Study: Hurricane Floyd boosted long-term use of N.C. emergency rooms, outpatient services

June 30, 2003

CHAPEL HILL -- Even after its winds abated and smothering floodwaters withdrew, Hurricane Floyd had long-term effects on health care for poor state residents living in counties damaged by the killer storm, a new University of North Carolina at Chapel Hill School of Public Health study shows.

The study, published in the July issue of the American Journal of Public Health, showed that the September 1999 hurricane -- the worst in recorded state history -- produced large increases in hospital emergency room and outpatient services use in affected areas.

"Our findings suggest that hurricane victims experienced substantial changes in patterns of care that endured for much longer than the initial crisis period," wrote lead author Dr. Marisa Elena Domino, assistant professor of health policy and administration. "These findings can have important implications for the management of disaster relief for this population."

Other authors of the report, all at UNC, are Dr. Bruce Fried, associate professor of health policy and administration, Dr. Yoosun Moon, and Jangho Yoon, both public health graduate students, and computer expert Joshua Olinick.

Earlier research showed that the storm dropped almost 20 inches of rain in some areas, killed at least 51 people, closed 250 roads, damaged 67,000 homes and destroyed about 8,000 of them, the authors wrote. It cost an estimated $6 billion. The Federal Emergency Management Agency and the Economic Development Administration found that 44 of the state's 100 counties were substantially affected by flooding.

A survey of 18 emergency departments in eastern North Carolina showed increases in suicide attempts, dog bites, fevers, basic medical needs and dermatitis during the first week following the hurricane. The short-term effect included fewer filled prescriptions and an almost 8 percent drop in hospital admissions for Medicaid recipients that first week and a 4 percent to 7 percent increase in emergency room visits in the first 11 weeks.

Because little work had been done to examine the impact of disasters on actual health services use, the UNC researchers used specialized statistical techniques to analyze July 1998 to December 2000 N.C. Medicaid claims and enrollment data. They were most interested in learning how stricken counties compared with those spared by the storm following the initial crisis.

A year after Floyd, they found no major changes in Medicaid enrollment, but they did find a surprising overall $13.3 million increase in total state and federal health expenditures because of the hurricane, or about $7.14 in additional cost for each Medicaid enrollee per month. The $13.3 million Medicaid total is for the 14 hardest-hit counties for the 12 months following the storm.

"We feel this paper and our findings are important because disaster preparedness has emerged as an increasingly important area of concern," Fried said. "While this work represents only one aspect of preparedness, it is important for us to understand the behavior of people under situations of crisis and high-stress.

Researchers focused on how people in the midst and aftermath of a natural disaster use health services, he said. Findings are relevant to both private and public payers of health services because of the insight we get about how natural disasters affect health care service use and costs.

"Of particular importance is that we looked at use and costs for an extended period after Hurricane Floyd, and identified patterns of health care utilization and cost," Fried said. "Looking at health-care utilization in a longitudinal manner -- rather than only at a single point in time -- should provide payers with information to help than anticipate and plan for changes in health-care service use and expenditures after a natural disaster."
The N.C. Department of Health and Human Services' division of medical assistance supported the UNC study.

Note: Domino is out of town until July 7. Thereafter, she can be reached at or 919-966-3891. Fried can be reached at or 919-966-7355 (w) or 414-9569 (c).

University of North Carolina at Chapel Hill

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