In a state which arguably has some of the best teaching hospitals plus an abundance of high quality healthcare systems, it comes as a surprise to learn that North Carolina was ranked as one of the worst states in the country for healthcare. In a recent survey of best and worst states for healthcare conducted by personal finance site Wallet Hub, North Carolina was ranked fiftieth, with the worst state being Alaska and the best state being Minnesota.
The study put a significant weight on three primary characteristics: healthcare costs, access to care, and outcomes. Other measures included the number of physicians per capita, the cost of insurance, the percent of insured, and the prevalence of certain diseases. The study indicated that the low ranking was influenced by the high cost of care in North Carolina, along with the challenges many North Carolinians face accessing care. North Carolina ranked last in both cost and access categories and ranked 33rd in outcomes/mortality rates. While access is not an issue in the major metropolitan cities, parts of the state remain very rural and these communities are facing a shortage of physicians. This shortage of physicians is getting worse as the state is experiencing year over year population growth. To further complicate matters, over the past several years, a pattern has developed whereby physicians are leaving their hometowns for medical training and then are not returning home to serve these smaller communities. Attracting and retaining healthcare providers in rural communities is a top priority for health policy experts in the state. As one potential solution, East Carolina University is looking to receive funding for a new medical school in hopes of alleviating the physician shortage in the eastern part of NC.
When it comes to healthcare costs, it appears that change may also be on the horizon. The topics of how to improve access and reduce cost are at the front and center of debates in the NC General Assembly. The Governor is a staunch supporter of Medicaid expansion in an effort to combat costs and improve access. In a recent and very public and heated standoff, the State Treasurer went to battle with hospital systems throughout the state seeking more transparency in healthcare costs. In an effort to save $300 million for taxpayers and State Health Plan members, the Treasurer’s Office’s plan would require providers to agree to be reimbursed a multiple of Medicare to be considered an in-network provider of the State Health Plan. The payment arrangement was pursuing providers and hospitals to accept 196% of the Medicare rates on average for reimbursement, instead of some undisclosed contracted fees they currently receive. Ultimately, the largest hospitals pushed back and did not agree to these terms, stating this significant cost reduction to the system could lead to reduced services and harm patients. Although the hospital systems won this round, the fight illuminated the need for more cost transparency in North Carolina and the growing sentiment for a change.