Access to quality, affordable health care in rural North Carolina is an issue, writes Becki Gray. She looks at four policy changes that could change the equation — not with a new government program, but by embracing innovation and removing barriers. One example is to allow providers to practice within the full scope of their training.

Twenty-two states have removed a requirement for a physician to supervise nurse practitioners. Fourteen states since 2010 have moved to “full practice authority” for advanced-practice registered nurses, nurse practitioners, and nurse anesthetists. When Arizona removed its requirement of physician supervision of nurse practitioners, the number of nurse practitioners serving rural areas jumped by 73 percent within five years. Removing government handcuffs from dental hygienists and allowing dental therapists and midwives to provide basic care would increase access and bring down costs when preventive and management measures can replace emergency care for serious yet neglected illnesses.

North Carolina is now known for its historic tax and regulatory reforms. The next frontier in reform is medical.