Rural Economic Development and Health Care: Nebraska’s Rural Health Works Project

1. Rural Economic Development and Health Care: Nebraska’s Rural Health Works Project Roslyn Fraser, MA Section on Health Services Research and Rural Health Policy Analysis Department of Preventive and Societal Medicine

2. Nebraska Rural Health Works is Li-Wu Chen, PhD; Keith Mueller, PhD; Liyan Xu, MS; and Roslyn Fraser, MA Brian Hesford, MA, who makes the maps Denny Berens at the Nebraska Office of Rural Health All rural communities who collaborate in the process

3. Why Nebraska is interested in the Economic Impact of the Health Care Sector • Health Care --- attracts businesses --- attracts retirees --- promotes job growth --- attracts health care employees --- increases human capital in a community

4. Input-output Analysis BACKGROUND • Sectors purchase from other sectors • Sectors sell to other sectors • Sectors sell outside the local economy • Sectors buy outside the local economy (Harris & Doeksen)

5. Economic Impact Analysis • Software: IMPLAN model • Database: IMPLAN’s State Data (NE) • Other Data: Community Health System Assessment Survey (Nebraska Center for Rural Health Research); U.S. Census Bureau County Business Patterns • Components: Employment, Income, and Economic Output

6. How Does Rural Health Works Work? Create Graphs and Tables Compile Other Data If no missing data: create economic impact flowchart with IMPLAN and survey results If there is missing data: re-run IMPLAN using estimates calculated from survey and County Business Patterns Request Arrives Create Economic Impact Flowcharts First Run of IMPLAN data Write text and finalize draft Send out Community Survey Health Economic Profile

7. EXAMPLE Phelps County Nebraska

9. Summary of the Results of Economic Impact Analysis for Phelps County Health Care SectorOther Sectors • 1 job 0.52 job • $1 of income $0.38 of income • $1 of spending $0.60 of output

10. Summary of the Results of Economic Impact Analysis for Phelps County • 14% of the county’s jobs are created directly or indirectly through health care. • 10% of the county’s income are earned directly or indirectly through health care. • 6% of the county’s economic output are created directly or indirectly through health care.

11. Summary on Economic Impact Results for 8 Counties

12. Other Vital Information • Demographic • Socio-economic • Health Status Indicators • Supply of Health Care Providers -- The above information is reported for both the county of interest and the state. --

13. Demographic • Population Change (1980-2000) • Population by Race (1990, 2000) • Population by Age (1990, 2000)

14. Sources: U.S. Bureau of the Census. Census 1990 and Census 2000, Summary Tape File 1. http://factfinder.census.gov. Nebraska Department of Health and Human Services Vital Statistics. Population by County, 1960-2001. http://www.hhs.state.ne.us/ced/tbl2.htm.

15. Table 1. Population by Race* for Phelps County and Nebraska, 1990 and 2000 * Individuals were allowed to identify race alone or in combination with one or more other races, therefore the totals will be more than 100%. Source: U.S. Bureau of the Census. Census of Population and Housing, 1990 and 2000, Summary Tape File 1. http://factfinder.census.gov.

16. Table 2. Population by Age for Phelps County and Nebraska, 1990 and 2000 Source: U.S. Bureau of the Census, 1990 and 2000 Census of Population and Housing, Summary Tape File 1. http://factfinder.census.gov

17. Economic Indicators • Median Household Income (1990, 2000) • Per Capita Income (1990, 2000) • Poverty Rate (1990, 2000) • Unemployment Rate (1990, 2000)

18. Sources: U.S. Census Bureau, Census 1990 and Census 2000, Summary File 3. http://factfinder.census.gov.

19. * Percent of residents aged 16 and older in the labor force that are unemployed. ** Percent of total population living below 100% of the Federal poverty threshold. Sources: U.S. Census Bureau, Census 1990 and Census 2000, Summary File 3. http://factfinder.census.gov.

20. Social Indicators • Percent of Residents Aged 25 and Older Who did not graduate from High School (2000) • Percent of 7-12th Graders Who Dropped out of School (2000-2001) • Percent of First Births Born to Unmarried Women, Younger than 20, with Less than a High School Education (1997-2001) • Crime Arrest Rate per 1,000 Population (1999)

21. Table 3. Selected Social Indicators for Phelps County and Nebraska Source: U.S. Census Bureau, Census 2000 Summary File 3. Nebraska Health and Human Services County Profiles. http://www.hhs.state.ne.us/profiles0802/phelps/profiles.htm

22. Health Status Indicators • Mortality Rate (1997-2001): -- Overall Death Rate -- Infant Mortality Rate -- Motor Vehicle Death Rate -- Unintentional Injury Death Rate • Maternal/Child Health Indicators (1997-2001): -- % of Pregnant Women Who Reported Obtaining Prenatal Care in 1st Trimester -- % of Pregnant Women Who Smoke -- % of First Births to Adolescents Aged 10-17 -- Low-weight Birth Rate • Top 5 Leading Causes of Death (1997-2001) • Top 5 Leading Causes of Hospitalization (1997-2001)

23. * Number of deaths per 100,000 population (age adjusted). ** Number of deaths per 1,000 live births. Source: HHS County Profiles. http://www.hhs.state.ne.us/profiles0802/phelps/profiles.htm.

24. *Number of babies born weighing less than 2500 grams (per 1,000 births). Source: Nebraska Health and Human Services County Profiles. http://www.hhs.state.ne.us/profiles0802/phelps/profiles.htm

25. *Number of deaths per 100,000 population (age adjusted). Source: Nebraska Health and Human Services County Profiles. http://www.hhs.state.ne.us/profiles0802/phelps/profiles.htm

26. * Hospitalizations for pregnancy and childbirth were excluded from this analysis. ** Defined as the proportion of inpatient hospital discharges to a population within clearly specified geographic boundaries, age adjusted per 100,000 population. Source: Nebraska Health and Human Services County Profiles. http://www.hhs.state.ne.us/profiles0802/phelps/profiles.htm

27. Supply of Health Care Providers • Number of Health Professionals per 1,000 Population (2001) • Number of Hospital Beds per 1,000 Population (2003) • Number of Long-term Care Beds per 1,000 Elderly (65+) Population (2000)

28. * Mental Health Professionals include: Psychiatrists, Licensed Psychologists, Master Social Workers, Certified Professional Counselors, Licensed Mental Health Practitioners, and Marriage and Family Therapists. ** Emergency Health Professionals include: Emergency Medical Technician (EMT) Paramedic, EMT- Intermediate, EMT- Basic, and First Responders Source: The Nebraska Health Information Project: 2001 Databook. (2001) Nebraska Center for Rural Health Research, University of Nebraska Medical Center.

29. Table 4. Selected Health Care Facility Beds-to-Population Ratios for Phelps County and Nebraska * Source: The Nebraska Health Information Project: 2001 Databook. (2001) Nebraska Center for Rural Health Research, University of Nebraska Medical Center. ** Source: Hospital Roster (4/11/03), Nebraska Department of Health and Human Services.

30. How communities in Nebraska use the rural health works profiles

31. Shared the Health Economic Profile with the Hospital Board of Directors- Long Range Planning Committee; Hospital Department Leaders; Hospital Medical Staff; and the Phelps County Economic Development Corporation. The Hospital Leadership and Medical Staff were very interested in the demographic and health status/disease data. Hospital CEO stated it was influential in their decisions to expand and to begin disease management. The Economic Development Corporation had a strong positive response to the economic impact data. They had not realized the large impact of the health care sector on other sectors within the local economy. Example 1: Phelps County

32. Example 2: Harlan County • Harlan County Health System Board of Trustees has been working for several years on the design of a facility renovation and expansion project. Being a county hospital, and because of the size of the proposed project ($6 million), the Board of Trustees is required to submit the proposal to the voters of the county for approval. A special election will be held at some point in 2006. • The Board is not without opposition and will need to expend significant time and resources to educate the public about the need for the proposed project. As one board member stated, “The demographic information contained in the profile, as well as the conclusions regarding the economic impact of health care, will be used in this education process to (hopefully) convince voters to approve the project and financing.”

33. Has published an article in local newspaper reporting selected data from the Health Economic Profile. Local hospital CEO distributed more copies of report and referred readers to the Nebraska Rural Health Works website. Example 3: Dundy County

34. Example 4: Webster County Requested report to supplement data for presentation during an appeal for a public bond to expand hospital services.

35. Beyond the community profiles • State-level profile • State-level ranking report • Induced effects study

37. Overall Income Earned, Nebraska 2002 (Direct and Indirect Impact, in Millions) $15,730.55 Manufacturing $14,597.18 Services $9,862.20 Health $7,892.95 Retail Trade $7,343.76 Government and non-NAICs $7,116.65 FIRE $6,649.26 Transportation, Warehousing, and Utilities $5,782.02 Construction $5,020.25 AFFH

38. Output Produced by Industry, Nebraska 2002 (Direct and Indirect Impact, in Millions) $64,973 Manufacturing $37,283 Services $26,239 AFFH $24,702 FIRE $21,872 Health $20,830 Government and non-NAICs $20,532 Retail Trade $18,782 Transportation, Warehousing, and Utilities $17,182 Construction

40. Contact Information • Web Site: http://www.unmc.edu/rural/NeRHW • Project Director: Li-Wu Chen, Ph.D. (liwuchen@unmc.edu) • Project Analyst: Roslyn Fraser, MA (rfraser@unmc.edu) • Phone: (402) 559-5260