On January 18th and 19th, 2017, our LMT class visited Dickson County, Tennessee and the focus for the session was on health and healthcare in Tennessee. In Dickson County, the community is using education in an attempt to create their own healthcare workers. Dickson County has experienced steady growth, and in order to be able to care for their citizens their public schools, technical colleges and Freed Hardeman University have played a huge role in filling a need for more healthcare workers and in recruiting more businesses to the county.
The need for more healthcare workers is not unique to Dickson County, Tennessee. In the next four (4) years, fifty percent (50%) of all practicing nurses will reach retirement age. Another issue is the fact that nursing school is extremely difficult to get into and it is even more difficult to complete. Education and encouraging students to go into the healthcare field is crucial.
Healthcare is huge business in Tennessee and in the United States. It is estimated that $3.2 trillion dollars was spent on healthcare in the United States in 2015. That amounts of 17.8% of the gross domestic product (GDP) in the U.S. That spending amounts to $9,990.00 spent per person per year on healthcare in the U.S. Aging “Baby Boomers” further complicate the healthcare industry, because 97% of healthcare spending is spent on only 50% of the United States’ aging population. Only three percent (3%) of healthcare spending is spent on the other fifty percent (50%) of the population. Finally, eighty percent (80%) of health care spending is spent in the final year of a person’s life.
Further complicating matters is the fact that thirty (30) million people in the U.S. are uninsured or under insured. Before the Affordable Care Act (Obamacare) that number was sixty (60) million uninsured or under insured in the U.S. According to statistics, fifty-two (52) million people are considered “medically disenfranchised” meaning they don’t have a regular source of healthcare, even if they have health insurance. Everyone’s healthcare is somewhat limited even if they have health insurance, because their healthcare is limited by their insurance policy language, their policy limits, and it is limited by their own personal wealth or finances.
Now, the raging debate in America is do American citizens have a right to healthcare in America? Some say yes and some say no. Others ask the question, do you have a personal responsibility for your own health? This second question focuses more on people’s eating habits, drinking habits, drug use, smoking, and their exercise regimen. Clearly, U.S. citizens and Tennesseans need to do a better job taking care of their own personal health.
In Tennessee, our four (4) biggest healthcare issues are: 1) smoking, 2) obesity, 3) physical inactivity, and 4) substance abuse. The state of Tennessee ranks 44th out of the 50 states in the U.S. for the health of its citizens. Now, what impacts Tennesseans’ health? According to studies, the factors that impact health are ranked by percentage as follows: environment 5%, healthcare 10%, social factors 15%, genetic development 30%, and finally, health behaviors 40%. So, your own health behavior has the largest effect on your own personal health. Therefore, your health is largely up to you. Schools need to teach personal responsibility to our youth, and we need to keep physical education and sports in our public schools to promote overall health and wellness and to battle childhood obesity, which has reached epidemic proportions in Tennessee and the U.S.
In Dickson County we learned that Middle Tennessee is in a “health bubble,” meaning that people in Middle Tennessee tend to be healthier than in the rest of the state. Experts say this is due to higher education levels and higher wealth that is concentrated in some of the Middle Tennessee counties. Williamson County is ranked number one (1) for wealth, education, and health. Wilson County is ranked number two (2) for health, Rutherford County is ranked number three (3), Sumner County is ranked number four (4). However, these rankings seem to be “faint praise” when you consider that the state of Tennessee is ranked 44th in the United States for overall health.
Why should counties and businesses in those counties care about where their county ranks for health? A county’s health ranking affects their ability to attract businesses to their county. Businesses do not want to locate in a county that is ranked low for overall health. Locating in an unhealthy county or state leads to higher costs for the business due to absenteeism, higher health insurance premiums, and lost productivity.
During our visit to the city of Dickson, we took a walking tour through their historic downtown. Our focus in Dickson County was on health and healthcare, but we also learned that the “health” of a city’s downtown is a reflection of the health of the entire city. To that end, Dickson has copied Franklin, Tennessee’s downtown zoning, ordinances, and codes. They have added restaurants, residential buildings, and mixed use buildings. This has increased their tax revenue, downtown rents have increased for landlords/owners, and the downtown footprint has increased. Dickson Mayor Donnie Wise said, “When a city loses their downtown, then they lose the soul of their city.” The mayor has a passion for their downtown. The city has applied for multiple government grants and has received several of them. They have invested in downtown parking, landscaping, lighting, a park, and other infrastructure. The projects and focus on downtown Dickson has created a totally different atmosphere in the downtown. Now, it is a place that people want to live, work, and play. There are no more vacant buildings. Mayor Wise said it was a long process and that it was lots of work, but that it was all definitely worth it.
In each county we have visited we have learned that everything usually starts with a small group of people who get together to make things happen years before they actually happen. Dickson County was no different. In Dickson County, leaders have learned that in order to promote growth that leaders need to have a vision for the future, and then they must work to make that vision a reality.
After our downtown tour, we later visited and toured the Tri-Star Natchez free standing emergency room. Our class learned that healthcare and healthcare delivery is changing rapidly. The speed of healthcare is improving due to improved technology. However, regardless of the technology, Dustin Greene, TriStar Horizon Medical Center CEO, told us that, “Hospitals don’t heal people. People heal people.” Community hospitals are committed to patient care and the improvement of the quality of life in their communities. However, oftentimes, community hospitals struggle with patient perception. Many patients will drive to the “big city” hospitals in Nashville for care, when they could have had as good of care or even better care in their own community hospital.
Another reason that community hospitals are important is that they are huge economic engines for their communities. They are huge employers. They bring people into the community from surrounding smaller communities that don’t have their own medical facilities. Also, much of the revenue of community hospitals is immediately reinvested into the community they serve.
Our discussion of healthcare in America took a somber turn when we began to talk about the future of Medicare, Medicaid, and Social Security. We learned that Medicare is going to run out of money sooner than expected. Medicare’s reserves will be exhausted in the year 2028. Social Security and its Disability Trust Fund reserves will run out of money in the year 2034. These numbers and dates are more sobering when you consider that approximately 50% of all hospital revenue comes from the government and its programs. Furthermore, one-third of all hospitals are currently in the red, and another one-third simply break even.
Clearly, our state and our nation has a lot of work to do regarding the health and healthcare of its citizens. However, Dickson County is doing its part to be a part of the solution instead of being part of the problem. More counties need to follow Dickson County’s lead, and focus more on promoting health and wellness and on training those that will take care of us all as we grow older.