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
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Coming from a rural area myself, I believe that we are at a disadvantage for health care. The National Rural Health Association is on the right track and should keep persuing this agenda.
ReplyDeleteI also come from a rural area and work as a CNA in a rural nursing home. I believe that we are a little bit set back compared to urban area nursing facilities because they seem to have more materials and supplies that they need right on their location. Where as in the rural areas we tend to have to med flight residents/patients out.
ReplyDeleteI don't know if this issue will ever be resolved. I think there are things that can be done to improve the problem. But facing facts - physicians are always going to choose to practice in urban areas.
ReplyDeleteIt would be nice if all people nationwide, whether rural, urban, inner city, suburban regardless had access to the same health care. This was a good idea for a reform and is something that should be pursued by our government.
ReplyDeleteI come from a rural area as well and this will continue to be an ongoing issue. I think the incentives the reform proposed to get the physicians to practice in a rural area are good ideas. However, more will need to be done to attract more physicians to rural areas because it will still be a bigger draw to work in an urban area.
ReplyDeleteI grew up in a rural area but currently reside in the city of Milwaukee. I have the advantage of seeing health care from both ends of the spectrum. I do believe that the incentives for Physicians and/or medical practitioners to remain in urban areas will undoubtedly keep them there. I also think it is unjust to imply that medical practitioners are all motivated by high salaries. Is it possible that research and the desire to make a difference could play a role in the decision to stay urban? The simple fact of the matter is that where you have more people, you also have more interesting cases and better facilities to use. The opportunities to make advances in modern medicine are far greater in these densely populated and diverse areas. The idea of a reform that will equalize health care throughout is very utilitarian but ultimately unrealistic.
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