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The following article written by Adele Woods was featured in Business NH Magazine—September 2009.

Innovation is the Prescription for Rural Health Care

With proposed national healthcare reform looming on the horizon, we must consider the unique needs of NH’s rural areas. For many years, one of the most important issues that rural communities have tried to address is cultivating an adequate, well-trained workforce. The population of NH’s rural communities is older than the state as a whole— 19 percent of Coos County residents are over 65 years old versus 13 percent statewide, according to 2007 state data. And there are fewer people in the workforce with the needed skills to treat them.

With an older population, rural communities need more services, whether it is primary care, specialty, or ancillary services. And with a looming primary care physician shortage, more emphasis needs to be placed on having nurse practitioners and physician assistants as studies show they can provide about 85 percent of the primary care needed. The shortage of nursing school instructors is well-documented and also needs to be addressed, as it contributes to the nationwide nursing shortage, which is especially dire in rural areas where many nurses are working well beyond retirement age.

Rural areas tend to have more self-employed people or small businesses with 10 or fewer employees. Therefore, access to health insurance is problematic and often prohibitively expensive. If the future of health care access continues to be via employer-based health insurance, then special provisions need to be made for those who must purchase their own insurance, whether it is through special pools for small employers and sole proprietors, health exchanges or other means.

The rural areas of NH, especially in the North Country, would make excellent incubators for testing proposed changes to the healthcare system, as these areas are well defined and isolated. Many of the major health care providers already work together through existing collaboratives, both formal and informal, and these would be ideal forums for innovative policies and practices. Technology upgrades on the horizon will lead to increased access to specialty care without travel. Right now, innovations in radiology, telepsychiatry and other areas are being implemented. Rural areas are often willing to bank together and share services that would not be possible in isolation. That mindset leads to a willingness to be flexible and to communicate across various healthcare sectors in unique ways — a necessity for meeting the future health care needs of NH’s rural residents.