Primary Care in Rural Minnesota Health Care Economics Presents an Ever-Fluid Reality Rural or urban, young or old, when you need care, you want it to be there for you — affordable, high-quality, and centered around your needs and goals. But the healthcare delivery and payment system is incredibly complex. Hospitals, clinics and individual healthcare providers throughout Minnesota are constantly adapting to market changes on all sides — new organizational affiliations, consolidation, value-based budgeting, population health pressures and declining inpatient care. In rural areas, the challenges can sometimes be more complex and require solutions that are tailored to rural needs. Relatively higher use of government healthcare programs, declining payment rates, changing insurance mandates, and intense workforce issues in rural Minnesota require that we continuously assess and analyze trends to help ensure our healthcare systems are positioned to provide necessary, affordable and appropriate care in communities all across the state. The Minnesota Department of Health’s (MDH) Office of Rural Health and Primary Care tracks Minnesota’s rural health systems and access to primary care for our rural residents, and uses that data to develop and implement programs to address rural healthcare needs.
The map of hospital affiliations shown below begins to reveal the complexities of current market trends. In 2017, half of Minnesota’s rural hospitals were affiliated with a larger provider group. This trend yields mixed results. Hospitals that are part of larger systems may offer increased access to specialty services and may increase their financial viability. But, affiliation can also lead to consolidation of services, meaning some services may be less available in rural areas, and patients may face transportation and other barriers in accessing them. The Data Highlights report also shows how noncompetitive hospital markets are in Minnesota. Analysis shows that highly
concentrated healthcare markets can lead to higher prices. We know that rural areas face a severe shortage of primary care physicians, including OB/GYNs, pediatricians and psychiatrists. Nine Minnesota counties lost hospital birth services between 2003 and 2018, with recent studies finding that increases in preterm births have been associated with the loss of these services in rural areas. Finally, we cannot underscore enough the impact closure of a healthcare facility has on its community. In many rural areas, the clinic or hospital is one of the largest employers in the area, as well as being an important part of a community’s identity. The loss of readily accessible health care causes great hardship to any local community, and then creates a domino effect that makes it harder for other parts of the community to grow. Young families may find it difficult to move to a community that does not offer healthcare services. We are still digging into how consolidation affects rural populations, particularly (Continued on page 14)
Rural Health Care in Minnesota: Data Highlights On National Rural Health Day 2019, MDH published Rural Health Care in Minnesota: Data Highlights (https://www.health. state.mn.us/facilities/ruralhealth/docs/ruralhealthcb2019.pdf ), a chartbook of data from across the department that “paints a picture” of rural health care in Minnesota. By Zora Radosevich, MPA MetroDoctors
The Journal of the Twin Cities Medical Society
March/April 2020
13
