The Health Equity Action Team is currently working to establish a health equity district to bridge coverage gaps in medically-underserved areas of East Baton Rouge Parish. In the above diagram, the darker green portions of the map indicate those areas with the least ease of access to routine and emergency medical care.
The following is a draft proposal for the Health Equity District response to an overlapping, ongoing network of healthcare inequities that affect EBR's predominantly African American and low-income communities.
For more information on this work and how to get involved, check for the latest Health Equity Actions on our TBR Upcoming Actions page.
East Baton Rouge Parish Health Equity District
Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane
—Dr. Martin Luther King, Jr.
Together Baton Rouge recognizes the gaps in access to healthcare in medically underserved areas of the parish is due in large part to a lack of dedicated funding and resources through the healthcare infrastructure. We propose the creation of a hospital service district, what we describe as a “health equity district”, to provide or coordinate health and other services for residents in medically underserved areas of North Baton Rouge and Old South Baton Rouge. The creation of this district will provide the will and ability to address long-standing inequities in access to quality healthcare services and other social determinants of health in the high poverty, medically underserved communities of the parish.
Metro Council Members, Members of the State Legislators for the proposed District, and Potential Partners
Background and Need
Louisiana’s unique public health care system of state-operated hospitals and locally run hospital service districts, which began under Huey Long, was privatized between 2011 and 2013. This resulted in the destabilization of public health care for the state’s uninsured and medically underserved populations, groups who had relied on that system of care for more than a century. The public hospital safety net had been removed and low-income areas of East Baton Rouge Parish experienced unprecedented withdrawal of hospitals as well as primary care services.
In 2016, the ratio of primary care physicians to population was 17 per 100K in North Baton Rouge compared to 96 per 100K people in the rest of the parish. Other glaring statistics on the wide range of health and other disparities include: a) percentage of the population living in food deserts-48% vs. 24%; b) percentage near poverty-47% vs. 20%; c) percentage uninsured 22% vs. 12%. Among the underserved population, the prevalence of all chronic diseases is higher and goes untreated for longer periods of time. Consequently, the communities with the highest need have the lowest access to care. To further exacerbate these issues, COVID-19 has proven to not be an equal opportunity pandemic.
During an April 2020 press conference, Mayor Sharon Weston Broome stated, “Coronavirus is a story not just about race, but about the disparities of access that exist across many demographics in our city, parish, state, and country.” The mayor-president reported that, as of April 2020 in East Baton Rouge Parish, 65% of people who died from COVID-19 were African-American, a group that makes up only 47% of the city-parish population. The COVID-19 pandemic shines a bright light on all of the long-standing health inequities due to the disproportionate impact it has had on low-income residents and African-American communities in the parish. COVID-19 adds new layers to the existing healthcare needs and inequities in North Baton Rouge, presenting its own unique needs that have required additional funding and resources.
Creation of a “Health Equity District” in North Baton Rouge formally to be known as the EBRP Hospital Service District No. 2.
Together Baton Rouge and its partners have worked for several years to better understand and find solutions to the above identified health inequities. After research and collaboration with our member institutions and other health care providers in the city, we propose the development of a hospital service district to build and expand health care services for residents living in medically underserved areas of the parish. This new district will be called and known as a “Health Equity District” with the mission of providing or coordinating health and other services through a system of care for the population living within the district and for addressing other social determinants of health. Social determinants of health are those conditions that exist in places where people live, learn, work, and play that affect their health, quality of life and health outcomes.
Through research and collaboration with the Louisiana Primary Care Association, the trade organization for Federally Qualified Health Centers in the state, we found that in Louisiana State law there are provisions for establishing entities to provide hospital and health care services in our parish.
Louisiana Revised Statute Title 46 Section 1051 authorizes the establishment of Hospital Service Districts. This law states, “Police juries of parishes are authorized and empowered, upon their own initiative, to form and create one or more hospital service districts within the respective parishes…” The law further states, (R.S 46: 1052) that the objects and purposes of the hospital service districts and the governing bodies created pursuant to the provisions of the law shall be to 1) operate hospitals, 2) administer other activities related to rendering care to the sick and injured 3) promote and conduct scientific research, 4) participate in any activity designed to promote the general health of the community, and 5) cooperate with other public and private institutions and agencies engaged in providing hospital and other health services to residents of the district. The statue provides two avenues to create a hospital service district. The first is a simple majority of the Metropolitan Council and the second is through a petition of not less than 25 persons owning or assessed for land in the district (RS 46: 1059).
Once established, the Hospital Services District becomes a political subdivision of the state, and for the purpose of purchasing and acquiring lands and purchasing, acquiring, constructing and maintaining physician and dentist offices, laboratories, and other physical facilities necessary to carry out its purposes. (RS 46:1072). This would be the second hospital services district in East Baton Rouge Parish. Hospital service district No. 1 was established in 1957 to support Lane Memorial Hospital serving East Baton Rouge and West Feliciana Parishes. And it would be different from the Baton Rouge Health District established by the hospitals a few years ago set up to coordinate services and infrastructure in the area of the parish that has all the healthcare facilities.
Many Hospital Service Districts have been created under Louisiana law in other parts of the state, including those located in Pointe Coupee, East Ascension, West Ascension, Iberia, North Caddo, Rapides, Orleans, and St. Tammany. And other states (TX, GA, and CO) use this model to provide services for uninsured and medically underserved people.
Another entity called the “Baton Rouge Health District” was established in 2015. The Baton Rouge Area Foundation provided the start-up funding and master plan for this district in south Baton Rouge, a 1000 acre area, comprising Baton Rouge General Medical Center, Our Lady of the Lake Medical Center, Mary Bird Perkins Cancer Center and Pennington Biomedical Research Center. According to their website, the focus of this district is physical infrastructure: roadways, recreational trails, landscaping, signage, and lighting. Another major component was to be access to the district off the interstate with signature gateway markers, greater pedestrian safety and aesthetic improvement. This district was not established in state law and does not address the lack of health care that exists in large segments of the parish.
Boundaries of the Health Equity District
The proposed boundaries for the Health Equity District would be established based on need. The Louisiana Primary Care Association used the system required by the federal Health Resources and Services Administration (HRSA) to designate health professional health shortage areas and medically underserved communities in proposing broad boundary lines. Based on this study, the Baton Rouge areas showing the largest gaps in health care access were all of or parts of the following zip codes: 70801,70802,70805,70806, 70807, 70811, 70812 and 70714. Additional data that drills down to population characteristics within census tracks and neighborhoods in these zip codes would be used to better refine and define the boundaries.
Health Equity Initiatives
The law grants hospital service districts broad authority to provide a wide range of health-related services. Commissioners appointed to govern this “Health Equity District” would conduct needs assessments, develop short- and long-range plans based on needs, and appoint appropriate staff to ensure that the services are delivered directly, through collaborative agreements or contractual arrangements. The health-related services could include, but would not be limited to, medical and dental clinics, pharmacies, mental health and substances abuse treatment centers, wellness programs, transportation, fresh food financing, and accredited training programs for health care jobs created in the district. Developing such a district focused on advancing health equity means establishing, planning, funding and implementing the project with the people living in the community. Engaging residents at all points in the decision-making processes of the district is essential for it to truly be a “health equity district.”
Based on the preliminary studies conducted by the Louisiana Primary Care Association in the 2019 “Bridging the Gap” report and data collected by various state and local COVID-19 task forces, one of the priority initiatives of the Health Equity District will likely be the opening of preventive and primary care services. The proposed model of service delivery would be the Federally Qualified Health Center (FQHC) model. FQHCs are community-based health care centers that receive funds from the federal Health and Human Services to provide preventive and primary care services in underserved areas. They must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay and operating under a governing board that includes patients. The FQHC is a “one-stop-shop” that provides preventive and primary care, dental, pharmacy, mental health assessment and treatment, and some specialty care.
Three FQHCs (Baton Rouge Primary Care Collaborative, CareSouth and Open Health) are now operating in several locations in north Baton Rouge. With funding and support from the Health Equity District, the existing corporations could possibly expand to new locations and/or new entities could open new primary care sites. In the past year, especially since COVID, more healthcare entities are looking at expanding facilities and services in North Baton Rouge, which the hospital district could coordinate across agencies.
The Health Equity District will be governed by a board of commissioners appointed by the Metropolitan Council. The number of commissioners range between five (5) and nine (9) in the various parishes. The number and types of expertise required of each commissioner will be set forth in the law establishing the district. At least one member of the board of commissioners shall be a resident in the district and at least ____% of the commissioners must receive one health services from a program within the district. Together Baton Rouge believes community level governance can and should be included in the planning and decision-making processes because advancing health equity involves shifting power to those most impacted by the inequities being addressed by the district - “nothing done for us, without us”.
Revenue and Financing
The Health Equity District will be a political subdivision of the state with the authority to issue tax-exempt bonds and call for election among voters residing within the boundaries of the district to dedicate tax revenue to fund the district. According to one study, there is a substantial property tax base in the targeted communities and a millage can be approved in the same manner as BREC, Council on Aging and the Library Board of Control. Additional studies by an economist can provide solid estimates on the amount the community could generate on their own behalf. As a political subdivision, the Health Equity District will also be eligible to apply for capital outlay funds thorough legislators for building projects.
Ongoing and sustaining revenues for the providers or health centers within the Health Equity District would include charges for services to patients, payments from insurance companies, and receipts from other governmental agencies in the form of reimbursements and grants. Medicare and Medicaid reimbursements will make up a large part of the revenue. Federally Qualified Health Centers are reimbursed for services rendered to Medicare and Medicaid patients a prospective rate, with final settlement determined annually after a cost report is submitted to and audited by Medicare/Medicaid program officials.