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Health Care Services: Three Critical Roles in Rural Economic DevelopmentEric Scorsone
Over the last two decades, health care services have become a critical engine of growth in rural Kentucky. In 1980, health care industry earnings represented 6.7 percent of all industry earnings. By the late 1990’s, health care’s share of industry earnings had risen to 12.3 percent in rural Kentucky. These statistics indicate that health care is the second largest industry category in rural Kentucky trailing only local government. Furthermore, medical transfer payments, in the form of Medicare and Medicaid, now represent more than 9 percent of rural Kentucky’s personal income. This is contrast to 1980 when these payments only represented 2.9 percent of personal income.
Health services include nursing homes and adult daycare, hospitals, physician and dentist offices, pharmacies, emergency medical services. An important question is why are health care services growing so quickly? These industries are in part responding to the growing levels of retirement and medical transfer payments, Social Security and Medicare, which are occurring in rural Kentucky.
Retirement-based personal income is the fastest source of income growth in rural areas. In 1990, retirement-based income represented 4.1% of personal income, while in 1999 that share had risen to 6.2%. Non-wage income is growing at twice the rate of job and wage based income. Combined with the aging of the population, rural health services will play an increasingly important role in the rural economy. These changes pose important challenges to rural communities. However, for these changes to result in economic prosperity, the source of income must be external to the community.
A community’s economic prosperity is based on export or basic industries. Basic industries are those that sell to customers or businesses from outside the community. These export or external dollars then allow a community to purchase a wider variety of goods and services from other communities. Larger markets also reduce firm costs and create more competitive local firms. In order for a community to prosper, it must attract and retain export or basic industries. For example, many manufacturing facilities sell their products to buyers outside of the county or region of interest. Agricultural producers generally sell their products to consumers outside of the region. Further, health care services, by attracting Social Security and Medicare dollars, are part of the economic base of the community. These retirement and health care dollars are external sources of income from the federal government.
However, health care role as a basic or export industry is only part of its influence on a community’s economy. Health care employers and employees are important purchasers of goods and services supporting many local business establishments. The occupations and employees who in work in health care, such as hospital and nursing home workers, physicians, dentists and pharmacists, are an important source of income in the community supporting services such as housing and construction, retail establishments, restaurants and other local services. The hospitals and other health care institutions are also important purchasers of local inputs such as laundry services, waste management and other resources.
An often-overlooked aspect of the health care system in economic development is the ability to attract and recruit firms based on community services. Company surveys reveal that managers often look at health care as an important issue in locating facilities. The existence of a strong health care network can lower health care costs for firms and their employees and provide value-added services for firms such as occupational health. Also, retirees and workers will be more likely to choose a location that has access to quality health care.
There are three major roles for health care in rural economic development: (1) as an economic base industry attracting external dollars, (2) whose employees and institutions are purchasers of local goods and services and (3) as a factor to recruit businesses and workers. The combination of changing demographics, growth in health care service employment and increased medical transfer payments implies that the health care system will be a major player in the future of rural Kentucky. This fact was recognized in the Kentucky Appalachian Commission’s strategic plan, “State Goal 5.2: Kentucky will recognize health care as a substantial economic sector and pursue strategies to grow the sector” (Kentucky Appalachian Commission, 2000).
The Kentucky Rural Health Works program is working to define and provide greater recognition of rural health care in local economies. This group includes representatives from the Department of Agricultural Economics (Eric Scorsone), Department of Rural Sociology (Ric Maurer), Cooperative Extension (Ric Maurer and Bonnie Tanner) and the Center for Rural Health (David Reese, Woody Dunn, Larry Allen and Bethany Adams). An important aspect of this project is establishing the economic impact of health care in the rural economy. Further studies are attempting to estimate the demand for health care in rural regions and financial feasibility for additional health care facilities.