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Is there a doctor in the county?

Study finds that reform could bring crushing demand for healthcare

Healthcare reform would bring an immediate, crushing demand for care in Mississippi, and it could take the largely rural Magnolia State a decade to produce enough care providers to meet patients’ needs.

That is the finding of a recently-released report from Northeast Mississippi Health Education Center’s Mississippi Center for Health Workforce (MCHW) housed at Mississippi State University. Titled “A Health Insurance Mandate and Its Effect on Health Care Demands,” the study looked at the state’s demand for care if Congress were to adopt what is commonly referred to as the Massachusetts Health Care Model. It finds Mississippi would need from between 56 to 464 physicians to meet the demand by newly-insured patients.

“If we increase the demand with the health insurance mandate, we will not have enough doctors,” said Dr. Jeralyn Cossman, Clinton Wallace Dean’s Eminent Scholar, associate professor at Mississippi State and director of the MCHW. “We don’t have the doctors we need in the current system.”

The study, led by Cossman and research associates Caleb Butts, MPPA, and Nicholas DiColandrea, MPPA, was based on existing Mississippi healthcare data applied to rates of increase among uninsured Massachusetts residents in 2006 when that state adopted its insurance mandate.

DiColandrea said changing Mississippi’s healthcare provision model to a system based on one similar to Massachusetts’ plan would dramatically improve access to rural care. It likely would take years, however, for the state to acquire adequate numbers of primary care physicians necessary to handle the likely increase in patients, he added.

Sam Cameron, president and CEO of the Mississippi Hospital Association, said it is logical that reform would bring increased demand, and that concern is high about meeting future needs if reform is passed. He said access to healthcare, particularly primary care, is already a major issue in Mississippi, and many counties are deemed medically underserved today by the federal government.

Numbers back up his stance. For instance, there is not a single primary care physician in Issaquena County. Statewide, 56 of the 82 counties have a current shortage of primary care physicians.

The report shows 49 counties would need to increase their physician supply by 25 percent or more to meet the likely increase in demand.

“Part of the problem is where physicians practice is not reflected in population distribution in the state,” Butts said.

Cossman said shortages in existing care access in Mississippi will exacerbate existing physician shortages. In 2007, her research showing the Mississippi Delta to be one of four national regions with the highest mortality-rate clusters illustrated the substantial need for primary care in that area.

Using 2006 U.S. Census data, adult and child utilization rates and Mississippi State Board of Medical Licensure information, the report calculated a statewide estimate for healthcare demand at 4,934 visits per doctor annually. Similar estimates were calculated for each county and compared to the statewide physician demand to estimate the number of primary care physicians needed in each county. That estimate was then compared to the number of primary care physicians in the county to estimate health care shortages (see the full report for more detail). 

The report found that if 48 percent of those who were uninsured became insured, based on analysis from the Massachusetts baseline year (prior to implementation of the health insurance mandate), Mississippi would need 52 primary care physicians to have adequate statewide coverage of care based upon current physician utilization rates.

However, as Butts pointed out there are systematic county-level shortfalls due to the misdistribution of primary care physicians across the state. Hinds County has an excess of 216 primary care physicians. Other population centers such as Forrest, Harrison, Lee and Lauderdale counties also have similar excesses in care providers.

Still, the report found that 38 percent of the 82 counties would experience a shortfall of more than five primary care physicians if a health insurance mandate is implemented, a shortfall of nearly 25,000 physician visits each year. Twenty of the 82 counties would need to at least double their primary care workforce for access to adequate care.

Cameron said the state as of late has increased funding for the University of Mississippi Medical Center to increase student capacity. That is certainly good news. But, it takes years to get physicians trained and practicing. The “pipeline” is long, and reform could overload the system before new help arrives.

Cossman observed that a decade usually is required to adequately train a new physician, a significant time period when considering major changes to existing healthcare systems.

The report did not consider the impact on nursing, though Cossman did say the use of nurse practitioners to complement healthcare access could help bridge the shortage. However, nursing has its own pipeline, and Cameron said an aging nursing faculty is a hindrance to producing more, qualified nurse practitioners. (Cossman added that the state’s nursing industry has already contacted her about a report on the impact of healthcare reform on its members.)

Cossman said she was not surprised by the report’s findings. She had access to years of data that showed how much demand there is currently for physicians in the state. She said Mississippi is one of the sickest and poorest state’s in the nation with a large uninsured population. Considering the lack of doctors to meet current needs, she expected the projected need to be large.




Physician need by county

County                 Current Need      Projected Need

Adams                  -3                       -2

Alcorn                    4                        5

Amite                     9                        10

Attala                     2                        2

Benton                  -1                       -1

Bolivar                    4                       4

Calhoun                 2                        3

Carroll                   6                        6

Chickasaw             4                        5

Choctaw                3                        4

Claiborne              4                        4

Clarke                   7                        8

Clay                      0                         0

Coahoma              -5                       -5

Copiah                  5                         6

Covington             2                         3

DeSoto                  37                       40

Forrest                 -56                      -63

Franklin                 2                        2

George                  4                        5

Greene                  8                        6

Grenada                1                        1

Hancock               6                        7

Harrison              -33                     -30

Hinds                  -219                   -216

Holmes                0                        0

Humphreys          5                        5

Issaquena            2                        2

Itawamba            8                        9

Jackson               25                       27

Jasper                 12                       12

Jefferson             0                        0

Jefferson Davis   5                        5

Jones                   -2                     -1

Kemper               5                        6

Lafayette            -10                    -9

Lamar                25                        26

Lauderdale        -42                     -41

Lawrence            3                        4

Leake                 9                        9

Lee                   -28                     -27

Leflore               1                        1

Lincoln              8                        8

Lowndes           3                        4

Madison            1                        2

Marion              5                        5

Marshall            17                     17

Monroe              3                       4

Montgomery      2                       2

Neshoba            7                       8

Newton              7                       7

Noxubee           3                        3

Oktibbeha         1                       2

Panola              12                      13

Pearl River        20                      21

Perry                 3                        4

Pike                 -9                        -8

Pontotoc          13                        13

Prentiss            9                        9

Quitman           4                        4

Rankin             27                        29

Scott                9                        10

Sharkey            2                        2

Simpson          3                        3

Smith               9                        10

Stone               2                        3

Sunflower        3                        4

Tallahatchie     8                        8

Tate                 2                        3

Tippah            11                       11

Tishomingo     6                        7

Tunica             5                        5

Union              3                        4

Walthall          3                        3

Warren           0                        0

Washington    2                        3

Wayne            8                        8

Webster         4                        4

Wilkinson       2                        2

Winston        10                        10

Yalobusha     6                        7

Yazoo           10                        11


Source: “A Health Insurance Mandate and Its Effect on Health Care Demand,” Mississippi Center for Health Workforce


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