Education and Job Growth

The U.S. economy has done a remarkable job rebuilding since the start of the COVID-19 pandemic. Relative to 2005, job growth plummeted nationally by 2 percent after the onset of the pandemic in April 2020. However, the U.S. labor market quickly rebounded, and relative job growth currently sits at 19.4 percent as of May 2024.

Contrary to the quick recovery exhibited in the national data, Michigan’s road to recovery has been paved with bumps. By April 2020, job growth at the state level had fallen 23 percent compared to 2005, and recovery has been a long journey. Employment failed to return to its 2005 level until August 2022. Even now, as of writing, relative job growth in Michigan is situated at 2.5 percent. On a positive note, while Michigan’s recovery is slow and laborious, the national-to-state gap in job growth has fallen by 3 percent since the pandemic’s start.

Turning to the local labor market, since 2005, the healthcare sector in Grand Rapids has stood as a beacon of light, leading the rest of the nation in the growth of healthcare support and technical occupations. Relative to 2005, 15 healthcare occupations have reported job growth above 100 percent, with the largest growth rates reported in occupations including pediatricians, occupational therapy assistants, physical therapy assistants, physician assistants, and home health and personal care aides. Moreover, not all healthcare occupations in Grand Rapids have prospered since 2005. For example, medical transcriptionists, licensed practical nurses, family medicine physicians, nuclear medicine technologists, and opticians all report job losses above 10 percent. However, a recovery is underway in family medicine physicians and opticians, posting local job growth numbers exceeding 10 percent within the last year. Meanwhile, medical transcriptionists and licensed practical nurses continue to face mounting job losses.

Extending beyond employment changes for select healthcare occupations, we turn to anticipated job openings in the coming year. Taking data from the Bureau of Labor Statistics (BLS) and the Michigan Department of Technology, Management, and Budget (DTMB), we anticipate a substantial increase in local job opportunities for home health and personal care aides, registered nurses, nursing aides and assistants, medical assistants, and licensed practical nurses. Meanwhile, we expect a small contraction in the number of Grand Rapids based pediatricians.

Employment is only one side of the labor highway. Therefore, we turn our analysis to the change in real earnings in select healthcare occupations. Between 2005 and 2023, medical records specialists, medical dosimetrists, health technologists and technicians, physical therapy assistants, occupational therapy assistants, nursing aides and assistants, audiologists, and licensed practical and vocational nurses posted real earnings increases above 7 percent in Grand Rapids. On average, these occupations observed an increase in local earnings that outpaced real earnings at the state and national levels. However, an alarming trend is emerging in local labor markets. For example, since 2005, 17 healthcare occupations have showcased declines in real earnings exceeding 7 percent, exacerbating the difficulty in finding and retaining talented healthcare practitioners. Nevertheless, 10 of the 17 declining healthcare occupations have undergone a real earnings rebound over the last year. 

The COVID-19 pandemic has structurally changed how economists analyze data. A new road requires a new map. Identifying shifts and recalibrating existing models is a prerequisite to plan, recover, and prosper in the future.

Medical Innovation

There has been an increase in medical patent activity in West Michigan since the 1990s, along with a growing number of new innovators. Patents with inventors residing in Kent County have increased from an annual average of 12.8 from 1990 to 1999 to 46.3 from 2000 to 2009, with a decrease to 32.7 patents from 2010 to 2023. However, behind these averages is a concerning development — a significant decrease in the number of medical patents since 2014, mirroring a decline seen nationally and statewide. In addition, medical patenting in the region comes from a relatively small number of companies. One positive development is a sharp increase in local patenting in 2023, though it is too soon to tell if this will continue.

Because patented medical innovations have a great potential for creating wealth and economic growth in West Michigan, continued research and development support is vital. Fortunately, National Institute of Health funding in West Michigan has grown substantially, possibly resulting in innovations and knowledge that do not result in patents.

Demographic Changes

Shifts in healthcare demand largely depend on changes in population demographics. As a result, we study the demographic shifts observed in Grand Rapids KOMA (Kent, Ottawa, Muskegon, and Allegan counties) and compare it to the changes observed in Detroit (Oakland, Macomb, and Wayne counties), the state of Michigan, and the United States as a whole. In 2023, we continue to find evidence of a migration from East to West Michigan, with the population declining in Detroit by 0.19 percent and burgeoning in KOMA by 0.52 percent.

Throughout the 1990s and again in 2013, the population growth rate in West Michigan equated to or exceeded 1.26 percent. While KOMA’s growth rate in 2023 falls below its historical average, it continues to outpace the national average of 0.48 percent. Turning to the aging population, a significant concern for community health planners, we confirm that the proportion of persons over 65 has increased in KOMA, Detroit, Michigan, and the United States, with notable inclines occurring around the Great Recession of 2007. In 2023, the 65-plus demographic comprised 16.7 percent of the KOMA population compared to 18.1 percent in Detroit.

The aging population poses an ongoing concern for healthcare professionals in acquiring the resources needed to meet the elevated healthcare demand now and in the future. Additionally, the aging population is expected to significantly strain Medicare funding as fewer workers become available to fund the healthcare of the aging population through the Medicare Part A trust fund. The aging workforce means we can expect employer-sponsored health insurance premiums to rise.

Health Care Overview

Our healthcare overview analyzes various risk and care metrics across geographical, racial, and gender lines, focusing on the disparities within and between West Michigan’s KOMA and the Detroit region. Since 2011, the number of uninsured persons has declined in both areas, decreasing the regional gap between Detroit and KOMA. While males are more likely to be uninsured, we find evidence of a narrowing gender gap in both regions. Moreover, racial disparities appear evident and problematic in the data. While the non-white-to-white uninsurance gap is decreasing in Detroit, we find a corresponding increase in KOMA. Gender and racial discrepancies also appear in our healthcare cost data. For example, if we turn to persons lacking care due to cost, we find a narrowing in the racial and gender gaps among Detroit residents. However, those gaps appear to be widening in KOMA, driven by more non-white persons and males finding care unaffordable. Possibly due to the lack of insurance and the cost of care, we see an increase in the racial gap for stable care sources among West Michigan residents, with non-white persons more likely to lack a secure source of care.

The pandemic prompted over a third of the populace to defer medical care, possibly causing a downturn in chronic condition diagnoses in 2020. Yet, the advent of COVID-19 vaccinations in 2021 rejuvenated individuals’ confidence in seeking medical services, evident from the subsequent surge in healthcare engagement and chronic condition diagnoses. This resurgence was further accentuated by a noticeable rise in routine checkups post-vaccine rollout after a significant slump in 2020.

In analyzing the trends in chronic conditions, we highlight elevated rates of high cholesterol, heart attack, heart disease, stroke, asthma, and diabetes in Detroit residents. Meanwhile, KOMA residents report higher rates of depression, which is consistent with the depressant properties of alcohol consumption and the observed binge drinking patterns in KOMA relative to Detroit. Suppose non-white citizens are less likely to seek mental health services, and instances of depression go unreported. To remedy this discrepancy, we track the number of poor mental health days reported by minority residents, finding a deterioration in the mental health of non-white KOMA residents and a widening of the racial gap.

Another predictor for the development of chronic health conditions, namely cancer and COPD, is tobacco consumption. Between 2011 and 2023, cigarette smoking decreased in KOMA and Detroit. However, this may highlight a substitution towards e-cigarette usage, which is corroborated by the increase in e-cigarette smoking in both regions.

Lastly, a precursor for many chronic health conditions is obesity, a trait more ubiquitous in both regions. In particular, we find an increase in the racial obesity gap among KOMA residents, with non-white citizens reporting more cases of obesity and white residents reporting fewer in 2023.

Benchmarking Communities

Compared to a group of peer communities, we 􀏐ind that the hospital admission rate in the Grand Rapids region has reached a record low for the city (80.65 admissions per 1,000 residents in Grand Rapids vs. an average of 105.82 in the peer communities). This represents a 10 percent increase for Grand Rapids, while the admission rate declined by 1 percent for the benchmark communities and the national average declined by 2 percent. As a result of this convergence, the admission rate in Grand Rapids is now 14.8 percent below the national average, which is a rebound from last year’s 6.6 percent difference, the smallest recorded in any year covered by this report. In 2022, Grand Rapids and Muskegon reversed long-running growth trend in outpatient visits per capita, instead experiencing a 13 percent decrease. This was not seen in any of the comparison communities, where rates remained steady. While Grand Rapids region still has the highest per capita outpatient visits to hospitals of all comparison communities, it is only 79 percent above the national average in 2022, compared with 108 percent in 2021.

The year 2022 marked a return to trend in emergency department (ED) visits per capita in Grand Rapids and Muskegon. In the previous year, the city experienced an uncharacteristic spike in ED utilization that caused its per capita visits to rival those of Detroit, the historical top utilizer of ED services. Whereas Grand Rapids had always been close to the national average, this spike brought its ED utilization 27.4 percent above the national average in 2021. The reasons for this spike include an early onset of wintertime viral illnesses, the rise of delta-variant COVID-19, and a surge in mental health-related emergencies. The 2022 data shows that ED visits per capita in Grand Rapids are essentially back down at the national average.

The data on number of hospital personnel and compensation per worker reveals that previously observed difficulties in hospital staffing are persisting in Detroit and the benchmark communities in 2022. Both of these continue to experience declining hospital-based personnel per capita in 2022 despite above-trend increases in real hospital payroll and bene􀏐its per employee. The country as a whole may have turned the corner on this, however, as the national average shows both personnel per capita and real payroll and bene􀏐its per employee leveling off. Of all the communities, only Grand Rapids experienced both increases in hospital personnel and declining compensation per employee, suggesting that the city has been more successful than its peers in attracting and retaining hospital based personnel.

Major Medical Conditions: Expenditure and Utilization Analysis

We used member data provided by Blue Care Network, Blue Cross Blue Shield of Michigan, and Priority Health to examine average annual expenditures and health care use for those diagnosed with at least one of the following six chronic conditions: asthma, coronary artery disease (CAD), depression, diabetes, hyperlipidemia, and low back pain.

Understanding that, from year to year, small coding changes may affect the composition of the diagnosis categories, we 􀏐ind mostly increases in per-member expenditures across conditions between 2021 and 2022 in KOMA counties. Spending was up for those diagnosed with asthma (+8.7 percent), low back pain (+4.8 percent), depression (+3.4 percent), hyperlipidemia (+2.6 percent), and diabetes (+1.8 percent). Spending also increased signi􀏐icantly for healthy patients (+8.3 percent). The only decline observed was for those with a CAD diagnosis (-5.4 percent). This is following general declines in expenditures observed last year.

Expenditure differences between 2022 and 2023 in Detroit tended to go in the other direction, with reductions between 3.6 and 12 percent. Expenditure increased in Detroit for healthy patients, though only by less than half as much as in Grand Rapids (+3.2 percent). The greatest differences concerned asthma and low back pain. All of this re􀏐lects what is generally good news for health care utilization in Detroit. While Detroit still utilizes inpatient services, ED visits, prescription 􀏐ills, and telehealth above levels observed in Grand Rapids, the 2023 data shows a signi􀏐icant narrowing of the gap. Utilization tended to decline slowly in Grand Rapids, but more quickly in Detroit.

Disparities

The member data from Blue Care Network, Blue Cross Blue Shield of Michigan, and Priority Health were linked with 2020 census data on population, mean household income, and race at the ZIP-code level. The goal of this section is to examine differences in private insurance coverage, underlying health characteristics, and the prevalence of several chronic conditions across ZIP codes with different income levels and racial concentrations. Furthermore, the insurance plans contributing data to this section provided detailed information on total member months by ZIP code. We observe patterns that are consistent with disparities by income and race in Michigan, although there are differences between the east and west sides of the state.

Concerning income, both KOMA and Detroit regions exhibited comparable disparities between High- and Low-Income ZIP codes in the underlying health characteristics of the population. This is despite KOMA having less disparity in household income than Detroit. The average risk score among residents of the Low-Income ZIP codes of the KOMA region is 27 percent greater than that of the High-Income ZIP codes; it is only 23 percent greater in the Detroit region. Similar patterns of greater health disparities by income in KOMA than Detroit were observed for CAD, diabetes, and hyperlipidemia.

Concerning race, despite the updated census information and coding changes, the different patterns in health disparities remain between the two regions, but for a smaller number of variables and the differences are more muted. Average risk scores were relatively high in High Share Black ZIP codes of Detroit, but not so for the KOMA region. High Share Black ZIP codes of KOMA have a greater prevalence of asthma than do its High Share White ZIP codes, while the reverse is true for Detroit. A similar pattern is observed for members with a depression diagnosis. For the first time since this report began tracking disparities, we find that diabetes was more prevalent in the High Share Black ZIP codes of KOMA than in the High Share White ZIP codes. While the disparity is not at the level consistently observed in Detroit, the finding of a new racial disparity is concerning. This section further shows that reduced prevalences of CAD, hyperlipidemia, and low back pain in Detroit were primarily realized by residents of the High Share White ZIP codes, while those in the High Share Black ZIP codes remained steady.

To summarize, we continue to find differences in racial disparities between the two regions, but less stark than was found in last year’s version of this report utilizing the same methods. The key income disparities in disease prevalence in KOMA uncovered in last year’s report remain and tend to be greater in magnitude than Detroit.