By Sarah McLeod, Social Work Intern with Public Health and Human Services and Martina Johnson, Adult and Home & Community Based Services Supervisor from Cook County MN - August 13, 2021

The Cook County Public Health and Human Services Department conducted a community survey from May 21st through June 12th, 2021 asking county residents to answer questions regarding health care accessibility. Survey questions were specifically aimed at gathering data related to transportation and lodging, but participants were invited to share other concerns related to their experiences accessing health care, both locally and out-of-county. 

Surveys were made available to county residents electronically and in paper format.  In addition to answering formatted questions, residents were offered the opportunity to provide narrative feedback and had the option of participating in a one-on-one interview with project liaison, Sarah McLeod, MSW intern with Cook County Public Health and Human Services.  A total of 127 surveys were collected and compiled. 

Survey Results

The majority of survey respondents indicated that they access primary care and dental care within Cook County.  Respondents needing to access eye care, specialty care, behavioral health/therapy, psychiatry, and chemical health services typically travel 100 miles or more to access this type of care.  Results showed that 39.3% of respondents travel outside of Cook County to access care one or more times per year, 34.4% travel outside of Cook County to access care every few months, and 15.6% of respondents travel outside of Cook County to access health care on a monthly basis.   

While 56.5% of the sample population are able to independently transport themselves to and from medical appointments outside of Cook County, 32.3% need either transportation or physical assistance every time they travel to a medical appointment.  The vast majority of survey respondents use their own vehicle or receive a ride from friends or family to access health care, with only 4.2% using a local support or ride program such as Care Partners, the In-Home Support Program or Grand Portage Health Services and 2.5% using the Arrowhead Transit bus to access health care.  Of participants who have utilized public transportation to access health care, 90.3% rated ease of access as either “somewhat challenging” or “very challenging.”  Limited routes, uncertainty about ride options or hours of operation, and difficulty scheduling a ride pick-up were cited as the primary challenges in using public transportation.   

With frequent construction on Hwy 61 and unpredictable weather conditions, many respondents cited road conditions as their primary concern when traveling to access health care.  Other concerns included the stamina required for lengthy/frequent travel, difficulty locating someone to drive, travel costs, and concerns about extended time away from family.  One-on-one interviews further identified concern from respondents over the limited transportation options available locally for persons who are wheelchair bound.  

Over 70% of respondents have needed to find overnight lodging when accessing medical care outside of the county, with 14.6% needing overnight lodging every time they travel for a medical appointment. When asked about costs, less than 3% of survey respondents have insurance coverage for lodging related to health care and over 43% of respondents reported spending at least $100 per night on lodging when their medical appointments result in an overnight stay.

Suggestions for Improvement

At the end of the survey, participants were prompted to leave their comments and suggestions for addressing the issues noted within the survey. Many respondents indicated wanting to see an expansion of telehealth services and the option for specialists to make regular trips to Cook County to see patients on a set number of days per month.  Respondents overwhelmingly indicated a desire for optometry services to be reinitiated in Cook County.  Suggestions for improving local transportation options included expansion of routes to include more areas of the county beyond Grand Marais, expansion of the route that travels to/from Duluth, the offering of more public transportation options, including volunteer or paid driver programs, and an option for a wheelchair accessible vehicle or vehicles that could be rented for transporting persons with mobility issues.   

Next Steps

These survey results are a first step in solving a critical issue in Cook County. While implementing ideas for improvement can be challenging, having concrete data related to health care accessibility gives a voice to local residents.  In the coming weeks, these survey results will be presented at various community meetings and communicated with local health care and transportation providers.  In addition, results will be made available for use by anyone who is looking to apply for grant funds or has other innovative ideas to meet transportation needs in Cook County.

Learn more about the Assessing Access to Health Care Services survey at the August 17 PHHS Board Meeting. The meeting is available to stream live on the Cook County website at www.cookcountyphhs.org. Contact us via email at [email protected] or follow us on Facebook @CookCountyPHHS  or on Instagram @Cook_County_PHHS to learn more about our work in supporting the health, safety and wellbeing of Cook County.

 County Connections is a column on timely topics and service information from your Cook County government. Cook County – Supporting Community Through Quality Public Service