New Hanover Regional Medical Center
Community Health Needs Assessment
September 30, 2016
The Community Health Needs Assessment is a requirement of the Internal Revenue Service of all nonprofit hospitals and is to be updated every three years. It was expected that hospitals not duplicate the work of other agencies that routinely complete Community Health Needs Assessment surveys, and that is the case here, as this document draws heavily on work done by the Health Departments in New Hanover and Brunswick counties in 2015, and Pender County in 2014. The medical center owes each a debt of gratitude.
This assessment will include a demographic overview of the community served, a review of process and methods used, a summary of input from other agencies, a prioritized description of health needs, a review of leading causes of death and health concerns, a review of the medical center’s existing facilities and resources, and an implementation strategy.
The implementation strategy of this Community Health Needs Assessment was adopted Oct. 19, 2016, by the Strategic Planning and Facilities Committee of the NHRMC Board of Trustees.
New Hanover Regional Medical Center was planning to undertake a full strategic plan review in early 2017. The findings of this assessment will be published in time to inform that planning review.
New Hanover Regional Medical Center is the tertiary, or specialty, hospital in Southeastern North Carolina, with its primary service area including New Hanover, Pender and Brunswick counties. NHRMC also serves, on a more secondary basis, the counties of Columbus, Onslow, Duplin and Bladen, and is receiving a growing number of referrals from additional counties in the region, to include those in South Carolina. But 79% of hospital discharges in those three primary counties are from New Hanover Regional Medical Center, and this was the determining factor in defining “community served” for this assessment.
The medical center opened in 1967 as New Hanover Memorial Hospital. A public referendum passed in November 1961 to build the new hospital, which merged separate black and white hospitals without protest, riot or bloodshed – a crowning civil rights achievement in the South in 1967. Since the day it opened, the hospital has served all in need of its care, regardless of race, ethnicity, creed or ability to pay.
Though the hospital was built to serve New Hanover County, it quickly became the hospital of choice for specialty services in the region, a reality the hospital later acknowledged by renaming itself “New Hanover Regional Medical Center” in 1991. The hospital has never received tax dollars for its everyday operations, and it paid off all county taxpayers’ building debt in 1993. All total, the county’s taxpayers have invested about $23 million, total, in NHRMC during its 49 years of operation, or less than a half million per year. In return, NHRMC has provided indigent care and community benefit in the billions, and has created an economic engine worth billions annually to the region’s economy.
The primary service area of NHRMC is the southeastern coast of North Carolina, which has parlayed its natural beauty and temperate climate into tremendous population and business growth in the past 25 years. The three counties’ population of 400,734 (New Hanover 220,538, Brunswick 122,765 and Pender 57,611) has doubled since 1990. From 2010 to 2015, Brunswick’s population grew by 14.30%, Pender’s by 10.4% and New Hanover’s by 8.7%.
This population is largely Caucasian in all three counties, including 81.4% in New Hanover; 85.5% in Brunswick; and 79.9% in Pender. African-American is the largest minority, with 14.3% in New Hanover; 16.6% in Pender; and 11.1% in Brunswick. The state average for Caucasians is 69.6%, while the state average for African-Americans is 21.5%.
The Latino population continues to grow, though not as quickly as in past years. The fastest growth is in Pender County, which grew from 4.9% in 2010 to 6.5% in 2015. In New Hanover County, 5.5% of the population is Latino, and the percentage in Brunswick County fell to 4.8% (from 5.2%). The region’s climate is suitable for large farm operations, which in turn draws a large migrant, Latino workforce. Native American and Asian minorities make up around 2%, combined, in the region.
As an attractive site for retirement, the region has a larger-than-average – and growing – retirement population. In Brunswick County, 28% of the population is older than 65, a marked increase from the 22.5% just five years before. In Pender, this group makes up 17.4% of the population, and in New Hanover, it’s 16.2%. The statewide rate for population greater than 65 is 15.1%.
Children less than the age of 18 make up 22.2% of the population in Pender County; 19.2% in New Hanover and 16.7% in Brunswick. Statewide, the percentage of children less than 18 is 22.8%. So the primary populations served by New Hanover Regional have considerable more retirement-age people and fewer children than the state as a whole.
Children in New Hanover County graduate from high school or a higher level at a rate of 91.2%. Some 37.2% receive a BS degree or higher. The county has 46 public and 25 private schools. The dropout rate is 2.8%, and 44% of the students in public schools in 2016 were enrolled in free or reduced lunch programs. The state average is 56%.
In Pender County, 85.9% graduate from at least high school and 21.6% receive a BS degree or higher. The county’s dropout rate is 1.84%, and 63.7% receive free or reduced price lunch.
In Brunswick County, 86.4% graduate from at least high school and 25.4% go on to receive at least a BS degree. Some 3.8% percent drop out of school, and 63.7% receive a free or reduced price lunch.
Regarding economy and employment, New Hanover County is by far the most urban of the three counties, and therefore is home to the region’s largest employers, the largest of which is New Hanover Regional Medical Center. Median household income in 2014 was $49,582 in New Hanover County; $46,955 in Brunswick County and $44,526 in Pender. The state median household income in 2014 was $46,693.
New Hanover County features a workforce that relies on tourism, health care and social assistance, retail trade, hotels and food services, and professional, scientific and technical services. A byproduct of its climate and coastal location is EUE/Screen Gems Studios, though policy decisions at the state level has reduced the number of major motion pictures, television series and commercials. Other large employers include PPD, General Electric, the University of North Carolina at Wilmington, and Verizon Wireless.
Brunswick County’s economy is based on retail trade, health care and social assistance, hotels and food services, construction, entertainment and recreation. Its largest employer is also its largest hospital, Novant Health. Pender County’s economic leaders are in health care and social assistance, retail trade, hotels and food services, manufacturing and real estate.
By 2016, the counties’ service economies were recovering from the economic downturn at the end of the century’s first decade. All three primary service counties had unemployment rates less than half of what it had been in 2012. Brunswick County’s unemployment rate stood at 5.5%, and Pender County’s rate was 4.9%. New Hanover County had a 4.7% unemployment rate. The state’s overall rate was 5.2%.
Despite employment recovery, the numbers of those living in poverty increased from 2011 to 2014. In New Hanover County, the poverty rate stood at 18%, up from 14.3% in 2011. Some 21% received Medicaid, the federal/state government insurance plan for the poor. In Pender County, 15.4% lived in poverty, and 25% had Medicaid. In Brunswick County, 15.7% lived in poverty, with 33% on Medicaid. In the state as a whole in 2014, 17.2 % lived in poverty and 18.4% received Medicaid.
Economic recovery and changes in national healthcare policy did reflect improvements in insurance status among the primary market area. In North Carolina in 2014, 15.2% of adults under age 65 were without health insurance. In Brunswick County, 17.4% of its people were uninsured, Pender County had an uninsured rate of 16.3% and New Hanover County’s rate stood at 14.5%.
Access to a primary care physician continued to be an issue, though that situation improved in Brunswick County. New Hanover County in 2014 had 10.3 physicians per 10,000 people, but in Brunswick, that figure increased to 8.4 physicians per 10,000 (up from 6.3 in 2011). In Pender, the rate remained at 2.8 per 10,000.
Process and Methods Used to Conduct the CHNA
This Community Health Needs Assessment owes a debt of gratitude to the public health departments in New Hanover, Brunswick and Pender counties, each of which produced a Community Health Needs Assessment for their individual counties in 2014 or 2015. Those assessments helped guide the priority and discussion of health concerns in this region. In all cases, details, statistics and further information on each health concern can be found within these assessments. What is presented here is a distillation of the work those county health departments put together.
These assessments can be found on line as follows:
Also, New Hanover Regional EMS, in the context of preparing for its Community Paramedicine program, compiled this Community Health Needs Assessment as well.
Priorities of health care needs of uninsured or under-insured groups were supplied through an emailed survey to community leaders of efforts to serve those populations. Agencies assisting with this effort include Community Care of the Lower Cape Fear, South East Area Health Education Center, New Hanover Regional Medical Center, Cape Fear HealthNet, and Coastal Horizons.
For nationwide and statewide health statistics and trends, data over the last three years was gathered from the U.S. Census, the N.C. Centers for Health Statistics, the Cecil Sheps Center for Health Services Research at UNC-Chapel Hill, the N.C. Division of Public Health, N.C. County Profiles, N.C. County Health Care Rankings, N.C. Institute of Medicine, and the Healthcare Business Market Research Handbook.