• 46°

John Hood: Boost health access by lowering cost

By John Hood

RALEIGH — Although policymakers sometimes portray increasing access and reducing costs as separate objectives for health care reform, the two are closely related.

When North Carolinians lack immediate access to primary care or mental health services, they bear the cost either of waiting for an appointment or traveling long distances to get the care they need.

According to the state Department of Health and Human Services, 82 of North Carolina’s 100 counties rate poorly in access in primary care. Most are exactly where you’d expect them to be, in our state’s most rural eastern and western areas.

Thinking about a lack of health care access as an additional cost helps clarify what might otherwise be muddy issues. For example, advocates of Medicaid expansion, Medicare for All, and other expansive approaches to government finance of health care tend to conflate price and cost. It certainly matters who pays the bills — patients, taxpayers or some combination thereof. But shifting the price from (relatively) shallow pockets to (apparently) deep pockets doesn’t necessarily change the cost.

Indeed, in some cases it may increase the true expense of delivering the service by making patients less cost-conscious or by imposing regulatory burdens that exclude some providers from the market, thus reducing competition.

In large swaths of North Carolina, access to medical care is a big problem. Let’s tackle it, in ways that don’t shift costs but actually reduce them.

One idea is to make it easier for advanced-practice nurses to set up shop in rural areas. For example, North Carolina is one of only 12 states requiring that nurse practitioners, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists agree to be “supervised” by a physician. I put that term in quotes because, in reality, the supervision is minimal — sometimes the docs and the nurses are separated by hundreds of miles and rarely see each other — but the latter must pay the former for the privilege.

A bill making its way through the General Assembly this year, the SAVE Act (which stands for Safe, Accessible, Value-directed and Excellent care), would address this and other unwarranted obstacles to providing affordable primary care in rural areas.

Another solution in some circumstances would be to expand the use of technology. While ill-suited for some services and patients, telemedicine is already used routinely and effectively to diagnose conditions, prescribe or supervise treatment, and provide counseling services. It could do more to expand access under the right regulatory framework.

To be more specific, North Carolina should not let its licensing laws block rural residents from accessing out-of-state specialists as long as those physicians are in good standing with their home states’ medical boards.

On the other hand, state lawmakers shouldn’t try to “help” the field expand by dictating to health plans how they must pay for telemedicine services. “If insurers are forced to pay for virtual services at the same rate as in-person services,” explains John Locke Foundation health-policy analyst Jordan Roberts, “there is no incentive for the utilization of technology that has the potential for cost savings and a more patient-centered form of care.”

No matter what policymakers do, there will still be local differences across North Carolina in access to medical services. People choose where to live based on a host of considerations. Some prioritize urban amenities. Others place a higher value on housing prices, family roots, rural lifestyles, and wide-open spaces.

Given economies of scale, some health care institutions and options are only going to be available in metropolitan areas. But the gaps don’t have to be as wide as they are now. Better access to primary care, in particular, will help keep rural North Carolinians healthier while saving time and money. That will, in turn, strengthen rural communities.

We don’t need to break the bank or vastly expand government to accomplish the goal. We simply have to reduce regulatory barriers so that health providers and patients can make mutually beneficial arrangements. We have to target cost, not just price.

John Hood (@JohnHoodNC) is chairman of the John Locke Foundation and appears on “NC Spin,” broadcast statewide at 7:30 p.m. Friday and 12:30 p.m. Sunday on UNC-TV.

Comments

Nation/World

Senate Democrats strike deal on jobless aid, move relief bill closer to approval

News

Duke Life Flight pilot may have shut down wrong engine in fatal crash

News

Two NC counties get to participate in satellite internet pilot for students

Local

PETA protesters gather in front of police department

Coronavirus

UPDATED: Eight new COVID-19 deaths, 203 positives reported in county this week

Crime

Sheriff’s office: Two charged after suitcase of marijuana found in Jeep

Crime

Thomasville officer hospitalized after chase that started in Rowan County

Local

Board of elections discusses upgrading voting machines, making precinct changes

News

Lawmakers finalize how state will spend COVID-19 funds

Local

Salisbury Station one of several ‘hot spots’ included in NCDOT rail safety study

Education

Essie Mae Kiser Foxx appeal denied, school considering options

News

Iredell County votes to move Confederate memorial to cemetery

Nation/World

Lara Trump may have eyes on running for a Senate seat

Local

Rowan among counties in Biden’s disaster declaration from November floods

Local

PETA plans protest at Salisbury Police Department on Friday

Education

Essie Mae Kiser Foxx appeal denied, charter revoked

Coronavirus

29 new positives, no new COVID-19 deaths reported

Crime

Blotter: Woman charged with drug crimes

News

Nesting no more: Eagles appear to have moved on from Duke’s Buck Station

Business

The Smoke Pit leaving downtown Salisbury for standalone building on Faith Road

Education

Shoutouts

High School

High school football: Hornets’ Gaither set the tone against West

Local

Salisbury to show off new fire station

Education

Livingstone College to host virtual Big Read events this month