Could Medicaid expansion save Kansas’ rural hospitals?
Lack of access to health care is a worrying issue nationwide, but it’s even more dire in rural areas. Last December’s closure of the hospital in Fort Scott, Kansas, is just part of a larger pattern of rural hospitals shutting their doors for good over the past decade. This hurts local economies, and, even more importantly, threatens health care access for people living in the countryside. State governments have an obligation to keep this from happening, and they can — without much effort.
One of the causes of declining rural health care access is hospital consolidation. The number of hospitals has declined dramatically over the past decade, and a focus on larger hospitals means that it doesn’t make sense for hospitals to open in sparsely populated areas. Government regulations are partly responsible for this trend.
Certificate of need laws are regulations that restrict the formation of smaller, more accessible care providers. Under their rules, a potential new provider must prove to state and local governments a “demonstrable need” for a new health care supplier. Established hospitals influence this process to keep smaller providers out of the health care market. As a result, fewer health care providers mean less competition, allowing established hospitals to raise prices.
Rural areas suffer the most from this form of regulation. According to the libertarian-leaning Mercatus Center, states with these laws have 30% fewer rural hospitals per 100,000 residents. Fortunately, Kansas is one of the states that has repealed its certificate of need laws — but they still restrict Missouri’s access to rural health care.
There are other approaches. Allowing health care professionals like physician assistants, nurse practitioners and pharmacists to provide more health services could help. As the Department of Health and Human Services found, nurse practitioners are often not permitted to provide all of the services they are trained to offer for fear their services won’t be up to snuff.
This concern is misplaced. Allowing nurse practitioners to provide more services is shown to improve health outcomes by increasing access and lowering costs. As the U.S. faces a looming shortage of primary care doctors, reforming scope-of-practice laws could address almost 70% of the shortage. This is especially true in rural areas, including parts of Kansas and Missouri: While 20% of Americans live in rural areas, only 12% of primary care physicians practice there. Recognizing nurse practitioners as primary care providers to lower costs and improve access in rural areas is an option that both Kansas and Missouri could consider. A similar policy idea would be to allow pharmacists to prescribe birth control, as 10 states and the District of Columbia have done.
One of the main problems rural hospitals face is a shortage of workers. One solution is to recruit more international medical graduates. In nearly all respects, these workers serve on the front lines of America’s medical needs. Over half of them practice in underprivileged, often rural, communities where per capita income is less than $30,000. In Poplar Bluff, Missouri, physician Raghuveer Kura is the only kidney specialist in town. He sees roughly 30,000 patients a year, and many drive as much as an hour to see him.
Recruiting more foreign doctors into rural communities is also an effective way for states to alleviate shortages in certain medical specialties. This is especially true in eldercare, where international medical graduates represent over half of field specialists. Recently, a bipartisan group of senators re-introduced a bill to help America further capitalize and retain international medical talent. The bill would strengthen a program that allows states to recruit up to 30 foreign physicians to practice in medically underserved communities. And this is exactly the kind of legislation rural areas need.
The reality is that government policy, whether through immigration restrictions or practice regulations, often inhibits rather than improves rural health care access. The answer to a lack of access to health care simply isn’t a top-down government solution. Instead, Kansas and Missouri could improve rural access if the governments would just take a few steps back.
Alex Muresianu is a writer for Young Voices, a 501(c)(3) nonprofit that helps cultivate young thought leaders. He co-authored this with Young Voices’ Sam Peak.