Medical care has a multitude of important functions in a rural area such as Harlan County. The first and obviously most important one is to provide services to people when they are ill or injured.

As complex as that primary function can be, it often pales in comparison with another, which is the business aspect of the healthcare industry and the impact those activities have on the economic development of communities.

The economic impact is borne out in a number of statistical ways: from the dollars generated by medical businesses, to the numbers that reflect employment and salaries, and even to the measurable standards of the quality of life a community affords its people.

Those quality of life standards affect the decisions individuals and businesses make when they evaluate whether to move into the county and invest here, said Joe Grieshop, Harlan County Judge-Executive.

"The healthcare sector of the economy does four things in rural communities," he said. "It keeps healthcare dollars local. It attracts outside healthcare dollars into the local area. It can retain existing businesses as well as attract new industry to the community. It also supports and promotes a healthy and productive workforce."

Harlan County has undergone an evaluation of the economic impact of its local healthcare system. The University of Kentucky commissioned such a study that was completed in December 2003. Grieshop noted the evidence of "a rural economic engine in healthcare" coming from that study was overwhelming.

"The UK study showed that, as of the year 2000, our local healthcare system supported nearly 1,700 jobs, produced over $107 million in local revenues, and paid nearly $60 million in salaries and benefits to the workforce," Grieshop noted.

Census figures posted by the Kentucky Commerce Cabinet show a total of 8,764 employed in Harlan County during that same year, meaning healthcare accounted for nearly 20 percent of the engaged labor force.

"That's just about one out of every five people working in this county are in a health or medical field, and that's just a huge segment of our population," Grieshop commented. "Then you also have to think about the number of jobs here that are not directly medical but rely on business that comes from medicine, and it's 4 to 5 percent more. So that's one out of four people working in Harlan County that depend upon the healthcare system for their livelihood."

The healthcare sector of the economy includes the hospital, nursing homes, medical offices, public health clinics and other resources. Southeast Community College also employs several health professionals who, while not directly involved in the medical business, are engaged in the training and development of the future workforce.

One of the leaders of the local healthcare system is Ken Thomas, senior vice president and market manager of Home Federal Bank in Harlan, who also serves voluntarily on the Board of Trustees of Appalachian Regional Healthcare, Inc., which owns and operates the hospital, two clinics and a home services agency and is the second largest employer in Harlan County. He is currently in his second year as chairman of the board.

"When people talk about economic development, they are usually talking about making something or distributing something," Thomas said. "People normally talk about economic development as some kind of industry or manufacturing, but the service industry is the direction our economy is headed and we need to be looking even more strongly at healthcare as a major contributor in the economic development of our community."

"Healthcare is a high-tech business," he added. "It elevates the overall quality of life in the community. It attracts and supports a high level of professionalism among the general population because it demands a high level of education and skill. It is an integral part of any effort to develop a retirement community, which is a major direction for Harlan County's economy. The issue of what kind of quality of life is available for people here will strongly influence the choice of whether someone decides to retire here or not."

Grieshop and Thomas agreed the future viability of the local economy, including the healthcare system, depends upon how much the local population is willing to support it by using it and spending their dollars locally.

"We need to support the hospital and local physicians and not take our business outside when we have the choice," Thomas said. "Keeping our medical care local makes the local system more economically viable, it keeps dollars in the community and allows ARH to reinvest in the community."

"The medical business is worth a whole lot of jobs to Harlan County and the more jobs we can keep at home the better," Grieshop said.

ARH, Thomas said, is investing heavily in Harlan County to make very positive changes both in its facilities and management in order to be more productive. He called it "creating a hospitality environment" that would be attractive to patients, their family members and friends, as well as doctors, nurses and other employees.

"You can stay at the Ritz-Carlton for $350 a night and they treat you like royalty," he commented. "Out here we charge $950 a night and we ought to treat people every bit as special."