North Carolina ranks 44th in the nation in access to health care. When you consider we have great access in some parts of the state — those close to metropolitan areas and teaching hospitals in Charlotte-Mecklenburg, the Triad, and Triangle — the overall ranking is misleading.

Access is especially poor in rural parts of the state.

In North Carolina, 20 counties don’t have a pediatrician, 26 counties don’t have an OB-GYN, and 32 are without a psychiatrist. Three counties haven’t had a dentist for the past 10 years, and 70 counties have been designated as dental health professional shortage areas. North Carolina consistently ranks 47th among the states in terms of dentist-to-population ratio. Seventy of the 80 rural counties are currently “medical deserts” for lack of availability to primary care .

Less access to health care brings poorer health outcomes, people don’t get diagnoses and treatment early, and the population experiences persistently higher mortality rates. When there’s less health care infrastructure, a downward spiral occurs. Fewer doctors want to practice in underserved areas, there’s less care, costs go up, and healthy people don’t access care in early stages of illness. Sick people get sicker. When less health care is available in an area, people don’t want to move there, fewer businesses expand and relocate, and there are fewer jobs. All of this results in higher rates of poverty. People get sicker, outcomes are worse, care is less accessible, and it comes with a higher cost.

We don’t have a physician shortage. We have an allocation problem. It’s not a matter of supply but of distribution. Most providers cluster in wealthier, more culturally diverse urban areas. Of the 434 medical school graduates in North Carolina in 2011, only 1.6 percent — seven graduates – are now providing primary health care in rural areas. Where to practice and live is a choice for doctors, but it goes further than doctor distribution.

Real economic costs are linked to a lack of health care. New entrepreneurs need access to health care to offset the risk of opening their own business and to attract and retain workers. A community that doesn’t have a good health-care system isn’t going to get to first base in recruiting new companies. To recruit good workers, employers must be able to ensure access to quality, affordable health care.

I’m not suggesting a new government program or set of regulations controlling where doctors can live and practice, exerting even more government control over our health care. I’m suggesting we do the opposite — that we remove the legal handcuffs that regulations have imposed on providers. I propose we solve the problem by empowering individuals, using the power of enterprise and free markets, not government regulations.

Four policy changes can be made that would transform our health-care system, innovative ideas that wouldn’t require new government programs and massive taxpayer funding.

Telemedicine allows interaction between patients and providers. Doctors can monitor and treat patients from a distance, saving time and money. Technology has been used in overcrowded emergency rooms, accessing experts located elsewhere to stabilize stroke victims and to save lives.

Exploring new models of health-care delivery is gaining acceptance from doctors and patients. Direct primary care offers patients 24/7 access to their doctors without the constraints and complications of insurance. Paying a monthly fee, fees for services rendered, and a high deductible insurance plan covers medical needs and restores the traditional doctor/patient relationship many had found missing. The state has more than 30 direct primary care physicians. Union County offered direct primary care as an option for its employees. In addition to great satisfaction with the plan, the county saved more than $1 million in health-care costs the first year.

Another way to expand care is to allow medical providers to practice within their full scope of 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 needs to repeal certificate-of-need laws, as 15 other states have done. Qualified doctors and medical providers must get government approval before they expand or build their practices, buy new equipment, offer different services, or open new facilities. The process is expensive and time-consuming. It’s particularly difficult for smaller practitioners. North Carolina has the fourth-most restrictive certificate-of-need laws in the country. Numerous studies confirm what common sense tells us: Certificate-of-need laws stifle competition, drive up costs, and limit access to care.

Major tax cuts, limiting the growth and scope of government, paying down debt, building savings reserves, and massive regulatory reform have propelled North Carolina to a No. 1 ranking in Forbes Magazine as the most business-friendly state in the country. In the Tax Foundation’s business tax climate index, North Carolina has climbed from 44th in the nation in 2010 to 11th.

These efforts have achieved a tremendous economic benefit for our state. A total of $5 billion has been returned to taxpayers, a net of more than 444,000 jobs have been created, businesses are growing, and more businesses have been created and are profitable. Unemployment has been cut in half since 2011. The next frontier of North Carolina’s reform efforts must be medical. Not only will it create more economic benefits for our residents, but, more important, it will save thousands of lives. High quality, accessible, lower-cost health care is literally a matter of life and death.

Becki Gray is senior vice president at the John Locke Foundation.