Hospitals have been a major part of Minnesota’s statewide news in the past few weeks, as both large and small facilities adapt to changing times.

The news about Hennepin County Medical Center and Sanford is a major development. There have also been articles about smaller facilities in places like Madelia in south central Minnesota and Virginia on the Iron Range.

Health care has seen vast changes in the past 20 years. It’s become more expensive with higher insurance premiums and higher out of pocket costs.

It’s also become more corporate. There are far fewer municipal hospitals, fewer that are governed by a locally based hospital board.

When considering the future of health care, it’s important to look back on how the basics of medical care worked in the past with much less in terms of facilities.

Marshall’s 20th century health care history is reflective of small cities. It wasn’t until the 1950s that it had a building that was constructed as a hospital.

Instead Dr. Gray’s hospital in the 1910s was created from the former South Side school building near today’s Marshall Municipal Utilities. Later a hospital was established in a large house on West Lyon Street that had been built by Marshall Milling Company owner William Gieske.

These facilities helped to launch a new era in medical care. Babies were more likely to be born in a hospital rather than at home. The West Lyon Street facility had a sick room in the former maid’s room for people in their last days of life. It was the closest thing they had to hospice care back then.

The era after World War II included the construction of Weiner Memorial Medical Center on what was then the eastern edge of town and the former Doctor’s Plaza on East College Drive.

The facilities grew as Marshall grew. A building expansion in the 1970s led to a co-location of the hospital and medical clinic.

A generation later it became clear that the trend was toward affiliations with larger hospitals in urban centers. Weiner Memorial became Avera Marshall. Like other new affiliations throughout the United States, it was undertaken with a goal to afford new technology, increase access to specialists and continue to offer a wide range of services at the local level.

Change has continued. People use more prescription drugs. They’re likely to travel about 100 miles for some types of medical appointments. The cost of care is beyond almost anyone’s ability to pay on their own, creating a dependence on health insurance.

We hope that technological advances extend life and improve the quality of life. If they give people five more healthy years, it’s worth the cost and the bureaucracy.

If it only prolongs life for a year or two, however, maybe more of the money needs to be spent on preventive care and promotion of healthy lifestyles. Maybe we need to retain health rather than just treating sickness.

It’s hard to imagine going back to autonomous local hospitals. We need the best of both worlds, the fiscal advantages of large health care corporations but the tradition of having personalized service.

There are many doctors who built entire careers around small towns. Besides Gray we have examples like Hedenstrom, Stover, Eckdale, Martin, Kaczerowski and others in Marshall. Smaller communities had doctors like Olson and Myers in Canby and Mulder in Ivanhoe.

Over the years they were supported by many dedicated nurses and health care workers, people who performed work that was often routine yet vitally important to the patients.

We need the exact same continuity in the 21st century. The worst thing that could happen would be if rural communities became training grounds for young health care professionals who move on to larger facilities in three to five years.

We need to continue to have health care professionals who spend most, if not all, of their careers in the same location. They should be like the best known doctors of the 20th century, or like what Bob Byrnes meant to Lyon County as its Extension agricultural educator.

Extension agents used to travel down almost every gravel road in their counties in a year. Likewise medical staff should aim to care for the children of people they’ve had as lifelong patients.

That’s the best way to sustain strong community ties. It’s up those at the top level of the health care industry to make sure local staffs get that chance. On a big picture level we sometimes wonder if the personal service will continue. By looking at recent individual success stories, we can believe the future is bright.

— Jim Muchlinski is a longtime reporter and contributor to the Marshall Independent