I am a second semester senior nursing student at UWEC. Living in Eau Claire, WI some people may call this a large community in the midwest but compared to many larger cities we lack many of the healthcare oppurtonities that a larger city such as milwaukee or chicago may have. Yes I argee that early access to care is an important part in saving someones life in emergent situations. And it is not just the physicians that we would need to put in these rural communities. Even if we could find physicians, there would still be a need for the rest of the health care staff, at the time of a traumatic event and the facilities.At this point I feel that our best option is similar to what Luther Midelfort Mayo has done in Eau Claire; creating community hospitals that can treat many minor problems, but work to diagnose and then transfer the patient via ambulance or helicoptor to eau claire, and possibly rochestor to treat the problem. For example if someone presented at the ER in some small town population 500, 1 hour from Eau Claire with chest pain and STEMI elevation. It would be more cost effective and provide better care to let the physicians diagnose the patient with an MI, and transfer him to Eau Claire where there is a cath lab, and can preform emergency open heart surgery, and have a critical care unit to take care of him, rather than leave him in Barron WI, where the only option is to treat the patient medicaly, not surgicaly.On a side note, Although Eau Claire could be considered a rather large community, Luther Midelfort hospital normally does not keep peds patients in house, rather transfer them to the cites or Mayo, the average daily census for pediatric patients at luther in Eau Claire is .72. At Sacred Heart the other local hospital the cenus is slightly higher.My thought for the best way to provide care is to aim at primary care and secondary prevention in the rural communites, where they can refer to larger hospitals, so there are able to seek more cares, where there is more specialization, and surgical options.
The most important aspect to care is for primary access to care
Friday, April 17, 2009
Monday, April 6, 2009
Reform Proposal 4 - Improving Rural Access Disparities
Our last reform focuses on improving the disparity between access for rural residents versus those in urban areas. At the bottom of the health care marketplace lie rural communities that lack the population base, local economy, or lifestyle benefits to attract and maintain substantial primary health care providers. 20% of the US population lives in rural areas that take up 80% of the land mass, yet 9% of all physicians practice in rural locations (RWHC). In the past two decades some physicians have spread into these low density areas, but the vast majority continue to locate in the areas already with large numbers of primary care providers leaving rural populations at an extreme disadvantage in their access and quality of care. Our health care system is set up with a market based model. Delivery is linked to where people can pay rather than where the care is needed (Shi and Singh).
Rural populations are among medically underserved areas (MUAs) that need the protective benefits of being seen early and treated in outpatient and primary care facilities. But the health problems of these residents are by and large under-diagnosed. Medicare payments to rural physicians are also dramatically lower than urban counterparts for equivalent services (NRHA). Rural populations could use primary care more and are receiving it less. They have less access and thus a poorer quality of overall health. They also experience cost difference as many times they must travel great distances to be seen. Or else they choose not to travel to see a primary care physician and don’t receive treatment early ending up with greater costs and morbidities.
It is understood that medical school graduates want to obtain prestigious, high paying jobs to pay off their debt and live the luxury their education has afforded them. This allows maldistribution by both specialty and location. Primary care rural doctors are hard to recruit and harder retain. Urban areas offer greater prospects for ‘high incomes, professional interaction, access to modern facilities and technology, continuing education and professional growth, higher standards of living’ among others (Shi and Singh). All of these lead to rural areas having to work harder to recruit and try to offset those options and entice doctors to consider their career location. Rural areas offer their own benefits as they have low density populations, cleaner environments, low crime rates, and a value system that embodies neighborliness. Rural primary care physicians also cite better job satisfaction as they are made to feel their services are essential and deeply appreciated by the community (NRHA).
In order to fix this issue it will take a multifaceted approach that is well-tuned to all the problems. First one must consider the desires of graduating primary care physicians. There already are national and state reimbursement packages for practitioners choosing to locate in rural areas which pay back tuition and debt they possess. These reimbursement programs should be expanded to allow more physicians the option of receiving these. They’re extremely effective but funded too modestly. Hospitals and clinics should also consider offering compensation packages which take into consideration pay cuts doctors take when locating rurally. Teaching hospitals producing rural primary care physicians should increase the number of slots available. It’s shown that those with rural experience are more likely to take jobs in rural areas. Training programs should facilitate admission to students coming from rural communities, offer educational experiences use internships for rural exposure (Shi and Singh). The rural communities should also feel empowered to make themselves attractive to potential health care workers and recruit those who will improve their primary care. Access to capital for these rural facilities should also be improved both federally and statewide to allow them the construction and modernization to attract primary care practitioners (National Advisory Committee on Rural Health).
These actions would decrease costs in transportation and residual care to rural residents by increasing primary care personnel to allow them better access and therefore improving their quality of health care.
The National Rural Health Association is a good source of advocacy and policy change that can be implemented to see health care for 62 million rural Americans improved. They’ve been instrumental in some of the recent changes that have taken place. They believe that ‘All Americans are entitled to an equitable level of health and well-being established through health care services regardless of geographic locale, gender, ethnic or racial background, or economic ability or status.’ (NRHA)
Resources:
Shi, L., & Singh, D. A. (2008). Delivering health care in America: A systems approach (4th ed.). Sudbury, MA: Jones and Bartlett Publishers, Inc.
National Rural Health Association. (2009). What's different about rural health care? Retrieved April 2, 2009, from http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-about-rural-health-care
The National Advisory Committee on Rural Health and Human Services - U.S. Department of Health and Human Services. (n.d.). Compendium of recommendations by the National Advisory Committee on Rural Health . Retrieved April 2, 2009, from http://ruralcommittee.hrsa.gov/nac_comp.htm
Rural Wisconsin Health Cooperative. (2009, February). Review and commentary on health policy issues for a rural perspective. Retrieved April 2, 2009, from http://www.rwhc.org/eoh09/February.pdf
Oregon Rural Health Association. (n.d.). Rural health disparities. Retrieved April 2, 2009, from http://www.orha.org/disparities.htm
Rural populations are among medically underserved areas (MUAs) that need the protective benefits of being seen early and treated in outpatient and primary care facilities. But the health problems of these residents are by and large under-diagnosed. Medicare payments to rural physicians are also dramatically lower than urban counterparts for equivalent services (NRHA). Rural populations could use primary care more and are receiving it less. They have less access and thus a poorer quality of overall health. They also experience cost difference as many times they must travel great distances to be seen. Or else they choose not to travel to see a primary care physician and don’t receive treatment early ending up with greater costs and morbidities.
It is understood that medical school graduates want to obtain prestigious, high paying jobs to pay off their debt and live the luxury their education has afforded them. This allows maldistribution by both specialty and location. Primary care rural doctors are hard to recruit and harder retain. Urban areas offer greater prospects for ‘high incomes, professional interaction, access to modern facilities and technology, continuing education and professional growth, higher standards of living’ among others (Shi and Singh). All of these lead to rural areas having to work harder to recruit and try to offset those options and entice doctors to consider their career location. Rural areas offer their own benefits as they have low density populations, cleaner environments, low crime rates, and a value system that embodies neighborliness. Rural primary care physicians also cite better job satisfaction as they are made to feel their services are essential and deeply appreciated by the community (NRHA).
In order to fix this issue it will take a multifaceted approach that is well-tuned to all the problems. First one must consider the desires of graduating primary care physicians. There already are national and state reimbursement packages for practitioners choosing to locate in rural areas which pay back tuition and debt they possess. These reimbursement programs should be expanded to allow more physicians the option of receiving these. They’re extremely effective but funded too modestly. Hospitals and clinics should also consider offering compensation packages which take into consideration pay cuts doctors take when locating rurally. Teaching hospitals producing rural primary care physicians should increase the number of slots available. It’s shown that those with rural experience are more likely to take jobs in rural areas. Training programs should facilitate admission to students coming from rural communities, offer educational experiences use internships for rural exposure (Shi and Singh). The rural communities should also feel empowered to make themselves attractive to potential health care workers and recruit those who will improve their primary care. Access to capital for these rural facilities should also be improved both federally and statewide to allow them the construction and modernization to attract primary care practitioners (National Advisory Committee on Rural Health).
These actions would decrease costs in transportation and residual care to rural residents by increasing primary care personnel to allow them better access and therefore improving their quality of health care.
The National Rural Health Association is a good source of advocacy and policy change that can be implemented to see health care for 62 million rural Americans improved. They’ve been instrumental in some of the recent changes that have taken place. They believe that ‘All Americans are entitled to an equitable level of health and well-being established through health care services regardless of geographic locale, gender, ethnic or racial background, or economic ability or status.’ (NRHA)
Resources:
Shi, L., & Singh, D. A. (2008). Delivering health care in America: A systems approach (4th ed.). Sudbury, MA: Jones and Bartlett Publishers, Inc.
National Rural Health Association. (2009). What's different about rural health care? Retrieved April 2, 2009, from http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-about-rural-health-care
The National Advisory Committee on Rural Health and Human Services - U.S. Department of Health and Human Services. (n.d.). Compendium of recommendations by the National Advisory Committee on Rural Health . Retrieved April 2, 2009, from http://ruralcommittee.hrsa.gov/nac_comp.htm
Rural Wisconsin Health Cooperative. (2009, February). Review and commentary on health policy issues for a rural perspective. Retrieved April 2, 2009, from http://www.rwhc.org/eoh09/February.pdf
Oregon Rural Health Association. (n.d.). Rural health disparities. Retrieved April 2, 2009, from http://www.orha.org/disparities.htm
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