The biggest success story in the table is No. 2, Minnesota’s Olmsted County, where the Mayo Clinic in Rochester draws patients from across the upper Midwest, as well as elsewhere in the United States and abroad. Mayo has become even more important to the city in recent years because IBM has reduced jobs there at what was once one of its bigger computer factories. “It is a true blessing to have a world-renowned health care institution based in our county,” says John Wade, the president of Rochester Area Economic Development Inc.
Every county that is dependent on the health care industry must decide whether to double down on its specialty or to diversify so it doesn’t have all its economic eggs in one basket. Olmsted County is open to all kinds of employers, but it’s emphasizing health care, says Patrick Seeb, the executive director of Destination Medical Center, which, despite its name, is not a hospital but an economic development agency responsible for doling out infrastructure funds from the State of Minnesota.
Seeb is trying to get people to call Rochester America’s Med City. Google and Epic Systems have opened offices there to work with Mayo on, respectively, data mining and electronic medical records, he says. And now other companies are arriving because of Google and Epic. “It’s concentric circles,” he says.
The third county on the list is a less happy story. Kentucky’s Breathitt County is in a part of Appalachia that has suffered from declining employment, dwindling population and poor health. “Health care is one of our biggest employers,” says Sue Clair, who has a real estate development company in the county seat, Jackson. “We don’t have any other kind of employment but that.” A 40,000-square-foot industrial building was put up more than 20 years ago with public funds but has never attracted a commercial tenant. “Right now it has the Breathitt County Water District in it,” she says.
Breathitt County is not alone on the list in being hard-pressed. Three of the top 10 counties are in eastern Kentucky, and another, Cumberland, is in south-central Kentucky, all of which are struggling economically. That’s no coincidence. When the local economy falters, total employment dwindles, and the need for health care services increases, both of which push counties upward on the list. Kentucky has the nation’s third-highest mortality rate, after West Virginia and Mississippi, according to the National Center for Health Statistics.
Kosali Simon, a health care economist who is the associate vice provost for health sciences at Indiana University in Bloomington, ran some calculations for me using her own set of data and found that the share of a county’s population in poverty is a predictor of the share of its employment from health care and social assistance.
Many economists view rising health care employment nationally as a mixed blessing. “Every person employed in health care is one less person available to work in other industries,” David Cutler, a health care economist at Harvard University, wrote in a 2018 article for The JAMA Forum, a publication of the American Medical Association. “Thus, people should work in health care only if the extra care is more valuable than the output would be in some other industry.”