Weeds have punctured through the vacant parking lot of Martin General Hospitalās emergency room. A makeshift blue tarp covering the hospitalās sign is worn down from flapping in the wind. The hospital doors are locked, many in this county of 22,000 fear permanently.
Some residents worry the hospitalāsĀ sudden closureĀ last August could cost them their life.
āI know we all have to die, but it seems like since the hospital closed, thereās a lot more people dying,ā Linda Gibson, a lifelong resident of Williamston, North Carolina, said on a recent afternoon while preparing snacks for children in a nearby elementary school kitchen.
More thanĀ 100 hospitals have downsized services or closed altogetherĀ over the past decade in rural communities like Williamston, where people openly wonder if theyād survive the 25-minute ambulance ride to the nearest hospital if they were in a serious car crash.
This issue is a bit more complex than just āhospitals shouldnāt be for profitā. Not to dismiss thatās a big driver here, but thereās a lot more going on.
Rural communities tend to have lower insurance coverage, that means for the people who do show up, their debt will eventually go into collections or be completely written off as a loss. Rural communities have vastly less access to better insurance and many just completely forgo insurance altogether.
Additionally, rural communities have a tendency to enter a death spiral between visits and costs. The number of people showing up at the hospital is low, but for the ones that do they show up with incredibly expensive conditions.
A lot of the financing and extended lines of revenue for rural hospitals is tied into the expanded Medicaid offerings under the Affordable Care Act (ACA). Thereās clear demonstration that states that have opted to not expand Medicaid are the ones overwhelmingly facing hospital closures. States that have expanded still face issues, but states that have not are facing worse outcomes for rural hospitals.
Finally, costs for healthcare have steadily increased at rates that outpace pretty much every program out there. Pharmaceutical companies are ever shifting costs of materials and medication making long term planning difficult. These companies cite new regulation requiring a remixing of their costs of products. Basically, if some state mandates $30 insulin, that makes cancer treatment go up some, massive percentage. So a requirement to reduce cost to consumer in one area induces an increase in cost somewhere else.
And no just telling hospitals they canāt drive a profit wonāt fix the issue. The doctors, insurance, coverage, politics over the ACA, the education of those doctors, the supply chain of the hospitals, and the production of medical supplies all have played a role in this. Thereās just thousands of things that have to change or weāre going to see more of this.
The entire thing is predicated on a completely unsustainable economic model. This system we have is completely unsustainable. It was never sustainable, itās just that the losses had to eventually add up enough to run the thing into the ground. And this isnāt limited to just Red States, itās just that the Red States are the ones least prepared for this slowly building problem. This issue is coming for everywhere. Thereās no hospital thatās going to survive this if we do not fundamentally change the system upon which our healthcare is built on.
There are just too many flaws to band-aid here. We have to have a massive overhaul of our system or people are literally going to die. The problem is, that we canāt tell who is going to be at the steering wheel to direct those changes. There has to be a shared vision between the two major political parties that can endure for decades to ensure that whatever new systems is made, is actually built. If the two parties that run our government can never agree, hang it up folks, weāre done here. I know some people are going to take that as an invite to bash the other party, but at the end of the day, we either all work together or we donāt.
We have to have some sort of change to our system like yesterday. It needs to be a massive change that take effect at ALL of the layers within the healthcare system. We cannot keep making minor incremental changes, itās just plugging one hole in the dam only for another one to spring forth.
Biggest change we can make to the whole model is making it non-profit. Hospitals should be patient first in all instances. That is probably the biggest hurdle to clear and then a bunch of the other issues you mentioned will actually be easier to solve. Right now there is too much private equity involved with insurance, hospitals and medical care in general. The costs associated with medical care are outrageous and also need to be addressed.
Welp weāve literally designed it that way so š¤·āāļø
Itās not just the financial part. Thereās still a huge shortage of qualified doctors. Even if you had infinite money to keep rural hospitals open, they couldnāt all be staffed with enough doctors.
Thereās also a management issue. Most doctors are terrible at management, but itās common for doctors to make the bulk of hospital management. Professional managers have the opposite problem as they donāt really understand patient care.
This leads to all sorts of odd problems, a notable one is the 12+ hour shift in most hospitals. This was done in part to reduce patient death, because transfer of care is the cause of most errors.