The Affordable Care Act is the catalyst for many health care discussions in Washington and across the U.S., but there’s much more to issues of health than the president’s flagship plan. As part of SDPB’s series the state of our state, this report examines how South Dakota stacks up.
Adult check-ups and consultations are often serious, calm conversations between patients and physicians. But throw a three-year-old into the mix, and you get theater. A Sanford nurse shows 3-year-old Samson that the flashlight the doctor uses to look in his ears won’t hurt. Mom Jacquee Scheick has Samson and his new little brother in the office for their regular doctor’s appointments. The nurse asks Scheick if she has any questions or concerns about her two-month-old, and she finds her list.
Scheick's questions are a sign she’s paying attention to her children’s health. Dr. Dan Heinemann says that kind of engagement is a pinnacle element of good health.
"Many times they go to the physician to fix sometimes," Heinemann says. "What they need to go to the physician is, ‘Doctor, how can I do a better job of taking care of myself?’"
Heinemann is the Chief Medical Officer for Sanford Clinic. He says people can prevent some ailments by taking ownership of their health. But some South Dakotans live great distances from doctors, and studies show those patients are less likely to follow through on important treatments. Plus, Heinemann is concerned about the workload of physicians who work in South Dakota’s most rural clinics.
"It’s a great place to live and practice, but it’s also a tough place in a small town to live and practice and be there 24-7, 635," Heinemann says.
He says that constant pressure can push physicians to leave, and that creates an additional hurdle to providing statewide access to care. The opportunity to receive quality health care is important in a state that faces immense health challenges.
"About 15 percent of adult South Dakotans are current smokers. I mean, that’s close to the national average, but we could certainly do much better than that," Secretary Doneen Hollingsworth with the state Department of Health says. "Obesity? We’re also very close to the national average, but almost 2/3 of adult South Dakotans are overweight or obese."
Hollingsworth says one third of South Dakota’s children also weigh enough to be classified overweight or obese. The state’s people have other health challenges when it comes to children.
"It has been said that infant mortality is the gold standard of monitoring the health of a population, and South Dakota’s infant mortality rate is too high," Hollingsworth says.
Hollingsworth says her department and other state officials are encouraging care that brings the number of babies who die down. The health secretary acknowledges that many of South Dakota’s health problems are exacerbated by the sheer size of the territory and its population distribution.
She and the president of the South Dakota Association of Healthcare Organizations agree on an advantage; Dave Hewitt says the state’s health providers are more likely than almost anywhere else to collaborate on best practices.
"I think that we are ahead of the curve when it comes to the rest of the country in offering a coordinated health care delivery system," Hewitt says. "Our biggest challenge moving forward is aligning that coordinated delivery system with a reimbursement system that encourages us to keep people well instead of just treating them when they’re sick."
Hewitt says that fundamental shift takes time and trial and error, but he points to facets of health care in South Dakota that are steps toward wellness through prevention.
"For example, lowering readmissions to hospitals after an initial admission; that’s a big deal. Reducing hospital-acquired infection rates; that’s a big deal. Reducing the number of bed sores that people acquire, say, in nursing homes. That’s a big deal, and that’s all happening in South Dakota," Hewitt says.
There’s more good news on the state’s health front, too. The state has some of the best numbers in the country when it comes to vaccination. In 2012, South Dakota’s overall influenza vaccination rate was second highest in the country. State Health Secretary Doneen Hollingsworth says that extends to the state’s youngest population.
"About 97 percent of South Dakota’s kindergarten students were protected against the diseases that they needed to be when they started kindergarten," Hollingsworth says.
Those vaccinations start early on, often when babies are just a couple of months old. Whether to follow the recommendations or alter the shot schedule for 2-month-old Roman is one of the bullet points on mom Jacquee Scheick's list. At his well-baby checkup, she’s trying to make the best decisions for her son.
They haven’t achieved it yet, but health professionals across the state say their priority is providing this opportunity to consult with medical experts, so families can choose to be healthy.