical for everyone. This is important for prevention and early diagnosis, which also keeps health costs low. Many people are frustrated in finding a doctor, they said — particularly those who may be unable to pay. Citizens are also concerned that there is a shortage of primary care doctors, which means that even those with a regular doctor don't get to spend enough time with him or her. Citizens supported a systematic effort to connect patients with doctors, but when that falls short, they supported more effective recruitment, expanded clinics and services.

3. Let's fill the gaps.
Many stories were shared about people falling through the cracks of our local health care delivery system. These people included the insured, uninsured, underinsured, people with chronic problems and those who need help navigating the system. Citizens support a better way — be it a clearinghouse, hotline or ombudsman.

4. The health care system could be more consumer-friendly.
Participants said obtaining proper health care is often complicated by transportation problems, work schedules and paperwork. They supported steps to help people overcome these barriers.

5. Respect is important.
Many citizens described feeling embarrassed, ashamed and mistreated when accessing the health care system. Yet they said they know that respect works both ways and that patients can be rude, unfair and cavalier about appointments. They said they want everyone — those who can pay and those who cannot — to be treated with care and consideration.

6. Funds are already available to fix many problems.
Citizens were more likely to support steps that will not increase taxes or fees. With the huge sums spent on health care, and with the local hospital sustaining a substantial surplus, they said a better system should be possible with funds that are available already. They said they prefer that their local health care providers focus more on collaboration and access issues.

Other themes

Participants felt so strongly about some issues that they often brought them up even though the issues were not included in the discussion booklets used at the forums. These included:

1. Lack of competition
A theme expressed in nearly every forum was that our community has only one hospital, few insurance choices and not enough providers. Citizens expressed these concerns over and over.

2. Abuse of the emergency room
Citizens expressed frustration about the inappropriate use of the Owensboro Mercy Health System (OMHS) Emergency Department (ER). They were concerned that the poor and uninsured have nowhere else to go, but also that people abuse the free services there, resulting in higher costs for everyone. (OMHS recently funded a full-time physician for the McAuley Clinic, which serves the uninsured.)

3. Poor health habits
Citizens said they are frustrated with those who are not conscientious about their health and behavior. They are increasingly aware that health care costs and insurance premiums are influenced by behavior choices that include smoking, substance abuse, poor nutrition, lack of exercise and lack of preventive care. They feel that more effective health education is key.

4. Information dissemination
Citizens said they are confused by and largely unaware of community resources — where to go for health services, how to get transportation, the hours and services at local clinics, which doctors accept Medicaid and uninsured patients, how to take advantage of prevention and early detection screenings, classes and support groups, etc. (The Public Life Foundation of Owensboro has already responded by publishing directories of primary care services and community health centers.)

5. Funding and staff
With the amount of money that is spent on health care, citizens expect a higher level of services and staffing. They feel more funds could be redirected to provide more physicians, nurses, nurse practitioners, physician assistants and office staff.

6. Paperwork
Citizens — as well as health care professionals — are overwhelmed and frustrated by the growing burden of filling out forms.

7. Appreciation of services
Despite anecdotes about the shortcomings, frustrations and challenges of Owensboro's health care system, citizens also gave examples of the generosity of many health care providers in our community. Free and reduced-price care and medications are provided routinely by caring professionals, organizations and institutions.

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Citizens' concerns, solutions

Cost is the top concern

Citizens ranked high medical costs and the cost of prescription drugs as their top two priorities among the seven access issues that were identified by the People's Health Project. Many participants told stories about the problems they have had paying for or getting the care they need — nine of 15 participants at one forum, for instance, said they had not been able to fill prescriptions because of the cost. Citizens said repeatedly that it is unacceptable that someone must take half of their prescribed dose of medicine or forego it entirely to pay food or utility bills.

People are "forced (to choose between) paying gas bills or medicine," said one. Another said a social services agency intervenened in the case of one woman who spent her money on medication: The gas company "was going to shut her gas off."

Among forum participants in general:

Citizens believe that costs are unjustly high because:

Citizens believe the high cost of insurance and medical care is primarily due to a lack of competition:

  • for the local hospital (formed by the merger of two former hospitals).

    "Having a 'bigger' health system does not mean it is better. Many people in this city are dissatisfied with our health system."
    —Hospice staff forum participant

  • among insurance companies in the region (because of changes in state law in Kentucky in the 1990s).
  • among doctors in Owensboro (particularly in areas where there is a shortage).

    "Lack of consumer knowledge and choice about local health care" are primary problems.
    —River Valley Behavioral Health forum participant












Other major factors are:

Other reasons cited for high costs were:

lack of early detection of medical problems (the problems become serious and more expensive to treat).

  • lack of preventive care.

    "Preventive care needs to be a primary focus."
    — Kentucky Wesleyan College forum participant

  • consumer demand for the latest technological advances in medicine (medical equipment, drugs, etc.).

    "To some degree we can get by on some of the less expensive medication in some circumstances. But patients want what is new, what costs more."
    — Chamber of Commerce forum participant

Citizens believe making the system more efficient, primarily for the poor, is the only justification for paying higher taxes or fees for health care.

"Health care issues of cost, access and quality are inherently complex. Tradeoffs and choices must be made."
— Participant in forum for human resources managers


There were many different points of view expressed at the forums, including these opinions on the availability of health care:

"For the most part I think affordable health care is available in some form and that programs that assist individuals exist. Many who do not have health care do not want it or do not take advantage of the system."
— Physicians forum participant

"National health insurance is a basic need and solution of many of the issues."
— Habitat for Humanity forum participant



More than 90 percent of participants also favored

Participants also suggested


The forum's discussion "promotes an environment of blame for problems in the health care system - doctors, hospitals, insurance companies and drug companies. The discussion does not focus on the individual's responsibility and the discussion that needs to take place at a societal level."
—OMHS staff forum participant

"I feel that our American culture has influenced how we "care"for poor people. We are too greedy, too individualistic, and too competitive."
— Central Latino Center forum participant


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Everyone needs a doctor

After the high cost of health care and prescription drugs, citizens are most concerned about the number of people without primary care and prevention services, and they connect this to the local shortage of doctors, another of the access issues identified by the People's Health Project.

  • 72 percent of forum participants ranked the lack of a regular doctor for many citizens as very important; 61 percent ranked a shortage of doctors as very important.
  • 14 percent of participants ranked the need for regular doctors as the most important issue; another 10 percent ranked the shortage of doctors as the most important issue.
  • Significantly more women than men ranked both issues as very important.

    "We need more doctors and assistance to help provide for everyone, especially those that have kids and work."
    — St. Joseph Fire Department forum participant
















Citizens believe some people don't have (or want) a regular doctor because of:

Citizens described the implications of not having regular doctors as:

Citizens believe there is a shortage of doctors which they attribute to:

Citizens said the shortage results in:

As solutions, more than 90 percent participants favored:


The connection between education and prevention

Participants in the forums stressed that people need more health education - whether from their doctor or some other source - so they'll learn how to protect their health and prevent serious illnesses.

"The key to good health is preventive. If more people believed this we would be a healthier community in the long run."
— Dugan Best Neighborhood Association forum participant

Patients should be equally educated by physicians on ways to improve their health.
— Owensboro Community College nursing class forum

"We need education in health lifestyles. Most of our health issues involve diet (poor diet, dental disease, heart disease, obesity, high blood pressure, etc.)."
— Seventh Day Adventist Church forum participant

"We have to stop the cycle at an early age. There should be health care classes that are mandatory in 1-12 grades. Health care is more important than some of the current required courses. Algebra II does not affect most people on a daily basis, but health care does."
— Chamber of Commerce Young Professionals forum participant


More than 80 percent supported trying to convince doctors to accept more nonpaying patients and providing a tax deduction for doctors for this service (most favored these only if they did not require a tax or fee increase).

Participants also suggested:

in regard to making sure everyone has a regular doctor:

in regards to addressing the physician shortage:

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Let's fill the gaps

Citizens are deeply concerned about the many people who fall through the cracks of our health care delivery system. Many shared stories of family or friends who were denied coverage by a health plan, whose condition deteriorated while waiting for approval for treatment (from an insurance company or the federal government disability agency) or who are not taking their medications because of cost.

  • 70 percent of forum participants ranked this issue as very important.
  • 8 percent of participants ranked it as the most important issue.
  • Significantly more women than men ranked this issue very important.

    "I have known people who really need health care but do not qualify under existing systems and therefore receive little to no care."
    — Precious Blood Church forum participant















Citizens were most concerned about:

Citizens described other gaps that included:

As solutions, more than 90 percent of participants also favored:

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The system could be more consumer-friendly

Fewer citizens rank inconvenience and intimidation as a critical issue, but transportation problems were discussed frequently during the forums. Participants were more willing to pay higher taxes or fees to address transportation problems than they were to spend money on some other proposed solutions to health care access problems.

  • 47 percent of forum participants ranked this issue as very important.
  • Significantly more women than men ranked this issue as very important. (Women, more frequent health care system users, are more likely to experience the inconveniences.)












Citizens said the major inconvenience in the health care system is transportation.

Citizens said they are frustrated by filling out forms, approval processes, being shuffled from one doctor's office to another and long waits.

"Even though you have a doctor, they tell you to go to a convenient care place. ... When you go to convenient care, people get frustrated waiting for 2-3 hours."
— Dugan Best Neighborhood Association forum participant

As solutions, nearly half of participants said they would be willing to pay higher taxes or fees for:

Participants also suggested:

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Respect is important

Citizens acknowledge that far too many people — providers and support staff as well as patients and families — do not always treat others with respect and courtesy. While participants rated it last in importance among the seven access issues, they shared many personal experiences where they felt they were not treated well by the medical system.

  • Forty-five percent of forum participants ranked this as very important.
  • Significantly more women than men ranked this issue as very important.










Participants had complaints about:

About 61 percent of participants said they favored taking steps to ensuring courtesy, respect and equal treatment for all if there were no costs associated with this.


Some people claimed that physicians and office staff treat uninsured and Medicaid patients with less respect than those who are insured:

"...the funds take awhile to come in to pay the physicians, so doctors' offices don't treat the Medicaid or Medicare patient special."
— Dugan Best Neighborhood Association forum participant

On the other side, a physician said:

"Medicaid patients are more demanding, more abrupt, more likely to sue." Because of low reimbursements, "I lose money each time I see one."
— Physician forum participant

Another physician acknowledged that it is harder for Medicaid and uninsured patients to get in to see a doctor. He does not accept them.

"The uninsured have a hard time. There are other factors involved. That is a reality."
— Physician forum participant

Still other forum participants complained about the "freeloaders" (AARP forum participant) whose care is paid for by "the rest of us who are willing to purchase insurance" (Small business owner forum participant).

"Sometimes those without insurance get in before the rest of the people waiting. Why? ...Because the uninsured do not have to complete all the forms that the insured are required to."
— Dugan Best Neighborhood Association forum


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Survey Results

Table 1

Forum Participants' Ranking of the Most Important Health Care Access Issues Facing Daviess County
(The issues were identified by an August 2000 Survey by the University of Kentucky)

Very Important %
Somewhat Important %
Not at All Important or Not Sure %
1. The high cost of prescription drugs
2. The high cost of health care in general

3. The large number of people without a regular doctor or a "medical home"

4. Gaps in our health care system
5. A shortage of doctors in Daviess County
6. Inconvenience and intimidation in the health care system
7. A general lack of fairness and courtesy in the health care system

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Table 2

Forum Participants' Assessment of 16 Possible Strategies To Address Health Care Access Issues
(The issues were identified by an August 2000 Survey by the University of Kentucky)


Favor, even if more taxes or higher hospital rates & fees are necessary %

Oppose %

Get people into health care programs they qualify for
Help Medicaid, Medicare, and uninsured patients fill out paperwork to get approval to see a doctor
Make sure doctors, clinics, hospitals, etc. do not over charge
Promote and support more and better health insurance plans offered by employers
Help patients find a regular doctor or a "medical home"
Expand transportation services to and from the doctor's office or hospital
Make it easier for doctors to distribute free prescriptins
Recruit more doctors to Daviess County
Do more to match health care needs with available doctors, clinics, hospital services, etc.
Take steps to ensure courtesy, respect and equal treatment for all
Have a doctor on a full-time basis work at existing clinics
Improve follow-up services after patients leave the emergency room
Provide a tax deduction for doctors who care for non-paying patients
Convince doctors to accept more non-paying patients
Establish new health care clinics in Daviess County
Use mobile health units for underserved neighborhoods & remote areas

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The voices: who participated

Widespread participation. Fifty-two forums were held from March 2001 to February 2002; 1,147 people were personally invited to a forum, 578 participated, and 491 completed questionnaires.

Urban and rural representation. Of those who completed the questionnaires, nearly two-thirds of the participants (64 percent) lived in the city of Owensboro, 29 percent lived outside the city limits in Daviess County and 6 percent were from other areas.

Age and gender participation. Forum participants ranged in age from younger than 18 years of age to older than 65. Women made up 65 percent of participants; 35 percent were men. (Coincidentally, these are the same percentages that responded to the Health 2000 survey conducted by the University of Kentucky).


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Letter of thanks

A project and report of this breadth requires the diligent work of many people. The Public Life Foundation of Owensboro is fortunate to have been able to put together an outstanding project. In particular I'd like to thank the following:

  • Public opinion consultant John Doble, for wise and valuable counsel and guidance throughout the project.
  • Carol Ireson and her assistant, Jennifer Galland, of the University of Kentucky for their comprehensive and meticulous analysis of data from the forums.
  • Beverly Mills of PLFO, for the organizational skills she brought to gathering and assembling the data from the forums.
  • Writer/editor Fran Ellers, for her efforts to make the report not only thorough but readable.

All these people contributed significantly to this project, but it succeeded in large part because of the leadership of Rodney Berry, PLFO president. Rodney attended virtually all the forums and moderated many of them. He helped design the study, collect the data, and write the report. Most importantly, Rodney has been tireless advocate for giving the people of Daviess County a voice in local health care decisions and debates. I offer my thanks to Rodney, the forums' participants and volunteers, and the team members who helped make this project and report possible.

John S. Hager Founder,
Public Life Foundation of Owensboro

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How the People's Health Project came about

Why health care access? In August 2000, the Public Life Foundation of Owensboro and more than 20 other sponsors released a comprehensive health needs assessment for Owensboro-Daviess County and the seven counties of the Green River Area Development District. The study, conducted by the University of Kentucky Center for Health Services Management and Research, included surveys, focus groups and telephone surveys of 1,800 citizens, each of whom was asked more than 90 questions about health and health care. Two major issues emerged as barriers to healthy citizens: access to health care and unhealthy lifestyles. Since several community organizations were already focusing on lifestyle issues, the Foundation targeted health care access.

From information to deliberation. The Foundation embraces a three-pronged process for community problem solving: information, deliberation, action. With new information from the UK study, the Foundation brought citizens together to deliberate in People's Health Project forums so they will be empowered to take action.

Easy-to-understand information. The UK study identified seven health care access issues. The Foundation presented these issues, themes and supporting data in easy-to-understand discussion guides for community forums.

Connecting with citizens. The Foundation developed an ambitious forum plan to attract citizens from all walks of life. Civic and service clubs, church groups, neighborhood associations, parent-teacher organizations, trade and professional associations and other groups hosted forums throughout Owensboro and Daviess County. Any group was welcome to participate, and all forums were open to the public.

Trained citizen leaders. The Foundation formed a citizens advisory committee which helped recruit moderators to lead the forums and recorders to take notes.

A chance to be heard. In each forum, participants were introduced to the latest information related to health access issues. They were asked to share personal or family experiences and circumstances. They told their stories.

Issues, options and strategies. Participants were then asked to discuss and rank the importance of various issues. They learned about opposing points of view. They shared ideas and explored possible community strategies.

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Progress in health care access
Key Initiatives in Owensboro-Daviess County Through August 2002

Clinics and charity care (1970s - present)
For many years, Daviess County's poor and uninsured turned to physicians and dentists who would provide charity care, the hospital emergency rooms, the Free Clinic (one night per week, working poor only), or the McAuley Clinic (one day/night per week).

Public opinion research (1998-99) Preston-Osborne and Doble public opinion studies documented local citizen concerns about health are (cost of care, insurance premiums, medications, distrust of system, etc.).












Health needs assessment (2000) Comprehensive University of Kentucky study stressed issues of unhealthy lifestyles and health care access.

Citizen voices (2001 -02) Public Life Foundation shared UK findings and facilitated citizen dialogue in 52 health care forums.

Attention to lifestyles (1990s - present) Healthy Horizons, OMHS HealthPark, Corporate Challenge, health fairs, screenings, school nurse program, Fit for Life school programs, and a planned Community Summit on Healthy Lifestyles point to a growing acknowledgement of the importance of behavior and personal responsibility in health care.

County government resolution (2001) A bold community goal is proclaimed by county leaders: 100% access and zero health disparities.

Examining models (2001) County judge-executive convened health care and community leaders to learn how other communities have improved access to quality care for all. A North Carolina model was introduced.

Federal grant, county tax for expanded public health facilities (2001) County government secured $2 million federal grant and the county health tax was increased to finance expanded public health facilities. Facilities will include space for a primary care clinic.

Prescription drug report (2001) Reacting to this citizen priority, the Public Life Foundation commissioned a prescription drug study, identifying resources and models from other communities.

McAuley Clinic partnership-pilot project (2001) Daviess County Fiscal Court, Green River Health, and OMHS formed a partnership to manage and monitor a free clinic staffed by a full-time physician, nurse practitioner, and caseworker.

Directories (2002) Responding to another need, the Public Life Foundation published directories to inform citizens of primary care and community health center resources.

Prescription drug and medical transportation task Forces (2002) The Public Life Foundation convened interested citizens, health care providers, and agency representatives to explore ways to work together to help more people with medications and transportation. Both groups are developing exciting collaborative models.

Citizens Health Care Advocates (2002) Concerned citizens who participated in Public Life Foundation forums have established an organization to work on behalf of the public interest in health care.

Robert Wood Johnson foundation grant A major grant proposal has been submitted by the Citizens Health Care Advocates to fund a four-year citizen-driven health access program.

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People's Health Project Forum Moderators
Ken Adkisson
Marcy Allman
Nelda Barnett
Rodney Berry
Vivian Craig
Debbie Crone
Bob Darling
Susan Davis
Marianne Smith Edge
Jeff Jones
Ralph Kunze
Ron Mayhew
Kathy Olson
Sister Rose Jean Powers
Dale Taylor
Lisa Townsend
Lisa Tullis
Virginia York

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People's Health Project Advisory Committee
Harold Baggett
David Bell
Jay Burns
Bruce Chisholm
Chuck Conkright
Diane Coomes
Don Crask
Janet Dillehay
Jerry Dockery
Sue Jarvis
Steve Kulka
Rosemary Lawson
Robyn Mattingly
Steve McFarland
Orlander Mitchell
Mark Moseley
Bill Moss
Elizabeth Pendley
Ethan Price
Patti Rayburn
Mary Shacklett
Dan Spalding
Roy Stone
Elnor Thielen
Trish Todd
Gayle Welsh
Sister Fran Wilhelm
Percy Wilkerson
Estell Young

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People's Health Project Recorders

Ruth Baird
Marian Bennett
Sandy Hallman
Sherry Hayden
Nancy Kamuf
Beverly Mills
Anne North
Patti Ogles
Branda Parker
Patti Rhodes
Cindy Shaver
Michelle Wright

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Forum Locations


Audubon Area Community Services
Moonlite Bar-B-Q Restaurant
Wesleyan Heights Methodist Church
Kentucky Wesleyan College
First Baptist Church
East View Elementary School
Third Baptist Church
Daviess County Public Library
Centro Latino Center
Utica Elementary School
St. Stephens Catholic Church
Campbell Club
Elizabeth Mundy Center
Apollo Heights Baptist Church
St. Joseph Fire Department
Dugan Best Recreational Park
Daviess County Farm Bureau
Roosevelt House
Owensboro Community College
Seventh Day Adventist Church
Foust Elementary School

RiverPark Center
Owensboro Christian Church
Colby's Restaurant
Precious Blood Catholic Church
Green River District Health Department
Boulware Center Mission
Zion United Church of Christ
Owensboro High School
Longfellow Learning Center
Friendship House
Counseling Associates
Kentucky State Building
RiverValley Behavioral Health
Estes Elementary School
Brescia University
Fourth Street Baptist Church
Owensboro-Daviess County Chamber of Commerce Settle Memorial Church
Owensboro Mercy Health System

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