Our Democratic friends are fond of saying that Republicans’ rejection of Medicaid expansion proves we are either unaware of the sad state of health care in South Carolina or unwilling to do anything about it. Neither is true.
There’s no question that many people in our state lack adequate access to quality health care. A report recently issued by the nonpartisan United Health Foundation gave South Carolina an “F” in overall health status, emergency care, primary care, chronic disease management, mental health and prenatal care. This is unacceptable.
But enrolling 500,000 more South Carolinians into Medicaid — even if it were affordable, which it isn’t — would do nothing to address the core and fundamental problem: There are not enough health-care providers in South Carolina to meet the needs of its residents. In order to truly improve access to health care, there must be an increase in the supply of providers.
South Carolina, with its estimated 3,600 primary-care physicians, ranks 40th among the states with just 77.5 physicians per 100,000 residents (nationally, the number is 90.1 per 100,000). Moreover, there is a strong bias in the distribution of those physicians to urban or suburban areas, and 42 of our 46 counties are medically underserved. One county (Lee) has no physicians at all.
This supply problem is compounded by the fact that medical students increasingly are choosing specialties outside of the primary-care field, as our society places an emphasis and increased value on specialized skills. Primary-care providers have been the backbone of the rural health-care system, and there are ever fewer of them to go around.
So how can we increase supply? One way, we think, is to better utilize our state’s estimated 3,500 advanced-practice registered nurses. These nurses hold at least a master’s degree in nursing, supplemented with advanced education and clinical training to autonomously assess, diagnose and manage a patient’s health care at the primary-care level.
The problem is that South Carolina laws severely restrict the health-care services these nurses are able to provide. These restrictions impose limitations on delivering care and prescribing certain medications, referring patients for diagnostic care and certifying hospice or long-term care for patients.
Perhaps the most restrictive law is the one that prohibits these nurses from providing care outside a 45-mile radius of a supervising physician. Since the majority of physicians practice in urban or suburban areas, nurses who are ready, willing and able to fill unmet health-care needs are legally barred from doing so.
We have filed bills — H.3078 and S.246 — to remove these legal barriers so that these nurses stand alongside our primary-care physicians to provide basic health-care services to South Carolinians. Since prices decrease when the supply increases, such a dramatic increase in the supply of providers would not only improve health-care outcomes but also drive down costs.
Our legislative efforts are opposed by the S.C. Medical Association, ostensibly not to protect economic turf but to protect the quality of patient care. It has been our experience, however, that those to be protected by this paternalism are rarely on organized medicine’s side; they consider increased access to health care at a lower cost a good thing.
Moreover, a multitude of studies show that the quality, efficiency, patient satisfaction and cost-effectiveness of advanced-practice nurses’ care is as good as the care provided by physicians. In any event, we believe patients should have the option of choosing to receive health care from these nurses, especially since the alternative now is in far too many cases no care at all.
So let’s cut the red tape that prevents nurses from providing the care they are qualified to give. Better access to health care at a lower cost is a clear win for all South Carolinians.
Sen. Davis is a Beaufort attorney, and Rep. Horne is a Summerville attorney. Contact them at firstname.lastname@example.org or email@example.com.