Saturday, November 28, 2009

Universal health care in rural New Hampshire town

NPR’s Morning Edition broadcasted a story earlier this month about a rural New Hampshire town that provides free health care to all of its residents. Tamworth, situated in Carroll County, is home to the Tamworth Community Nurse Association, an organization with more than 80 years of providing nursing services to the town’s 2,510 residents.

TCNA’s services are available to all of Tamworth’s residents irrespective of ability to pay and access to health care. These services include everything from home visits for treatment or emotional support, making a nurse available to the public and running a meals on wheels program. TCNA represents a unique response to an all too familiar problem in rural America: inadequate access to health care. According to the broadcast:

Like many rural communities, Tamworth has more than the average share of elderly, many who find it hard to get around. And then there's that other rural problem, not enough doctors. There's one doctor in Tamworth. He's so busy that he can't take walk-in patients. The town nurses do. Last year, [Joanne Rainville, the Director of TCNA,] and two part-time nurses fielded 7,000 visits, many in their clinic at the back of town hall.

Rural residents face many challenges to affordable and accessible health care. First, many rural residents must travel considerable distances to visit a qualifying service provider, especially when specialized treatment is necessary. Second, rural households tend to have fewer financial resources than their urban counterparts, which places health insurance beyond the reach of many.

Moreover, the “health status” of rural America is lagging behind the general population, according the U.S. Department of Agriculture. For instance, rural residents are more likely to be age 65 or older. Disability, chronic disease and mortality rates are also higher in rural places than in urban ones, even after controlling for age.

Residents of Tamworth are no exception to the broader trends seen across rural America. So, how is TCNA able to continue providing its own version of “universal health care” to the townspeople of Tamworth?

It's not easy. Rainville writes grants and begs donors for gifts. But she can almost always count on taxpayers for close to a third of her budget. This year, at town meeting, voters said no to cost of living raises for town employees, but they funded the nurses, this time to the tune of $40,000.

With the issue of health care reform creating heated debate and much disagreement, it is interesting to think that one rural town has been offering some form of health care to all of its residents for more than 80 years. It remains to be seen whether TCNA can be viewed as a model for other community's to replicate or if such a program can only exist in this extraordinary community. Nevertheless, TCNA demonstrates the possibility of translating the strong sense of community that characterizes many rural places into a potentially lifesaving service and underscores the ability of rural places to develop solutions to problems that confound policymakers across the country.


CityMouse said...

This reminds be somewhat of Ollie's presentation about the clinic in Montana that offered Bankruptcy services to rural residents. In the same sense, clinics are offered to rural residents who may not be able to either afford health care, or are prevented from obtaining services because of transportation difficulties and where they live. I think this is really groundbreaking. While the level of care might not be state-of-the-art, I think it's important that rural people have access to at least basic health needs and are not penalized for living in rural areas.

camp said...

I love it. Now I don't have to move to Canada or Copenhagen for universal care...
If I'm doing the math right we're looking at a cost per person of just $60 per year for access to free nursing care. And nothing less than home visits! I became home visit convert during my wife's pregnancy - we had a midwife come to our house more than twenty times, including for the birth, and it is another world in terms of quality of care.
I'm surprised to see that they can manage 7,000 visits with an effective staff of less than 3 and a budget of $150k... that works out to just $21/visit. But it's not difficult to imagine that costs would be significantly lower than they are in SF/Sacto areas.
If the healthcare legislation process weren't so intractable a federal subsidy for a TCNA approach to care seems like a healthy idea. More local management, local control but financial and perhaps administrative support from the feds. I won't hold my breath..

Anonymous said...

This actually reminds me of the brief discussion of health insurance co-ops that congressional leaders had for about a week in August. Allowing people to pool together to buy insurance has a similiar effect to providing universal health care for a small group of people; it's the way insurance is largely structured in Germany. This got me thinking. Why isn't there a local health care co-op movement? Why wouldn't small towns and communities band together to buy insurance that would cover the entire town? Obviously, every population varies by the same basic parameters (age, race, etc). However, some of that heterogenity is reduced due to the simple nature of rural demographics. Neighbors in more rural areas would seem to be more likely to face similar health issues than neighbors in rural areas. Furthermore, given the structure of rural economies, the benefits of a healthy local population are likely to be more localized as well. A small community would be better able to select a health care plan that meets its needs, much the way TCNA is responseive to local needs. Perhaps such co-ops would provide better incentives for local health care providers too, making medical care in rural areas that much more sustainable. It would the equivalent of the slow food/local food movement but with less people who have an unheathly obsession with soy.