For many Americans, health care is difficult to obtain. This has little to do with whether or not they have insurance. Rather, it concerns the distribution of medical resources, the patterns of patients’ lives, and the obstacles we throw in the way of innovation. We can do better.
When I’m sick, my employer is pleased for me not to come to the office. My absence doesn’t cost me any wages. My doctor is nearby and usually sees me the same day I call her. If not, her colleagues see me. There’s a 24-hour emergency room near my house. My city abounds in specialists.
Not everyone enjoys such riches. Some rural counties don’t have a single doctor. Still more lack hospitals and emergency rooms. On Native American reservations, care from the Indian Health Service can be sparse. The problem isn’t just distance from urban centers.
Linguistic minorities often live where no medical personnel speak their languages. Migrant workers and long-haul truckers are often far from home. For those with mobility problems, a trip to the doctor can be an odyssey. Some have lives that make access difficult. Some lose wages if they miss work. For some parents — particularly single parents — it’s difficult to find care for children when there’s a need to visit the doctor. Some in urban centers don’t have access to automobiles; public transport is often spotty and cabs costly. Some have rare medical conditions for which no local providers have expertise. And sometimes, regardless of who and where you are, sickness can come at night, when a trip into the darkness isn’t viable.
In June 2019, the Ways and Means Committee of the U.S. House of Representatives established a bipartisan Rural and Underserved Communities Health Task Force. In contrast with debates over insurance, this effort offers real possibilities for harmonious action. In November, I submitted written testimony about how “Delivery System Innovation Is the Key to Better Healthcare,” recommending eight specific areas to the task force for health care delivery reform:
(1) Get out of the way of telemedicine: Telemed offers medical care at a distance anytime and anywhere cellular or internet signal is available. This can involve video conferencing, remote monitoring, online prescriptions, asynchronous consultations, emails or telephone conversations. Licensing requirements and other regulations sometimes discourage telemed.
(2) Allow nonphysician providers to practice up to their qualification level without physician supervision: Communities short on physicians may be able to fill gaps by using nurse practitioners, physician assistants, pharmacists and others. Requiring physician supervision of these professionals discourages their use.
(3) Abolish or lessen certificate-of-need requirements: Competition among hospitals and other providers is vital to meeting patients’ medical needs and desires. Many states force providers to undergo a lengthy, expensive process of begging the state for permission to provide more care.
(4) Remove obstacles to charity care: Many health professionals find it satisfying to provide charity care to underserved patients. But state-by-state licensing regulations sometimes make it impossible or impractical to provide such care.
(5) Encourage innovative business models: Direct Primary Care and other novel business models offer ways to provide care where traditional delivery methods are impractical. Federal laws and state regulations often discourage the use of such innovative models.
(6) Welcome international medical graduates: While a remote county might find it impossible to attract American-trained doctors and nurses, competent professionals trained in other countries are often willing to fill such gaps in order to gain the chance to live and practice in the United States. Immigration laws and state licensing requirements can prevent this from happening.
(7) Accommodate trailing military spouses: As military personnel move around the country, many bring with them spouses who are qualified health care professionals. However, state-by-state licensing requirements often delay or deter these professionals from working in their new home states.
(8) Enable unmanned aerial systems: In several foreign countries, drones regularly transport blood supplies, drugs and medical equipment from urban centers to more rural areas. U.S. aviation regulations inhibit the adoption of such technologies here.
In many cases, the best path to improving care in rural and underserved communities is to simply get out of the way of those who are qualified to deliver care and wish to do so.