Health Care

August 18, 2014

NC task force offers prescription for improving rural health care

The 2.2 million people who live in the state's 60 rural counties are more likely to be sick and to lead shorter lives than their urban counterparts, but the health gap can be narrowed by focusing on seemingly unrelated issues – such as economic development – as well as things that are more directly related, such as persuading more psychologists to settle in rural areas.

The 2.2 million people who live in the state’s 60 rural counties are more likely to be sick and to lead shorter lives than their urban counterparts, but the health gap can be narrowed by focusing on seemingly unrelated issues – such as economic development – as well as things that are more directly related, such as persuading more psychologists to settle in rural areas.

That’s according to the final report released Monday from a statewide task force on improving rural health.

The Task Force on Rural Health was led by the N.C. Institute of Medicine and the state government’s Office of Rural Health and Community Care and funded by the Kate B. Reynolds Charitable Trust.

Since health is closely tied to income, its recommendations include a number of things aimed at lifting the economy in the rural part of the state, even including more access to broadband Internet service.

“The task force really saw education and economic activity as instrumental to the development of improved health in rural communities,” said Adam Zolotor, interim president of the Institute of Medicine, an independent, quasi-governmental group charged with giving state leaders advice on health issues.

The report essentially recommends that state and local leaders, employers, health care providers and nonprofits working with rural populations be mindful of a host of sometimes subtle factors that underpin public health.

Its recommendations include: boosting support for child care and education; bolstering economic development; better educating rural residents about insurance options under the federal health law; promoting better eating and exercise habits among kids; supporting proper incentives for educating, recruiting and retaining health care professionals in rural and underserved areas; and screening and treatment in primary care offices and public health clinics for mental health and substance abuse issues.

The report does not mention Medicaid expansion. A previous Institute of Medicine task force report recommended that the state extend Medicaid coverage under the Affordable Care Act – also known as Obamacare – to more people, something that would not only improve access to health care in rural communities but also pump more money into local economies via health care spending.

According to an unrelated report also unveiled Monday, the decision by Gov. Pat McCrory and Republican lawmakers not to expand Medicaid coverage will cost the state $51 billion in lost federal money and thousands of jobs over the next decade. McCrory said the state Medicaid system was broken and that expanding the program would not help.

That study, issued by the nonpartisan Robert Wood Johnson Foundation and the Urban Institute, a policy research group based in Washington, D.C., says the state will lose nearly $40 billion in Medicaid funding and more than $11 billion in reimbursements to North Carolina hospitals if the state continues to forgo expansion through 2022, according to The Associated Press.

It’s estimated that about 319,000 low-income workers would have gained health insurance coverage had the state expanded Medicaid, the AP reported.

The N.C. Hospital Association estimates the state’s 109 acute care facilities have laid off at least 2,000 employees as a result of the decision to forgo Medicaid expansion, coupled with other state and federal cuts to the entitlement program, the AP said. Conversely, expanding Medicaid would create an estimated 20,000 new jobs statewide.

North Carolina is one of 24 Republican-led states that declined to expand Medicaid under the federal health care overhaul.

Economic emphasis

The Institute of Medicine report’s emphasis on economic development comes from research that shows increased income corresponds to better health, particularly among those with lower incomes.

And rural North Carolinians are not only more likely to be sick, but also more likely to be poor. More than 22 percent of them were at or below the federal poverty line in 2012, compared with 16.7 percent of urban residents.

State and local officials, of course, live and breathe economic development, and would seem to be already spending as much time and money on it as they think proper.

The report, though, isn’t so much saying that more money should be spent as it is urging that everyone involved should better understand all the interconnecting pieces, said Andy Lucas, the Stanly County manager and a member of the task force.

“I would agree that the funding streams are limited,” Lucas said. “I think having this task force begins to draw more focus so that we can be more targeted and more efficient and effective with the use of our resources.”

It’s also less about getting more money than about developing new partnerships and relationships so that everyone involved connects the complicated pattern of dots and uses their limited resources in more effective ways, he said.

Zolotor said that representatives of the group have met with state department heads and the response was encouraging.

“I think this is an opportunity to really underline the issues and say, you know, if (the Department of Commerce) is going to rehab a building for a clinic, let’s make sure the Office of Rural Health knows, and that new clinic isn’t going to be competing with other doctors who are having trouble making ends meet in the community,” he said.

“We don’t want to take business away from existing resources in the health care sector, and let’s also coordinate with the Office Of Rural Health to work on recruitment and retention to ensure we’re getting the appropriate number and kind of health care providers to work in that rehabilitated space.”

Already the report has had an effect, said Chris Collins, director of the N.C. Office of Rural Health and Community Care. Acting on suggestions by locals in eight task force meetings in rural communities, her office has applied for more federal funding for incentives to persuade mental health professionals such as licensed psychologists and social workers to work in rural areas.

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