Report: Pennsylvania employment strong, but job growth leaves regions, industries behind

UNIVERSITY PARK, Pa. — With the U.S. economy on track for potentially the longest expansion on record after the Great Recession of 2008-09, employment in Pennsylvania overall is strong. But the rosy statewide job numbers can mask persistent decline in various industries and regions across the state, according to economists in Penn State’s College of Agricultural Sciences.

Their conclusions are reflected in a report newly released by Penn State’s Center for Economic and Community Development, titled “Pennsylvania: Bust to Boom? Great Recession to Recovery & Beyond.” Through the liberal use of graphics, the report illustrates job growth and decline statewide and in five regions and 20 major industry sectors.

“While the Pennsylvania economy as a whole shows strength, it’s important to look at the distribution across the state,” said co-author Theodore Alter, professor of agricultural, environmental, and regional economics and the center’s co-director. “There’s a diversity of impact, and looking at the aggregate doesn’t give the correct picture.”Graphic on Pennsylvania employment numbers

The report’s findings mirror those of two companion reports on the geography of employment and population shifts — released by the center in 2018 and earlier this year, respectively — that showed a significant contrast between southeastern Pennsylvania, which enjoyed mainly job and population growth from 2000 to 2017, and the rest of the state, with primarily declines.

The trends woven through this trilogy of reports suggest the existence of “two Pennsylvanians,” noted co-author Theodore Fuller, development economist in the Department of Agricultural Economics, Sociology and Education.

“Employment change in Pennsylvania’s five regions over the 10 years [2008-2018] covered in this report ranged from solid growth in southeastern Pennsylvania to widespread decline in western counties, and a mix of growth and decline in central, northern and northeastern Pennsylvania,” Fuller said. “This pattern was most stark during the recession and recovery but continued into the post-recovery growth years of 2015 to 2018.”

As an example, he pointed out that the 15 counties designated as southeastern Pennsylvania gained 133,000 jobs from 2015 to 2018, with 80,000 of that increase coming in the five-county Philadelphia metropolitan statistical area. In contrast, the 19-county western region gained only 3,000 jobs. While employment increased by 16,000 in the seven-county Pittsburgh MSA during this period, the other western counties combined lost a net of 13,000 jobs.

Fuller added that two major industrial developments underway that soon could bolster job creation and stimulate the economy of western Pennsylvania are construction by Royal Dutch Shell of a natural gas “cracker” plant in Beaver County — expected to be operational in the early 2020s — and a $1 billion investment by U.S. Steel to upgrade its Mon Valley Works by 2022.

In addition to regional changes in employment, there were winners and losers among industries, the report showed. Manufacturing and retail trade were in the top three industries in total employment in 2018, but they lost, by far, the most jobs among the 20 major sectors between 2008 and 2018. Manufacturing employment fell by nearly 80,000 and retail trade jobs declined by more than 28,000 over the 10-year period. Other industries with significant job losses were wholesale trade and educational services.

On the other hand, the state’s largest employment sector, health care and social services, gained more than 165,000 jobs during 2008-2018. In 2018, almost one in five Pennsylvanians was employed in this sector. Other growth industries included accommodation and food services, transportation and warehousing, and professional and technical services.

Pennsylvania’s top employment sector, health care and social services, gained 165,000 jobs in the 10-year period ending in 2018, but the largest number of those jobs were categorized as low-wage positions.

However, employment change doesn’t tell the whole story, the researchers said. Examining the average weekly wages of the jobs gained and lost provides additional insight.  For instance, of all the jobs added in health care and social services between 2008 and 2018, by far the largest number were categorized as low-wage positions.

Across all the sectors analyzed, the greatest growth was in low-wage jobs, and the greatest losses came in middle-wage jobs, fueled by the decline in manufacturing employment.  “Since 2008, we’ve seen a hollowing out of that middle-wage area,” Alter said. “And that suggests widening inequality, which could have profound implications for Pennsylvania’s economy going forward.”

The report is available on the Center for Economic and Community Development website.

Other contributors to this report were undergraduate research associates Raymond Hoy, Nolan Martino and Tessa Sontheimer; and Cristy Halerz Schmidt, applied research educator, Center for Economic and Community Development, Penn State. The U.S. Department of Agriculture’s National Institute of Food and Agriculture supported this work.


New Resource: Management Methodologies and Value-Based Strategies: An Overview for Rural Health Care Leaders

The Rural Health Value team has released a new resource outlining eight commonly used change management methodologies that are rural-relevant. It is intended as a guide to help rural health care leaders identify which approach(es) might be most useful to them and their organizations.

Management Methodologies and Value-Based Strategies: An Overview for Rural Health Care LeadersOffers rural health leaders an overview of eight commonly used management methodologies to help guide change, plus additional resources and references for further exploration. (June 2019)

Top resources on the Rural Health Value website:

  • Value-Based Care Assessment – Assess capacity and capabilities to deliver value-based care. Receive an eight category readiness report.
  • Physician Engagement – Score current engagement and build effective relationships to create a shared vision for a successful future.
  • Board and Community Engagement – Hold value-based care discussions as part of strategic planning and performance measurement.
  • Social Determinants of Health – Learn and encourage rural leaders/care teams to address issues to improve their community’s health.

Contact information:

Keith J. Mueller, Ph.D.

Co-Principal Investigator

Rural health could be a powerful issue in the 2020 election

The views expressed by contributors are their own and not the view of The Hill

As former senators from rural states, we’ve seen firsthand the importance of providing affordable, quality care to those living in rural areas. The isolation that exists in some parts of South Dakota and Maine means residents have limited access to care.

Many patients must travel great distances to even reach a hospital. Yet more and more rural hospitals are closing around the country. In fact, 106 of them have shut down since 2010. It is staggering to think of these challenges when, compared to people living in urban and suburban areas, rural Americans are generally older and poorer, more uninsured or underinsured, and therefore less healthy.

Rural health is a bipartisan issue that greatly concerns all Americans. While it has never been a top tier issue on the campaign trail, we believe it could be a powerful topic in the 2020 election and demands attention by policymakers and candidates.

Our survey with the American Heart Association conducted by Morning Consult, shows that 92 percent of Democrats and 93 percent of Republicans consider access to rural health an important issue. Perhaps even more encouraging, three in five voters say they are more likely to endorse a candidate who makes access to rural health care a priority.

At a time when Democrats and Republicans agree on little, it is clear rural health transcends political parties. However, efforts by lawmakers to revive rural America have been largely unsuccessful in recent years. People living in remote areas continue to face greater disparities and barriers to high-quality health care than those in non-rural communities.

More than half of the rural voters polled say access to medical specialists, such as cardiologists, oncologists and gynecologists, is a problem in their local community, compared to 33 percent of non-rural voters, and more than one-quarter (27 percent) say it is difficult to access behavioral health professionals, compared to 16 percent of non-rural voters. Forty-seven percent of rural voters also agree access to quality health care is a challenge, compared to 34 percent of non-rural voters.

In addition to our national poll, we surveyed adults living in three rural states that will be important in the 2020 election: Iowa, North Carolina, and Texas. When it comes to accessing medical services or treatment, rural voters are more likely than urban and suburban voters to agree that appointment availability (56 vs. 50 percent) and the distance to receive care (50 vs. 37 percent) are obstacles.

Today, nearly 60 million Americans live in rural communities. Data from the Centers for Disease Control and Prevention show these residents have a greater risk of dying from heart disease, cancer, stroke, and chronic lower respiratory disease, and that should prompt candidates and policymakers alike, to take action.

Four policy options could help rural communities receive the quality care they deserve:

First, allow rural communities to adjust their health care services to better suit the needs of their local area. Critical Access Hospitals and other rural inpatient facilities need pathways to transform, in order to focus on emergency and outpatient services, and primary and prevention-focused care.

In Texas alone, 17 hospitals have closed in the past nine years. One in five Texas voters say it is difficult to access hospitals, urgent care facilities, primary care physicians, and medical specialists in their community.

Second, create new payment mechanisms for rural providers that account for low patient volumes, growing health care needs, and demographic trends in rural communities. Facilitate alternative payment and care delivery models that could help hospitals transition to value-based care.

Third, build and support a sustainable and diverse workforce. The patient-to-primary care physician ratio in urban areas is 53 physicians per 100,000 people, while rural areas have only 40 physicians for the same number of residents.  

Indeed, our survey shows that one in three rural adults in North Carolina — and 46 percent in Iowa — believe that access to medical specialists and quality health care are problems in their communities. New workforce models should be designed with universities and community health centers to expose providers to rural environments and telemedicine. Nurse practitioners, physician assistants, and pharmacists could also help fill vital primary care roles.

Fourth, expand telemedicine services to virtually connect patients with medical professionals. To be an effective tool, rural areas need adequate broadband and reimbursement for services.

Geography should never be an impediment to quality care. Tackling the barriers to delivering high-quality and efficient health care to rural America is long overdue. With the 2020 election campaign underway, candidates and policymakers have an opportunity to create a health care system that better serves all Americans.

Tom Daschle is a former Senate majority leader from South Dakota and a co-founder of the Bipartisan Policy Center.  Olympia Snowe is a former Senator from Maine and a BPC board member and senior fellow. They co-chair BPC’s Rural Health Task Force.   

CDC Information on Syringe Services Programs

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VA Announces Final Community Care Regulations under MISSION Act

VA Announces Final Community Care Regulations under MISSION Act. On June 5, the U.S. Department of Veterans Affairs (VA) announced the publication of two final regulations as part of its new Veterans Community Care Program under the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018. One of the rules focuses on a new urgent care benefit. VA also published the final regulation for the Veterans Community Care Program governing how eligible Veterans receive necessary hospital care, medical services, and extended care services from non-VA entities or providers in the community. The new Veterans Community Care Program replaces the Veterans Choice Program, which expired June 6, 2019. Of note, the final rule addresses payment of higher rates to health care providers in highly rural areas. The term “highly rural area” means an area located in a county that has fewer than seven individuals residing in that county per square mile.

CMS Requests Feedback Reducing Regulatory Burden

 CMS Requests Feedback Reducing Regulatory Burden – August 12.  On June 6, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) seeking new ideas from the public on how to reduce administrative and regulatory burden as part of the agency’s Patients over Paperwork initiative. CMS is especially seeking innovative ideas that broaden perspectives on potential solutions to relieve burden and ways to improve: reporting and documentation requirements; coding and documentation requirements for Medicare or Medicaid payment; prior authorization procedures; policies and requirements for rural providers, clinicians, and beneficiaries; policies and requirements for dually enrolled (i.e., Medicare and Medicaid) beneficiaries; beneficiary enrollment and eligibility determination; and CMS processes for issuing regulations and policies.

HRSA Requests Public Feedback on Health Center Service Areas

 HRSA Requests Public Feedback on Health Center Service Areas – July 8.  The Health Resources and Services Administration (HRSA) is seeking input from the public on service area considerations that may inform decisions to expand the program through the addition of new service delivery sites onto existing health centers.  The considerations include factors such as proximity to existing health centers, parameters for unmet need, and consultation with other local providers.   

Unmet Need for Personal Care Assistance Among Rural and Urban Older Adults

Unmet Need for Personal Care Assistance Among Rural and Urban Older Adults.  Despite differences in health, health services, economic, and demographic characteristics, little is known about whether rural and urban areas differ in unmet need for personal care for older adults with functional limitations. This brief from the University of Minnesota Rural Health Research Center addresses that gap by analyzing rural-urban differences in unmet need for help across 11 activities

HRSA Releases Allied Health Workforce Projections for 2016–2030

HRSA Releases Allied Health Workforce Projections for 2016–2030. The Health Resources and Services Administration (HRSA) recently released Allied Health Workforce Projections providing national-level health workforce estimates for the following occupations: chiropractors and podiatrists, emergency medical technicians and paramedics, medical and clinical laboratory technologists, occupational and physical therapists, optometrists and opticians, pharmacists, registered dieticians, and respiratory therapists.  While shortages of health care providers in rural areas is well-known, consistent data on rural allied health professionals has been difficult to collect and analyze.  Visit HRSA’s Bureau of Health Workforce website to see more data, projections, and federal programs.

Challenges of the Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C.

Challenges of the Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C. Previous research on HIV and hepatitis C (HCV) among people who inject drugs (PWID) has focused on urban or international populations, yet the US opioid epidemic is moving away from metropolitan centers. In this report, researchers examine the increasing rurality of opioid injection, the challenges to treatment and prevention that are unique to rural areas, and the public health interventions needed to address them.