ARIEL HART / ahart@ajc.com

Opinion: Putting Ga. on a path to better health care

In 2018, the United States had the highest rate of maternal deaths in the developed world. Shockingly, 60 percent of pregnancy-related deaths were preventable if the patients had access to better medical care — and mothers in Georgia are especially vulnerable. In fact, preventable sources of maternal mortality were the most common cause of pregnancy-related death in rural areas of the state.

It’s time for the state to encourage the type of innovative solutions that will give Georgians greater access to the care they need.

The nearly one in five Americans living in rural areas struggle to find quality care, facing physician shortages, minimal access to specialists, and long travel times to clinics, among many problems. Rural hospitals are now closing at an alarming rate. Seven rural hospitals failed in Georgia since 2010, and that could be just the tip of the iceberg of unsustainable hospital finances.

Another 26 rural hospitals across the state, or 41 percent of Georgia’s existing rural hospitals, are at high financial risk. In most of those communities, the endangered hospital is indispensable, not just to health but to local economic well-being. One study found that when a hospital closes in a rural area, income per capita drops by 4 percent and unemployment levels rise by 1.6 percent. Closures have far-reaching detrimental impacts beyond access to care.

Provider shortages put rural residents at risk. In Fulton County, Georgia’s most populous county, the physician-population ratio is 922 residents per practicing physician. By comparison, Taliaferro, Georgia’s most rural county, has zero practicing physicians in the entire county. In 2016, Taliaferro County had a premature death rate three times higher than Fulton County. Mothers living in rural areas with provider shortages have higher rates of pregnancy-related mortality.

Obstetrical unit closures in rural areas are becoming more common, mainly due to low patient volume and staffing difficulties. This translates to rural Americans facing difficulty accessing the specialists they need. The consequences of these closures can be dire: Decreased prenatal care, increased out-of-hospital births, low birth weight, and even sometimes infant mortality are all associated with the closure of rural obstetrical units.

A lack of specialists leads to clinics being inadequately trained to treat complex health problems. Given the unpredictable nature of pregnancies and childbirth, even standard births and low-risk pregnancies can now become dangerous.

Loss of obstetrical services, alone, is associated with a 5 percent increase in pre-term births. This is believed to be in part due to reduced prenatal care and expectant mothers’ stress and anxiety from living long distances from their providers.

What can be done to save newborns and mothers across Georgia? Unfortunately, rural health factors such as population health and provider deficiencies are unlikely to improve anytime soon. The Mercatus Center’s “Fortress and Frontier in American Health Care” research points to improvements in information technology as an answer to addressing these pressing issues.

Telehealth, defined as the remote diagnosis and treatment of patients through telecommunications technology, is already being used in many rural counties across the country, and mothers using these services are seeing positive results.

In a 2018 study published by the Mayo Clinic, 300 women with low-risk pregnancies were split into two test groups. Some mothers received standard prenatal care through 12 in-person office visits, while the others were assigned eight in-person office visits and six telehealth virtual visits. While there was no difference in patient outcomes, women in the telehealth group reported significantly higher levels of satisfaction with the care they received. In another trial, the use of telemedicine in Arkansas allowed patients in rural areas to access maternal-fetal medicine specialists and reduced by 50 percent the need to travel long distances to see a provider.

Mercatus’ Healthcare Openness and Access Project (HOAP), which measures how open and accessible each state’s healthcare system is to patient and provider preferences, currently ranks Georgia 50th out of 50 states and the District of Columbia. While Georgia allows some telemedicine, its practice is limited. The state currently uses a “hub and spoke” model, for example, that requires Medicaid patients who could benefit from telehealth services to be at a physical office location with a trained provider, instead of their homes.

There’s room for improvement when it comes to providing greater access to health care in Georgia. Legislators could expand laws that allow for the free flow of medical development, such as innovative payment models for services utilizing telemedicine. Simply embracing the technology that already exists is a step in the right direction.

Darcy Nikol Bryan is an associate clinical professor at the University of California Riverside and has an active practice in obstetrics and gynecology. Her research encompasses public policy and the impact of technology on healthcare provision with a focus on women’s health. Davis Warnell is a program associate with the Mercatus Center at George Mason University.

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