Robust Health Regulators Making Government Work for Everyone

Government works. No, not all the time. And yes, we’d often like it to work better. As Winston Churchill famously said in 1947, democracy is ”the worst form of government, except all those other forms that have been tried from time to time.” This week there was an example of government really working well in North Carolina – and working for the rural areas, small towns and sometimes passed-by parts of our state.

NC health regulators who decide whether hospitals can have permission to move away from rural areas to the wealthier and more populous regions of the North Carolina have been considering such a proposed move in Franklin County. Their decision? Franklin Regional Medical Center, in partnership with UNC/Rex Hospital, was forcefully denied permission to move closer to Wake County.

In reading over the state’s official decision document, it’s clear that the two major reasons the move was denied were the effect on healthcare access for elderly and lower-income folks and the serious quality problems that apparently resulted in a hospital death. Looking closer though, there was reassuring detail and tone to this dry state ruling that spoke of a deep and abiding commitment of these regulators to do their very best for every person in North Carolina – regardless of income, geographic location, or political connections. For example, the decision speaks of the impact of increased driving time on small rural communities in Franklin like Centerville:

The applicants did not adequately demonstrate that more than doubling the time it takes to reach the hospital would not adversely affect the residents of Centerville with respect to access to services currently provided by FRMC.

Regulators were willing to go further however with their concern about rural communities in the northern and eastern parts of the county:

[T]he five census tracts that will be negatively impacted in terms of geographic accessibility by the proposed relocation of the hospital to Youngsville included almost 57% of the population of Franklin County in 2000. Even if the population of the southern and western census tracts increased at a faster rate than the population of the northern and eastern census tracts, a substantial percentage of the population of Franklin County would still be negatively impacted by the proposed relocation. Further, the residents of Franklin County who will be negatively impacted by the relocation include relatively higher populations of medically underserved groups, including lower income persons, the elderly, and racial minorities.

In other words, a hospital can’t get away with abandoning the people in serves just because there are richer and greener pastures nearby. A new need in a different area doesn’t outweigh the needs of the area currently served, even if it might not be as profitable a place.

Every North Carolinian should be proud of our state employees who did the research, looked at the data, drove the roads, and thought about the interests of all people — including people who often don’t have as strong a voice as those who give big campaign contributions or hire fancy public relations firms or get multi-million dollar executive salaries for running for-profit hospital chains. It isn’t easy to stand up to that sort of pressure. The dry language of a regulatory decision reveals, in this case, a respect and concern for rural and lower-income areas of our state that is often missing in Raleigh political circles. Trying to guarantee quality health access for everyone in North Carolina makes us a better, more productive and fairer state. And that’s democracy that works.

One Comment

  1. Hadley Callaway

    May 4, 2008 at 9:34 am

    The DHSR regulators may have concern for the citizens, but the State Health Coordinating Council does not. Otherwise, they would consider the number of facilities per capita in each county when they decide where new Certificates of Need will be issued. There is no place in the State Medical Facilities Plan where the number of facilities per capita is even listed!

    You wonder why there are two North Carolinas? Because there is very little healthcare in rural areas. Healthcare is a major economic engine. Also, businesses cannot locate where their employees will not have healthcare.

    There are no facilities, the SHCC says, because there are no doctors to drive usage. This is a chicken and egg phenomenon. It has to start somewhere. There should be an effort to locate new medical facilities in areas where the population is underserved.

    Also, I would refer you to an interesting report by Georgia Watch (http://www.georgiawatch.org/documents/NorthsideWhitePaper_000.pdf).