Health care solutions for rural Wisconsin

If you live north of Highway 10 in Wisconsin and you need health care, the chances are high you are, or will be, a patient at the Marshfield Clinic.

With 55 clinical sites and more than 700 physicians, the Marshfield Clinic is a dominant source of health care in northern, central, and much of western Wisconsin. From dental clinics to food safety testing to research in about 400 active studies, the clinic offers a surprising array of services to its 400,000 or so patients.

While the nearly 100-year-old clinic strives to make it all appear seamless and easy, it’s not immune to the unique challenges of providing health care in rural Wisconsin — or much of rural America, for that matter.

Meeting those challenges is an often-overlooked ingredient in rural economic development strategies, especially in communities where distance, cost, income levels, access to technology, and a lack of trained medical professionals can combine to crimp growth.

“We’re all facing the issue of the affordability of health care,” said Dr. Susan Turney, chief executive officer of the Marshfield Clinic Health System, during a recent meeting of the Wisconsin Technology Council in Minocqua. “But it is more pronounced in rural areas.”

Demographics are a major reason why. The 30 or so counties in Marshfield’s service area skew older than Wisconsin as a whole — and also poorer. In fact, the ratio of paid workers to people who receive Medicare in the clinic’s service area is about 1.5 to 1, nearly half the national worker-to-beneficiary rate of about 3 to 1. About 25 of the counties in the clinic’s general service area have poverty rates at or below Wisconsin’s poverty rate, according to 2012 figures from the UW–Madison Institute for Research on Poverty.

While that doesn’t prevent the clinic from being one of the largest and most effective health systems in the state, it complicates how it reaches patients in more remote locations.

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Telemedicine is a part of the answer in rural Wisconsin. The Marshfield Clinic was one of the first health care organizations in Wisconsin to institute telemedicine in 1997, although many others have done so since. Telemedicine is practiced through video connections to help patients in one location get treatment or advice from health professionals elsewhere. Applications can range from digital stethoscopes to devices to hear heart and lung sounds to rapid stroke diagnosis, all done remotely.

The technology isn’t cheap, of course, and broadband connections are essential to delivering the service. That’s not always ubiquitous in rural Wisconsin.

Other trends defining rural health care nationally include expanded outpatient care, home care, and delivery through non-traditional settings, such as retail stores. Electronic health records are practically a necessity in rural settings due to distance, which is why Marshfield Clinic launched its in-house records and software system years ago. Because dental care is tied to so closely to overall health, especially for children, the Marshfield Clinic operates dental centers in multiple locations.

One of the biggest issues facing rural Wisconsin and America is the mismatch between people and doctors. About 20% of the U.S. population lives in rural settings — and those people are served by just 10% of the nation’s doctors.

A similar gap exists within nursing, which is why several campuses within the University of Wisconsin System and the state’s private colleges are expanding their nursing training programs.

According to the National Rural Health Association, rural residents are less likely to have employer-provided health care coverage or prescription drug coverage, and rural poor are less likely to be covered by Medicaid benefits than their urban counterparts. Health issues disproportionately found in rural settings include hypertension, death and serious injury from many types of accidents, alcohol abuse and tobacco use, and access to mental health services.

As policymakers weigh strategies to attract more talent, jobs, and wealth to rural Wisconsin, planning for health care needs, costs, and delivery should be a part of the discussion. Health care is changing rapidly in the United States, and rural America can’t afford to fall behind.

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