How did the cost of health care in Graham County become the highest in North Carolina?
In a state ranked second highest for health care costs and third highest for average monthly insurance premiums, in a nation with the most expensive health care in the world, Graham County residents face some of the highest health care costs on the planet.
But why?
When it comes to health care, the more rural the area, the more expensive the health care.
From infant mortality rates to opioid-related deaths, rural areas fare worse than those with higher populations.
The North Carolina Medical Journal explained that “rural residents are generally older, have lower income, face more chronic diseases, and are more likely to partake in risky behaviors, and are generally in worse health” than their urban counterparts, but in a state with so many rural counties, Graham County residents face the highest health care costs of all their rural counterparts.
According to the Health Affairs Journal, much of the expensive is due to lack of access to health care. The county has a lack of providers, with a doctor-to-patient ratio one-sixth the state average. Without local options, the emergency room becomes the primary care physician, with more than one-third of residents using the ER as their regular doctor.
Ambulance rides and ER visits are the most expensive way to obtain health care and hardly the most effective.
With an estimated 80 percent of EMS calls deigned non-emergency, 4-out-of-5 calls drive up the cost of health care unnecessarily.
With no specialists in the county, patients are often referred to those in Asheville – up to two hours away – and twice as far as the nearest ER. Many residents are not willing or able to make that trip and tend to forgo recommended treatments, winding up back in the ER when symptoms return or worsen.
Graham County DSS Director Cris Weatherford cites transportation as “a huge part of the high cost of health care.” In an average month, DSS provides around 1,000 non-emergency trips to doctor appointments. In the month of October, DSS provided gas vouchers or transit for 375 appointments, costing a total of nearly $23,000.
“Medicaid expansion could help so many people,” said Weatherford. “It would bring in federal dollars, and the more people who have health insurance, the more doctors are likely to come here and work.”
With 18.5 of residents lacking health insurance, Graham County is a hard sell to health care providers looking for a place to practice and with the state legislature still locked in battle over Medicaid, change might not be forthcoming any time soon.
Another proposed solution is tele-health, which gives rural residents access to specialists in other areas. However, in a county where only 49 percent of residents have reliable internet or cell phone service, tele-health is some distance in the future.
According to Graham County Health Department Director Beth Booth, there are other cultural issues driving up the cost of care.
“Most people here don’t seek preventative health care, which is cheap health care,” Booth said. “They don’t go to the doctor until it’s to the point where you can’t manage it cheaply.”
Booth is backed up by CDC statistics data, showing that rural Americans are more likely to die from potentially treatable conditions such as heart disease, cancer, injury, respiratory disease and stroke.
Booth also pointed out that the lack of providers makes residents hesitant to seek care.
“If people have one bad experience, they don’t go back. People here are like people everywhere, they like options,” Booth said.
“Here in Graham County, we just don’t have many options.”