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PAGE 55 Insurance status affects the availability of transportation to medical appointments, particularly for those on Medicare. One provider said: “Patients who need medical care and have a managed care plan, such as Alliance or Anthem Blue Cross, they are able to obtain transportation through their insurance for medical appointments, pharmacy visits, dental visits, and therapy visits. But mainly our patients who have Medicare, it’s difficult for them to have a transportation resource unless they use paratransit or Wheels.” While community health clinics were cited frequently as a regional strength, people noted long appointment wait times and an insufficient number of health clinics overall. This often resulted in emergency room use for routine health care (including prescription refills), as one community member described. “Yes we have access, but it takes us two months in order to get a doctor. So basically, we have to go to the emergency room if we want to get seen right now.” Data show that the dentist ratio for municipalities in the Tri-Valley is in line with or better than the ratios for Alameda County and California. For the four types of providers in Table 21, Livermore notably lags behind the other two municipalities. The ratios for obstetricians or gynecologists and primary care providers are particularly concerning, and likely indicate that people in Livermore seeking prenatal, gynecological, and primary care face barriers to access (Table 21). Although community members acknowledged that the Tri-Valley built a dental clinic (following the identified gap in the 2011 needs assessment7), and PRIMARY CARE PHYSICIAN PRIMARY CARE NURSE PRACTITIONER DENTIST OBGYN Dublin 1,624 4,107 970 3,947 Livermore 2,600 8,840 1,263 11,098 Pleasanton 698 2,040 804 1,611 Alameda County 997 2,394 1,172 3,009 California 1,038 2,324 1,297 3,976 Table 21. Provider to Patient Ratio Source: NNPES NPI 2022 expanded services overall at Axis Community Health, they noted long wait times for dental care. One individual indicated that their children waited 1.5 years to receive dental care. The Kaiser Permanente Walnut Creek Health Center reported that children in need of dental services using general anesthesia must travel outside the Tri-Valley area, leading to the geographic and transportation barriers mentioned earlier in this section.10 Others described the insufficiency of dental coverage through Medicare and Covered California and the difficulty of finding dentists who accept the plan: “Access to a dentist is a very difficult thing. A few dentists don’t want to accept any ‘other than premier’ dental plans. And so, you know, you are in a queue, and there are fewer dentists that do accept those lower benefits for dental types of work. Is that unfair? It’s an equity issue, I’ll say that.” As with other regional opportunity areas, participants noted how the health care system was differentially experienced by sub-groups or -populations. The need for health care services for children was mentioned frequently, with participants noting that kids had to travel to Oakland’s Children’s Hospital for acute and non-acute exams. Seniors were also highlighted as a group with distinct health care and supportive health care navigation service needs. Finally, for non- English speakers and those who speak it as a second language, the need for translation services in health care settings was mentioned frequently and further explored in the linguistic and cultural responsiveness opportunity area. The Stanford 2022 Community Health Needs Assessment also identified Latinx, undocumented people, veterans, and unhoused populations as groups who struggle to access care due to a lack of providers and available appointments.11 EASTERN ALAMEDA COUNTY HUMAN SERVICES NEEDS ASSESSMENTSS Page 113 of 554