Здравоохранение в Южной Дакоте: стабильный драйвер экономики и вызовы дефицита услуг

"A Farmer, a Nurse, and a Welder Walk Into a Bar." That’s not the setup for a joke. It’s the title of an independent economic report that highlights the impact of the healthcare industry in South Dakota. The report, from the Dakota Institute, analyzes the ways healthcare drives GDP in the state and is both a growing, stable, and firmly entrenched industry. Tracy Dice, DBA., is an economist at Dakota Wesleyan University in Mitchell and author of the report. She spoke with SDPB’s Lori Walsh about her research. A transcript of this interview follows. TRACY DICE My daughter has Down syndrome. And so I first started thinking about Medicaid and how that has been impacted in our state. And so I was thinking about, OK, well, what's happened with Medicaid in the past 10 years? And that's something I'm interested in and want to research. And then I went, wait, I need to back up. I need to kind of get what is the landscape of health care in South Dakota before I can go into those tinier details. So for me, it began with wanting to go into these other articles eventually, but needing to get let's get what the big picture of health care in South Dakota is first. LORI WALSH So an economist who has a personal perspective. lived experience in your family asking questions and then saying, well, why not apply what I already know as an economist to find some answers? I love the beginning of that. In South Dakota, we talk constantly about the ag industry and to a certain extent about the trust industry, especially depending on the politics of the day, right? It seems much rarer to talk about healthcare industry as an economic driver. You might talk about deserts, you might talk about maternal care, Medicaid expansion, those are all political hot topics, but just a basic understanding of healthcare as an economic driver of the state. That's interesting. Tell me a little bit about what you found about the share of GDP that is provided by this industry. TRACY DICE Yeah, so you mentioned, you know, the trust industry, ag, all of those are things that we hear constantly. And for some reason, healthcare just doesn't seem to be a political hot topic. So we don't pay attention to it as much. We pay attention to the little pieces and the issues like Medicaid expansion and those things, but not an overall economic driver perspective. So when I started doing my research, I was wondering, how big is it? And when I look, depending on the year, because ag fluctuates so much, it's about 10% of our South Dakota GDP, which is a pretty decent piece of the pie, when you look at the fact that it does overtake everything except for finance and insurance. Some of the years, there are years that you know manufacturing might jump up because there's a big push for manufacturing one year or ag has a really good year so agriculture jumps up. It was really cool for me to see that health care not only is that 8% to 10%, I think we've leveled out at about 9.6% this last year in 2024, but it's really consistent compared to agriculture, where agriculture can jump up and down and up and down. Health care is pretty stinking consistent with how much of our GDP it is. LORI WALSH We're going to put a link up on our website to your report on the Dakota Institute website. But explain for people why we don't have data from every county, because it has to do with the population. Help explain that a little bit, please. TRACY DICE Absolutely. So we have 66 counties in South Dakota. And when I was looking at the GDP magnitude, we could only get data for 28 of those 66 counties. Because we have such small populations in certain counties, if they would give me that data or I'd be able to find it, that data would be able to let people infer individual income, individual taxes, and all of that for specific people in those counties. So because there's only like one doctor, one clinic, or maybe it's a private clinic, it's not even a clinic, it's just one healthcare practitioner in that county, we would be able to kind of discern their individual information from that. So that's why it's not available in every county. LORI WALSH So let's talk about in what ways do we see health care as an economic driver? Let's talk employment first. TRACY DICE Yes. Employment, when we look at the labor force in general, here I was able to get 31 counties instead of 28 counties. The total employment is on average about 15.9% of employment in that county comes from the healthcare industry. I work at a college where one of our biggest majors is nursing. I have a sister who was an ER nurse. I know how many nurses we have and how many we still need. But when you think about other people in the healthcare industry, it's crazy that 15% of employees in most counties in South Dakota are employed in the healthcare industry. When you think of how many industries there are in general. LORI WALSH So jobs, investment and expansion. What about the wages? How are the wages for these jobs? TRACY DICE Wages are fantastic for most of these jobs. When you look at the wage of healthcare workers in the counties that I was able to find data for, 18 of them have average health care wages that are higher than the average wage in that county. LORI WALSH So fairly well-paid, which means that money often goes back into the county economy and into the state economy often. What makes it stable? How do you measure stability when we talk about like, hey, this is not as volatile as, say, ag or finance can be? What lends itself to stability? TRACY DICE In economics, we have things called elastic and inelastic goods. And elastic goods are things that when the price increases, people tend to stop buying them. So when the price of steaks go up, people might look for a cheaper protein like eggs, just ground beef. Whereas when you look at healthcare, healthcare is an inelastic good. So if you get sick or you break your arm, you're going, most people, are going to go to the doctor still. You're not going to just tough it out on your own if your hand is hanging there or something like that. So it's more of an inelastic driver, inelastic good for drivers of economics where you're still going to need that health care no matter what the cost. So no matter what the cost may be, we're still going to see people going to the doctor. And that's kind of one of the things that we've seen with healthcare in general as a country is that healthcare costs are high and we just, we need it. LORI WALSH So we either delay that care and then it might be more expensive, or we get the care that we need and then we're facing some of the personal financial hardships from, you know, paying for that care. But the industry itself, that creates a fairly stable situation. Are there gaps? Are there places in, you know, we talked about maternal health deserts. Are there places in the state where this industry is absent? TRACY DICE So in the article, it shows a lovely little map of South Dakota, and it's got all the different types of health care facilities within the state. And there's one in the top left corner. So it's the northwest corner of South Dakota. It's Harding County. And there's not a single "dot" in that county. They have to go to Lemon, South Dakota, if I'm remembering correctly, to get any health care. LORI WALSH So you've got a 2,678 square mile region without a single health care facility. TRACY DICE Correct. LORI WALSH Welcome to South Dakota. TRACY DICE Yes. We are vast. We are wide. LORI WALSH We are vast and wide, and you might have to cover a lot of space. So what does the future look like? What are some of the challenges for this industry? Because, you know, we said in the beginning of this conversation, a lot of times it goes under the radar. What is the future outlook? TRACY DICE Looking to the future, another one of those economic drivers in health care is the population aging. And one of the things I showed in there is that almost all counties are seeing some form of increase in that over 65 age range in their population. I think it's Lincoln County is actually showing 120% increase in the 65 plus age range. So we're gonna need more healthcare because as you get older and as you age, you tend to need more healthcare. going for just, you know, simple things like your blood pressure meds or something like that, but you also might have a fall and need more care. You could also need a nursing home, and those types of services are needed as we see that population age. So as we look towards the future, I think we're going to see that this profession is either going to maintain or increase in its GDP and its wages and its labor force, all of that, because my prediction is that we'll see it increase. Maybe not a ton in like our percentage of GDP, but overall number of jobs and wages, I hope, would increase in the future because of the fact that we're going to be needing all of this healthcare for our aging population. South Dakota is a nice place apparently for the elderly to come and retire, maybe not in the winters. And the Department of Labor and Regulations already stated that we're 3,500 jobs short as of August of last summer. So we need more workers. And I just, I, I don't foresee it shrinking in any way. So I see it maintaining its stable position or even increasing. LORI WALSH How far back did you look in the data when we look at growth? And were there any significant, obviously I'm thinking of the pandemic, were there significant shifts in this industry growth? TRACY DICE Not really. I looked back to 1998. So almost 30 years back is what I was looking at. And it just really has a very steady growth as part of our GDP. There is a slight bump in 2020, obviously, but it really just has a nice steady line, a linear line that increases compared to the other industries. LORI WALSH So what did you take away then, you know, as you looked at your original question, which is as a parent, How am I, you know, finding health care for a kid who has health care needs? Now that you've done this ground level work, what do you see is going to start layering on top of it? TRACY DICE Oh, so much. There's so many things. Now that I've got kind of this baseline and now that I have healthcare really should be a part of the conversation as one of these big economic drivers in our state, there are so many questions that can go into, okay, how do we help? What policies might we need? You mentioned deserts and maternal care. Those are two questions I'd love to look into at some point. Looking at the Medicaid expansion and maybe helping with policy. There are so many questions that I have from a parent perspective on what's going to be there for my child as she grows up. She's only nine. We have a long time ahead of us for this, but it's not just my child. There's so many others in the state that need help. Do they get the help they need? How far do they have to travel for that health care? I have a good friend who had a baby at 24 weeks pregnant, maybe, it was in the early 20s. He spent six months in the NICU in Sioux Falls, but he was born in Yankton because they were living in rural South Dakota and they had to travel how far to just get to a hospital that could do a C-section. And then the baby ended up being flown to Sioux Falls while she was still in Yankton. And there's just so many questions on can we make it better for people? LORI WALSH Our parents as they get older and live in these places. Maybe we grew up on the farm and then we left, but our parents are still there. What happens next? I think lawmakers will be very interested in this data too, as they look at policy to say, Hey, this is one of the under talked about industries. How does that industry come to the table to, to when you're talking about economic growth, you know, what is economic growth in one in our biggest or second biggest industry even look like? TRACY DICE Oh, and going with the aging population — Where are the nursing homes at? What about memory care facilities? Again, because I know there was a nursing home close to me that just closed a few years ago. Where do those beds go? And how far do you have to travel to get your loved one who may need assisted living or that elderly care eventually towards the end of their life? Correction: Tracy Dice's academic credentials were misstated in an earlier version of this story. Dice has a Doctorate in Business Administration (DBA).