The Transylvania Times -

Losing Rural Health Care


Last updated 1/15/2020 at 2:52pm

A story entitled “Rural County Buys Its Own Medical Machines” on Page 9A in today’s paper about Graham County purchasing its own CT and mammogram machines reflects the complexity of issues that make rural health care problematic.

Graham County, which borders Tennessee, has a population of 8,500 people. With so few people in this remote county, it is cost prohibitive for private physicians and medical groups to work there. As a result, the county has just four physicians. The nearest hospital is an hour away and there are no specialists nearby. It is a health care desert.

Since health care is scarce, residents have to seek many treatments at facilities an hour or more away. But Graham, like many rural counties in North Carolina, is poor and many of its residents do not have the financial means to travel long distances for care. Pregnant women have to travel at least an hour away because the nearest hospital that offers labor and delivery services is in Sylva. Those services had been available in nearby Murphy, but those services were eliminated because Erlanger Health System, which owns the Murphy hospital, said the demand for labor and delivery services had declined. Erlanger is not alone in making such decisions. Mission Hospital closed the birthing center here at Transylvania Regional Hospital, as well as its hospitals in Mitchell and Macon counties. Eliminating labor and delivery services in rural counties is a nationwide trend.

Residents in Graham County, however, also did not have close access to medical machinery from which many residents could benefit – in particular, mammograms and CT scans. The mammography machine cost $284,215 and the CT machine $404,527, costs too high for the four physicians to afford. Those machines were not obtained by the county without a fight. North Carolina requires medical facilities to obtain a certificate of need (CON), which indicates the machinery is necessary to provide medical care but is not providing duplicate services. CONs are not easy to procure, partly because it can reduce profits for those who already have the machinery. Since no private medical entity was providing these necessary machines in Graham County, the state provided the CON and the county was able to purchase the equipment.

Strict proponents of private enterprise, however, fear government competition. But in many cases involving health care, private enterprises are absent because they cannot make the profit they desire. Are those people, like those in Graham County, supposed to do without local health care? Government has often stepped in to provide services where private enterprise has left a vacuum. Without government intervention, we would not have Medicare or Medicaid, which have been a bulwark in providing improved health care to the elderly and impoverished.

Government programs, however, can be abused and some of the citizens have abused Medicaid. Graham County is a sinkhole for Medicaid, which spends about $2,000 per person in that county. One reason is that people do not use medical services properly. According to the article, more than 70 percent of ambulance calls are not for emergencies. This is a gross waste of taxpayer money and emergency services. Apparently, some irresponsible residents in Graham County feel no compunction about wasting government money or services. However, some of those unnecessary calls might be made because residents have not had medical checkups. As a result, whenever an elderly man feels a burning pain or a pregnant woman who has never been to an obstetrician/gynecologist feels an unknown pain or discomfort in her abdomen, they may truly believe they need to go a hospital immediately.

The inferior health care situation in Graham County is the result of multiple interwoven factors: its remote location and sparse population; residents who improperly use government services; a small number of physicians; an absence of specialists, modern medical machinery and medical facilities; a lack of private investment due to the improbability of profits due and a population whose health is not improving despite Medicaid.

Unfortunately, Graham County is not an anomaly. With the closing of several rural hospitals in the state, as well as the elimination of specific services in others, medical access and care in rural counties seems to be getting worse, not better.


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