Robert Graboyes is an economist who is a senior research fellow with the free market-oriented Mercatus Institute at George Mason University and specializes in the economics of health care.
The Healthcare Openness and Access Project (HOAP) is a 2018 study that Graboyes co-authored with Dr. Darcy Bryan and the Dartmouth Institute for Health Policy’s Jared Rhoads. It ranks the states on the flexibility and discretion that patients and providers have in managing health and healthcare.
Mississippi finished just outside the top 10 among the best states and the District of Columbia at 11th overall, better than Louisiana (12th), Alabama (20th), Tennessee (34th) and Arkansas (37th). Wyoming was ranked best, while New Jersey was the worst.
Where Mississippi fell short in the index was on pharmaceutical access, which measures the difficulty of obtaining certain classes of drugs, including experimental ones. The Magnolia State ranked 41st. The state also was ranked 44th for the number of taxes on healthcare services and devices.
“Mississippi's actually ahead of the curve on telemedicine, as it should be because it’s the perfect state for that,” Graboyes said.
He said the state’s regulation of medical practice is one of the nation’s least restrictive.
Graboyes said that two ways the state can improve its healthcare access is to allow nurse practitioners to practice without the supervision of a physician and to end the state’s certificate of need regime.
Certificate of need laws are designed to restrict competition among medical facilities and require that the building of a hospital or even the procurement of some specialized diagnostic equipment be approved by the state Board of Health.
“It’s hard to find a virtue to it (CONs),” Graboyes said. “It skews resources. Anything that blocks the supply of quality care, whether it be difficult medical licensing or restrictions or requirements such as a nurse practitioner who can’t hang his or her own shingle, is not productive.
“You have a couple of counties here that have no doctors and you could get a nurse practitioner or two in there who can do an awful lot that a doctor can.”
Graboyes said that one of the ways that healthcare access can improve and costs can fall nationwide in the future is for the industry to end the Progressive-era practice of eschewing business techniques for the healthcare industry.
He said the 1910 Flexner report, which eliminated proprietary schools and centralized teaching standards at medical schools, is where the concept of medicine as not a business but a social instrument.
He said the logic of having the healthcare industry run by doctors is the same as having the airlines being run by pilots.
“Of course medicine is a business,” Graboyes said. “It’s life and death, but so are a lot of other things. Where medicine differs from other professions is there is this terrible intimacy. The corporate practice of medicine isolated the medical field from business practices.”
He used an example of how surgical patients can remember the name of their doctor and his qualification, yet those who traveled on an airplane were unaware of the pilot’s name and how many hours he’d flown in his career.
Graboyes cites the example of a hospital chain in India which performs heart bypass operations at a fraction of the cost such a surgery would be in the United States. That surgery would cost $100,000 in the U.S., but in India, the surgery only costs $1,000.
Not only is the surgery in India cheaper, it gets results, Graboyes said, that are equal or even better than those in the U.S. or Europe.