By Tom Still

MINOCQUA – 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.

Read this commentary in the Wisconsin State Journal here.

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.

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 percent of the U.S.
population lives in rural settings – and those people are served by just 10
percent 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

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.