Minnesota, like so many other states, is struggling with outmigration in rural areas. Southwest Minnesota has been particularly hard hit with this as the region did not benefit from the “rural renaissance” of the 1980s and ’90s experienced in other parts of the state — such as the Northeast region of Minnesota. As the overall population ages, it is expected that the 55-75-year-old population in non-metro areas will increase by 30 percent by 2020 and the 65+ age group will be the largest population group by 2030; it is increasingly important that we look at factors to counteract outmigration, especially of young people, in rural areas as well as health care solutions for the older population.
In 2007 the Baltic Rural eHealth project was conducted in Norway, Sweden and Denmark. The research focused on the impact of eHealth, or telemedicine, on outmigration. In the United States, similar — but smaller scale — research has been conducted in Maine and Tennessee, as well as a study that looked at the outmigration effects of a North Dakota hospital closing. Little research has been done to see how eHealth or telemedicine could impact out-migration in Minnesota.
Telemedicine is a technology that in many ways is still in its infancy; it is not widely used, and the applications are still fairly limited. This is also the main reason little research has been done regarding the advantages of telemedicine, and in particular how it may or may not affect out-migration. The kinds of telemedicine currently in common use are electronic communication between hospitals, between hospitals and primary care centers, between different levels of care, and between general practitioners and specialists.
Qualitative and quantitative benefits
The Baltic Rural eHealth study found both quantitative and qualitative benefits from the use of telemedicine. Quantitative benefits found include cost saving from reduced patient travel and reduced hospital admissions. Qualitative benefits found included access to greater personnel resources, greater patient access to specialist care, quality of treatment, and more readily available information.
The research also found that the general benefits of increased telemedicine might prevent out-migration of health-care professionals as rural health-care jobs will be able to offer more professional support and a higher degree of prestige.
In Denmark the study focused on whether the supply of health-care services has any impact on settlement and if eHealth/telemedicine might contribute to counteract out-migration. When the researchers looked at actual behavior it appeared that access to health-care services played an insignificant role in migration, but when they looked at assumed preference, i.e. when they asked people about their presumed behavior in case of cuts in local health-care services, many indicated that they would consider moving. When paired with the positive attitude toward possible eHealth solutions, the researchers found it probable that eHealth can, to an extent, counteract out-migration.
Issue of access
In the same study, respondents were asked whether they consider access to health care very important, 73 percent of rural respondents and 48 percent of urban respondents agreed. The study also found that women, older people, people in households with long-term illness, and those with lower completed levels of education put particular emphasis on local access to health-care services. This is a particularly important finding as the overall population will age and chronic illness such as diabetes is growing.
The study also found that 29 percent of rural respondents and 10 percent of urban respondents would consider moving if the nearest hospital closed, and within these groups 72 percent would welcome eHealth solutions.
The results of the Baltic Rural eHealth study are probably not entirely applicable for Minnesota, but they provide a valuable guideline when looking at our own state. We already know that rural Minnesota is struggling to keep health care professionals in the community. Introducing telemedicine to these areas will help local physicians provide diagnosis with the help of specialists, they will have increased access to other professionals, and more jobs can be kept in the community.
Like the rest of the western world, Minnesota is facing a future with an increased need for health care services. Our population is growing and the need for services will grow with it. At the same time we also see a growth in long-term illness and chronic illness across age groups which will further increase demands on our health care system. Fundus photography for potential blood clots in the eye for diabetes patients, video conference for locally executed kidney dialysis, use of digitally sent images of skin disease, and home-based self-management for patients with diabetes and Chronic Obstructive Pulmonary Disease (COPD) are all methods of telemedicine that have been successfully implemented in rural parts of Norway. It is likely that similar implementations in rural Minnesota will be beneficial as well.
Economic benefits
A report by the Research Council of Norway found that telemedicine provides documented economic benefits by cutting travel costs to hospitals, avoiding unnecessary admissions at specialty hospitals, lowered time spent by practitioner on administrative tasks, as well as cutting administrative costs for paper and postage.
The council also concluded that telemedicine has a higher initial cost than traditional health care services, but a lower variable cost which means that as user rates go up, savings will too. Teleradiology and video-consult dermatology already have sufficient volume in Norway to show that telemedicine is more cost effective than the traditional alternative.
The use of telemedicine is something that our state should consider as its applications continues to grow, both as a means of counteracting outmigration from rural areas as well as a way of providing quality care to the aging population across the state.
Nina Slupphaug is a Health Care Policy Associate at Minnesota 2020, a nonpartisan, progressive think tank based in St. Paul. A version of this article originally appeared on its website.
