Economics of Health Care

1
Economics of Health Care
Val Schott, MPH Director, OSU Center for Rural
Health
Oklahoma State University Center for Health
Sciences Center for Rural Health Tulsa, Oklahoma
2
(No Transcript)
3
Presentation Overview

• Trends in Health Care
• Economic Impact of a Rural Hospital
• Estimate Need for a Primary Care Physician
• Estimating Cost Revenue For A Rural Primary
  Care Physician

4
Trends in Health Care
5
Health care expenditures for the year 2006 were
____ per capita in the United States.

1. 4,790
2. 7,026
3. 12,782

6
Health care expenditures for the year 2006
amounted to___ percent of gross domestic
production.

1. 16.0
2. 19.6
3. 13.8

7
National Trends in Health Care
United States Health Expenditures and Employment Data 1970-2006 Projected for 2008, 2012 2016 United States Health Expenditures and Employment Data 1970-2006 Projected for 2008, 2012 2016 United States Health Expenditures and Employment Data 1970-2006 Projected for 2008, 2012 2016 United States Health Expenditures and Employment Data 1970-2006 Projected for 2008, 2012 2016 United States Health Expenditures and Employment Data 1970-2006 Projected for 2008, 2012 2016
Year Total Health Expenditures (billions) Per Capita Health Expenditures Health Expenditures as of GDP Health Sector Employment (000)
1970 75.1 357 7.2 3,052
1990 714.0 2,813 12.3 7,814
2000 1,353.6 4,790 13.8 10,858
2002 1,603.4 5,560 15.3 11,536
2004 1,852.3 6,301 15.9 12,055
2006 2,105.5 7,026 16.0 12,602
Projections Projections Projections Projections Projections
2008 2,420.0 7,957 16.5 --
2012 3,173.4 10,110 17.9 --
2016 4,136.9 12,782 19.6 --
8
In 2004, payment for physicians services was
______ percent of health care expenditures.

1. 21
2. 30
3. 84

9
National Health Care Expenditures
Type of Health Service
National Gross Domestic Product
10
Economic Impact of A Rural HospitalMarshall
Memorial Hospital
11
Critical Access Hospitals may be located in
_______________________.

1. a physical location designated as a Medically
   Underserved Area (MUA) or Health Professional
   Shortage Area (HPSA) as that type of hospital is
   intended to provide service to underserved
   populations.
2. a rural community where the hospital is 35 miles
   by primary road or 15 miles by secondary road
   from another hospital.
3. Both (a) and (b) are correct.

12
Since Critical Access Hospitals are limited to no
more than 25 beds and an average length of stay
of no more than 96 hours, they are too small to
provide any significant economic impact for their
rural community, thus the acceptance by the
Centers for Medicare and Medicaid (CMS) of this
type of facility.

1. True
2. False

13
(No Transcript)
14
MARSHALL MEMORIAL HOSPITALMEDICAL SERVICE AREA
15
Objective of the Report

1. Review economic trends of the health sector for
   the U.S. and Marshall County
2. Identify the Marshall Memorial Hospital medical
   service area
3. Summarize the direct economic activities of
   Marshall Memorial Hospital
4. Summarize the direct economic activities of
   Marshall Memorial Hospital
5. Estimate the secondary impacts of Marshall
   Memorial Hospital on the economy of Marshall
   County.

16
Marshall County Trends in Health Care
Employment and Payroll for Marshall County, Oklahoma Employment and Payroll for Marshall County, Oklahoma Employment and Payroll for Marshall County, Oklahoma Employment and Payroll for Marshall County, Oklahoma Employment and Payroll for Marshall County, Oklahoma Employment and Payroll for Marshall County, Oklahoma Employment and Payroll for Marshall County, Oklahoma
EMPLOYMENT EMPLOYMENT EMPLOYMENT PAYROLL (100s) PAYROLL (100s) PAYROLL (100s)
Year Health Services of Total Total HealthServices of Total Total
1988 176 9.5 1,856 1441 5.8 24,878
Based on SIC 1989 250 11.5 2,178 1752 6.1 28,553
Based on SIC 1990 184 9.0 2,043 1761 5.8 30,213
Based on SIC 1991 253 10.8 2,339 2353 6.5 36,213
Based on SIC 1992 174 6.5 2,668 2452 6.0 40,844
Based on SIC 1993 361 12.8 2,814 4906 10.8 45,365
Based on SIC 1994 332 11.1 2,986 5235 10.4 50,171
Based on SIC 1995 363 11.7 3,112 6364 11.9 53,621
Based on SIC 1996 310 11.7 2,646 6198 12.6 49,246
Based on SIC 1997 355 11.6 3,052 7603 12.5 60,612
Change1988 - 1997 101.7 n/a 64.4 427.6 n/a 143.6
Based on NAICS 1998 462 13.6 3,395 7390 11.5 64,154
Based on NAICS 1999 536 15.4 3,685 7848 11.3 69,708
Based on NAICS 2000 422 12.2 3,470 8001 11.1 71,984
Based on NAICS 2001 346 10.1 3,440 7936 10.8 73,580
Based on NAICS 2002 357 11.4 3,143 8760 12.2 71,546
Based on NAICS 2003 423 12.1 3,499 11401 13.6 83,723
Based on NAICS 2004 493 13.1 3,753 12964 14.7 88,271
Change1998 - 2004 6.7 n/a 10.5 75.4 n/a 37.6
17
Marshall Memorial HospitalMedical Service Area
Census Population Population Estimates Projections for City of Madill Marshall County, Oklahoma, 1980-2020 Census Population Population Estimates Projections for City of Madill Marshall County, Oklahoma, 1980-2020 Census Population Population Estimates Projections for City of Madill Marshall County, Oklahoma, 1980-2020 Census Population Population Estimates Projections for City of Madill Marshall County, Oklahoma, 1980-2020
City of Madill Marshall County State of Oklahoma
1980 Census 3,187 10,550 3,025,290
1990 Census 3,069 10,829 3,145,585
2000 Census 3,410 13,184 3,450,654

2004 Estimates 3,572 13,952 3,523,546

2010 Projections 4,370 16,900 3,591,516
2020 Projections 5,380 20,800 3,735,690

Change 1980 - 2000 7.0 25.0 14.1
Change 1990 - 2000 11.1 21.7 9.7

Change 2000 - 2004 4.8 5.8 2.1

Change 2000 - 2010 28.2 28.2 4.1
Change 2000 - 2020 50.6 49.1 6.0
18
Marshall Memorial Hospital Direct Economic
Activities
Direct Economic Activities of the Marshall Memorial Hospital Direct Economic Activities of the Marshall Memorial Hospital Direct Economic Activities of the Marshall Memorial Hospital
Component Estimated Jobs Estimated Income
Marshall Memorial Hospital 143 5,569,000
Source 2006 Local employment and income data Source 2006 Local employment and income data Source 2006 Local employment and income data
19
Marshall County Employment, Income, Retail
Sales Impact
Total Employment, Income, and Retail Sales Impact of the Marshall Memorial Hospital on Marshall County Total Employment, Income, and Retail Sales Impact of the Marshall Memorial Hospital on Marshall County Total Employment, Income, and Retail Sales Impact of the Marshall Memorial Hospital on Marshall County
Employment
Total full-time part-time employees 143
Hospital employment multiplier 1.52
Secondary Employment Impact 74
Total Employment Impact 217

Income
Total payroll plus benefits 5,569,00
Hospital income multiplier 1.35
Secondary income impact 1,949,150
Total income impact 7,518,150

Retail Sales Sales Tax
Estimated county impact on retail sales 2,420,092
Estimated Marshall County sales tax (1) 24,201
Estimated city impact on retail sales 2,536,624
Estimated City of Madill sales tax 76,099
20
Overview of Community Economic System
21
Estimating the Need for aRural Primary Care
Physician
22
(No Transcript)
23
Objectives

• To examine the need for primary care physicians
  in Atoka, Oklahoma and
• To estimate the costs and revenues associated
  with establishing a primary care physician
  practice in Atoka, Oklahoma.

24
Purpose of Study

• Determine the need for primary care physicians
• Determine medical service area and populations
• Estimate primary care physician office visits
  and
• Estimate the total demand for primary care
  physicians in the medical service area.

25
Methodology of Study

1. Estimate the costs and revenues to establish a
   primary care physician practice
2. Estimate capital costs
3. Estimate annual capital costs, annual operating
   costs and total costs
4. Estimate revenues based on type of visit
5. Estimate alternate collection rates and
6. Determine estimated net income.

26
(No Transcript)
27
Marshall Memorial HospitalMedical Service Area
Atoka County, Oklahoma Medical Service Area Atoka County, Oklahoma Medical Service Area
Service Area Population
Atoka 2,988
Caney 199
Stringtown 396
Tushka 345
Wardville N/A
Remainder of County 9,951
Total Medical Service Area Population 13,879
28
Purpose of Study

• Determine the need for primary care physicians
  and
• Estimate the total demand for primary care
  physicians in the medical service area.

29
Annual Physician Office Visits
Total Annual Physician Primary Care Physician Office Visits Generated in the Atoka County Medical Service Area Total Annual Physician Primary Care Physician Office Visits Generated in the Atoka County Medical Service Area Total Annual Physician Primary Care Physician Office Visits Generated in the Atoka County Medical Service Area Total Annual Physician Primary Care Physician Office Visits Generated in the Atoka County Medical Service Area Total Annual Physician Primary Care Physician Office Visits Generated in the Atoka County Medical Service Area Total Annual Physician Primary Care Physician Office Visits Generated in the Atoka County Medical Service Area Total Annual Physician Primary Care Physician Office Visits Generated in the Atoka County Medical Service Area Total Annual Physician Primary Care Physician Office Visits Generated in the Atoka County Medical Service Area
MALE MALE MALE FEMALE FEMALE FEMALE
Age (Years) 2000 Population Visit Rate Total Visits 2000 Population Visit Rate Total Visits Total Physician Visits
Under 15 1,400 2.4 3,423 1,266 2.3 2,876 6,299
15 to 24 1,018 1.2 1,200 731 2.3 1,694 2,894
25 to 44 2,414 1.6 3,969 1,621 3.1 5,071 9,039
45 to 64 1,783 3.0 5,369 1,596 4.1 6,563 11,931
65 to 74 545 5.4 2,936 544 6.1 3,312 6,248
Over 75 346 6.7 2,317 615 6.4 3,964 6,282
TOTAL 7,506 19,214 6,373 23,480 42,694
Annual Primary Care Physician Office Visits 26,555 Annual Primary Care Physician Office Visits 26,555 Annual Primary Care Physician Office Visits 26,555 Annual Primary Care Physician Office Visits 26,555 Annual Primary Care Physician Office Visits 26,555 Annual Primary Care Physician Office Visits 26,555 Annual Primary Care Physician Office Visits 26,555 Annual Primary Care Physician Office Visits 26,555

Based on 62.2 of Total Physician Office Visits Primary Care Office Visit Based on 62.2 of Total Physician Office Visits Primary Care Office Visit Based on 62.2 of Total Physician Office Visits Primary Care Office Visit Based on 62.2 of Total Physician Office Visits Primary Care Office Visit Based on 62.2 of Total Physician Office Visits Primary Care Office Visit Based on 62.2 of Total Physician Office Visits Primary Care Office Visit Based on 62.2 of Total Physician Office Visits Primary Care Office Visit Based on 62.2 of Total Physician Office Visits Primary Care Office Visit
30
Annual Physician Office Visits
Primary Care Physician Office Visits Given Usage by Local Residents in Atoka County, Oklahoma, Medical Service Area Primary Care Physician Office Visits Given Usage by Local Residents in Atoka County, Oklahoma, Medical Service Area Primary Care Physician Office Visits Given Usage by Local Residents in Atoka County, Oklahoma, Medical Service Area Primary Care Physician Office Visits Given Usage by Local Residents in Atoka County, Oklahoma, Medical Service Area Primary Care Physician Office Visits Given Usage by Local Residents in Atoka County, Oklahoma, Medical Service Area Primary Care Physician Office Visits Given Usage by Local Residents in Atoka County, Oklahoma, Medical Service Area Primary Care Physician Office Visits Given Usage by Local Residents in Atoka County, Oklahoma, Medical Service Area Primary Care Physician Office Visits Given Usage by Local Residents in Atoka County, Oklahoma, Medical Service Area
Usage 70 75 80 85 90 95 100
Number of Primary Care Visits a Different Usage Levels Number of Primary Care Visits a Different Usage Levels Number of Primary Care Visits a Different Usage Levels Number of Primary Care Visits a Different Usage Levels Number of Primary Care Visits a Different Usage Levels Number of Primary Care Visits a Different Usage Levels Number of Primary Care Visits a Different Usage Levels

18,589 19,916 21,244 22,572 23,900 25,227 26,555

Number of Primary Care Physicians Number of Primary Care Physicians Number of Primary Care Physicians Number of Primary Care Physicians Number of Primary Care Physicians Number of Primary Care Physicians Number of Primary Care Physicians
3.7 4.0 4.3 4.5 4.8 5.1 5.3
If 85 usage level, then 22,572 total primary care office visits for an estimated 4.5 total primary care physicians. If 85 usage level, then 22,572 total primary care office visits for an estimated 4.5 total primary care physicians. If 85 usage level, then 22,572 total primary care office visits for an estimated 4.5 total primary care physicians. If 85 usage level, then 22,572 total primary care office visits for an estimated 4.5 total primary care physicians. If 85 usage level, then 22,572 total primary care office visits for an estimated 4.5 total primary care physicians. If 85 usage level, then 22,572 total primary care office visits for an estimated 4.5 total primary care physicians. If 85 usage level, then 22,572 total primary care office visits for an estimated 4.5 total primary care physicians. If 85 usage level, then 22,572 total primary care office visits for an estimated 4.5 total primary care physicians.

Based on 4.976 average primary care office visits/physician practice/year in Oklahoma Based on 4.976 average primary care office visits/physician practice/year in Oklahoma Based on 4.976 average primary care office visits/physician practice/year in Oklahoma Based on 4.976 average primary care office visits/physician practice/year in Oklahoma Based on 4.976 average primary care office visits/physician practice/year in Oklahoma Based on 4.976 average primary care office visits/physician practice/year in Oklahoma Based on 4.976 average primary care office visits/physician practice/year in Oklahoma Based on 4.976 average primary care office visits/physician practice/year in Oklahoma
31
Estimate Cost Revenue to Establisha Primary
Care Physician Practice
32
Methodology of Study

1. Estimate the costs and revenues to establish a
   primary care physician practice and
2. Estimate capital costs.

33
Estimate Capital Costs

• Illustrate 2 Budget Alternatives
• Alternative 1
• Assume 2,750 primary care physician office visits
• Alternative 2
• Assume 4,750 primary care physician office visits

34
Estimate Capital Costs

• Capital costs are the total of all
• capital equipment and items
• Assume a 1,500ft2 building will be rented for
  both Alternatives with three examination/treatment
  rooms

35
Estimate Capital Costs Both Alternatives
Typical Equipment Found in Primary Care Physician Office Typical Equipment Found in Primary Care Physician Office
EQUIPMENT SUMMARY EQUIPMENT SUMMARY

Total Reception Area 1,927
Total Business Office 24,604
Total Examination/Treatment Rooms (3) 26,202
Total Laboratory 4,894
Total Physicians Office 3,435
Total Conference Room/Staff Lounge 1,442

TOTAL EQUIPMENT SUMMARY 62,505
Total Equipment Costs are the SAME for BOTH Scenarios Total Equipment Costs are the SAME for BOTH Scenarios
36
Purpose of Study

1. Estimate the costs and revenues to establish a
   primary care physician practice and
2. Estimate annual capital costs, annual operating
   costs and total costs.

37
Estimated Capital Costs Both Alternatives
Estimated Capital Costs for a Primary Care Physician Practice in Atoka, OK Estimated Capital Costs for a Primary Care Physician Practice in Atoka, OK Estimated Capital Costs for a Primary Care Physician Practice in Atoka, OK
Cost Item Cost Item Total Cost

ESTIMATED CAPITAL COSTS
Equipment
Estimated Total Equipment Costs 62,505

ESTIMATED TOTAL CAPITAL COSTS 62,505

ESTIMATED ANNUAL CAPITAL COSTS
Equipment
(Based on 10 year loan _at_ 10 interest) 10,172

ESTIMATED TOTAL ANNUAL CAPITAL COSTS 10,172

Total Equipment Costs are the SAME for BOTH Scenarios Total Equipment Costs are the SAME for BOTH Scenarios Total Equipment Costs are the SAME for BOTH Scenarios
38
Estimated Capital Operating Costs (Both
Alternatives)
Estimated Annual Capital Operating Costs for a Primary Care Physician Practice in Atoka, OK Estimated Annual Capital Operating Costs for a Primary Care Physician Practice in Atoka, OK Estimated Annual Capital Operating Costs for a Primary Care Physician Practice in Atoka, OK
Costs for 2,750 Visits Costs for 4,750 Visits

ESTIMATED ANNUAL CAPITAL COSTS 10,172 10,172

ESTIMATED ANNUAL OPERATING COSTS 20,702 20,702
Total Annual Building Costs 22,150 22,468
Total Annual Office Costs 17,682 24,854
Total Annual Medical Costs 60,256 71,640
Total Personnel Costs with Benefits 120,790 139,674

TOTAL OPERATING EXPENSES 130,963 149,846
39
Methodology of Study

1. Estimate the costs and revenues to establish a
   primary care physician practice and
2. Estimate revenues based on type of visit.

40
Estimate Revenues per Visit Type
Estimate Revenues Based on Type of Visit Estimate Revenues Based on Type of Visit
Type of Office Visit are Estimated Based on Research Type of Office Visit are Estimated Based on Research

Initial Office Visit 14.9
Routine Office Visit 85.1
Visits with Additional Charges 47.0
Hospital Visits 8.6
ER Visits 8.2
Nursing Home Visits 3.6
Nursery Visits 1.7
Home Visits 4.2
41
Estimate Types of Visits Alternative 1
Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit
Type of Visits Number of Visits (2,750) 1999 Updated Rate Schedule 1999 Updated Rate Schedule 1999 Updated Rate Schedule Revenues Revenues Revenues
Type of Visits Number of Visits (2,750) High Average Low High Average Low

Initial Office Visit 410 60.75 40.64 27.00 24,908 16,660 11,070
Routine Office Visit 2,340 47.52 33.28 25.47 111,197 77,869 59,610
Visits with Additional Charges 1,293 83.98 30.69 11.48 108,591 39,676 14,837
Hospital Visits 237 55.50 46.18 34.76 13,153 10,945 8,239
ER Visits 226 135.00 76.68 40.50 30,510 17,330 9,153
Nursing Home Visits 99 65.49 41.18 24.75 6,483 4,076 2,450
Nursery Visits 47 189.00 118.22 67.50 8,883 5,556 3,173
Home Visits 116 101.25 54.70 35.86 11,745 6,345 4,159

REVENUES High Range 315,469 REVENUES High Range 315,469 REVENUES High Range 315,469 REVENUES High Range 315,469 REVENUES High Range 315,469 REVENUES High Range 315,469 REVENUES High Range 315,469 REVENUES High Range 315,469
REVENUES Average Range 178,459 REVENUES Average Range 178,459 REVENUES Average Range 178,459 REVENUES Average Range 178,459 REVENUES Average Range 178,459 REVENUES Average Range 178,459 REVENUES Average Range 178,459 REVENUES Average Range 178,459
REVENUES Low Range 112,691 REVENUES Low Range 112,691 REVENUES Low Range 112,691 REVENUES Low Range 112,691 REVENUES Low Range 112,691 REVENUES Low Range 112,691 REVENUES Low Range 112,691 REVENUES Low Range 112,691
42
Estimate Types of Visits Alternative 2
Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit Estimates of Primary Care Physician Office Visits by Type of Visit
Type of Visits Number of Visits (4,750) 1999 Updated Rate Schedule 1999 Updated Rate Schedule 1999 Updated Rate Schedule Revenues Revenues Revenues
Type of Visits Number of Visits (4,750) High Average Low High Average Low

Initial Office Visit 708 60.75 40.64 27.00 43,011 28,770 19,116
Routine Office Visit 4,042 47.52 33.28 25.47 192,076 134,508 102,968
Visits with Additional Charges 2,233 83.98 30.69 11.48 187,535 68,521 25,624
Hospital Visits 409 55.50 46.18 34.76 22,699 18,889 14,218
ER Visits 390 135.00 76.68 40.50 52,650 29,905 15,795
Nursing Home Visits 171 65.49 41.18 24.75 11,199 7,041 4,231
Nursery Visits 81 189.00 118.22 67.50 15,309 9,576 5,468
Home Visits 200 101.25 54.70 35.86 20,250 10,940 7,171

REVENUES High Range 544,728 REVENUES High Range 544,728 REVENUES High Range 544,728 REVENUES High Range 544,728 REVENUES High Range 544,728 REVENUES High Range 544,728 REVENUES High Range 544,728 REVENUES High Range 544,728
REVENUES Average Range 308,149 REVENUES Average Range 308,149 REVENUES Average Range 308,149 REVENUES Average Range 308,149 REVENUES Average Range 308,149 REVENUES Average Range 308,149 REVENUES Average Range 308,149 REVENUES Average Range 308,149
REVENUES Low Range 194,591 REVENUES Low Range 194,591 REVENUES Low Range 194,591 REVENUES Low Range 194,591 REVENUES Low Range 194,591 REVENUES Low Range 194,591 REVENUES Low Range 194,591 REVENUES Low Range 194,591
43
Purpose of Study

• Estimate the costs and revenues to establish a
  primary care physician practice and
• Estimate alternate collection rates.

44
Estimate Collected Revenues Alternative 1
Estimated Collected Revenues (2,750 visits) Estimated Collected Revenues (2,750 visits) Estimated Collected Revenues (2,750 visits) Estimated Collected Revenues (2,750 visits)
Collection Rates Revenues for 2,750 Visits Revenues for 2,750 Visits Revenues for 2,750 Visits
Collection Rates High (315,469) Average (178,459) Low (112,691)

95 Collections 299,696 169,536 107,056
90 Collections 283,923 160,613 101,422
85 Collections 268,149 151,690 95,787
82.5 Collections 260,262 147,229 92,970
80 Collections 252,376 142,767 90,153
75 Collections 236,602 133,844 84,518
70 Collections 220,829 124,922 78,884
45
Estimate Collected Revenues Alternative 1
Estimated Collected Revenues (4,750 visits) Estimated Collected Revenues (4,750 visits) Estimated Collected Revenues (4,750 visits) Estimated Collected Revenues (4,750 visits)
Collection Rates Revenues for 4,750 Visits Revenues for 4,750 Visits Revenues for 4,750 Visits
Collection Rates High (544,728) Average (308,149) Low (194,591)

95 Collections 517,492 292,741 184,861
90 Collections 490,256 277,334 175,132
85 Collections 463,019 261,927 165,402
82.5 Collections 449,401 254,223 160,537
80 Collections 435,783 246,519 155,673
75 Collections 408,546 231,,112 145,943
70 Collections 381,310 215705 136,213
46
Purpose of Study

• Estimate the costs and revenues to establish a
  primary care physician practice and
• Determine estimated net income.

47
Comparison of Alternatives 1 2
Estimated Net Income for a Primary Care Physician Practice Estimated Net Income for a Primary Care Physician Practice Estimated Net Income for a Primary Care Physician Practice Estimated Net Income for a Primary Care Physician Practice Estimated Net Income for a Primary Care Physician Practice Estimated Net Income for a Primary Care Physician Practice Estimated Net Income for a Primary Care Physician Practice
Type of Visits Alternative 1 (2,750 visits) Alternative 1 (2,750 visits) Alternative 1 (2,750 visits) Alternative 2 (4,750) Alternative 2 (4,750) Alternative 2 (4,750)
Type of Visits High Average Low High Average Low

Revenues Based on 82.5 Collections 260,262 147,229 92,970 449,401 254,223 160,537

Total Annual Capital Operating Expenses 130,963 130,963 130,963 149,846 149,846 149,846

NET INCOME 129,299 16,266 (37,993) 299,555 104,377 10,691
48
References

• Bureau of Labor Statistics
• Bureau of Economic Analysis
• Centers for Medicare Medicaid Services
• National Health Expenditures, 1970-2004
  National Health Expenditure Projections,
  2005-2015
• U.S. Census Bureau, County Business Patterns,
  1988-1997
• National Ambulatory Medical Care Survey, 2004,
  National Center for Health Statistics
• 2006 Regional Economic Information System, Bureau
  of Economic Analysis
• 2006 Local Employment Income Data for Marshall
  County, Oklahoma
• U.S. Census Bureau, 1980, 1990, 2000 Census
  2004 Census Estimate Populations 2010 2020
  Census Population Projections
• 2006 Oklahoma Department of Commerce Population
  Projections for the State, Metropolitan Areas and
  Counties, 2000-2010

49
Questions?
50
(No Transcript)
51
Acknowledgments

• Rural Development - OSU Cooperative Extension
  Service
• OSU Center for Rural Health
• OSU Center for Health Sciences

52
For Additional Information
Tulsa Office OSU Center for Health Sciences1111 West 17th StreetTulsa, OK 74107-1898 Phone [phone] Fax [phone] Oklahoma City Office 900 N. Portland Ave.Suite BT200Oklahoma City, OK 73107 Phone [phone] Fax [phone]
http//ruralhealth.okstate.edu
53
Individual Contact Information
William Pettit, D.O. Associate Dean Assistant Professor for Rural Health 918.584.4379 william.j.pettit_at_okstate.edu Val Schott, MPH Director, Center for Rural Health 405.945.9197 val.schott_at_okstate.edu C. Michael Ogle, D.O. Director, OSU Physicians Rural Clinic Services 580.977.5000 rockino_at_hotmail.com Dennis Carter, D.O. Rural Health Professor 2008-2010 Poteau
Richard Perry, M.A. Director, OkAHEC 918.584.4378 richard.r.perry_at_okstate.edu Jeff Hackler, M.B.A., J.D. Director, Grants Resource Development 918.584.4611 jeff.hackler_at_okstate.edu Vicky Pace, M.Ed. Clinical Training Coordinator 918.584.4332 vicky.pace_at_okstate.edu Chad Landgraf, M.S. GIS Analyst 918.584.4376 chad.landgraf_at_okstate.edu
Toni Hart Program Coordinator 918.584.4368 toni.hart_at_okstate.edu Matt Janey Program Coordinator 918.584.4377 matt.janey_at_okstate.edu Rod Hargrave FLEX Program Coordinator 405.945.9196 rod.hargrave_at_okstate.edu Corie Kaiser Health Consultant 405.945.9194 corie.kaiser_at_okstate.edu
Morgan Farquharson Clinical Coordinator 918.584.1989 morganf_at_okstate.edu Jan Barber Administrative Coordinator 918.584.4360 jan.barber_at_okstate.edu Sherry Eastman Program Specialist II 918.584.4375 sherry.eastman_at_okstate.edu Dora Johnson Administrative Assistant 918.584.4310 dora.johnson_at_okstate.edu
Stacy Huckaby Administrative Assistant 918.582.1989 staci.stewart_at_okstate.edu Stacy Huckaby Administrative Assistant 918.582.1989 staci.stewart_at_okstate.edu Billie Bowman Administrative Assistant 405.945.9197 billie.bowman_at_okstate.edu Billie Bowman Administrative Assistant 405.945.9197 billie.bowman_at_okstate.edu