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Rural counties make up about 80 percent of the land area of the United States, but they contain less than 20 percent of the U.S. population. The relative sparseness of the population in rural areas is one of many factors that influence the health and well-being of rural Americans. Rural areas have histories, economies, and cultures that differ from those of cities and from one rural area to another. Understanding these differences is critical to taking steps to improve health and well-being in rural areas and to reduce health disparities among rural populations. To explore the impacts of economic, demographic, and social issues in rural communities and to learn about asset-based approaches to addressing the associated challenges, the National Academies of Sciences, Engineering, and Medicine held a workshop on June 13, 2017. This publication summarizes the presentations and discussions from the workshop.
Straub and Walzer have assembled a well-balanced collection of articles by experts in the field of health care, beginning with two which explore the changing populations and economies of rural areas. Successive chapters explain issues such as recent developments in home patient care, cost-saving innovations, and the pros and cons of rural HMOs. Of special note are those essays which project the future of health care and provide alternative approaches to health care services such as the viability of the rural hospital in the future; progressive non-hospital options; and ways to maximize resources in the years to come. Since this detailed work investigates the major facets of the struggling rural health care system, it will prove valuable not only to health care officials, but also to health care and social science faculty, and to state and local officials whose understanding of health care issues directly affects their policy making.
There are 46.2 million Americans (15% of total population) living in rural counties. Rural populations disproportionately suffer from inadequate access to, high cost of, and poor quality of health services compared to urban populations. Furthermore, rural populations have lower income, lower educational attainment, worse insurance coverage, and poor health status. In response to the goal of Healthy People 2020 to eliminate disparities, this dissertation developed and conceptualized three topics to address rural health disparities. Using the 2004-2010 Medical Expenditure Panel Survey (MEPS), the first study found that geriatricians were less likely to be a usual source of care for both rural and urban older adults. The finding may be a result of the geriatrician shortage that exists while the aging population in the United States is growing. Also using the 2010 MEPS, the second study found that rural populations had a higher spending on prescription drugs and urban population had a higher spending on hospital emergency care. The result of quantile regression further indicated that the geographic factor might affect high spending users more than low spending users. For the third study, the 2011 California Healthcare Cost and Utilization Project (HCUP) provided evidence that rural residents had higher maternal readmissions rates in spite of the delivery mode. The maternal readmission rate seems way lower than other procedures but it is still important to monitor the quality of caesarean section deliveries. The primary limitation of this dissertation may be the poor generalizability to populations in different age groups or living in different areas from California. However, the trend data, quantile regression, and generalized estimating equation employed in this dissertation presented rural health disparities in a different approach. Considering access, quality, and cost problems in rural areas as a whole, our research findings suggest that improving access to quality of care in rural areas should be a major priority. Moreover, addressing this healthcare deficiency should also subsequently reduce the unnecessary costs of care. In conclusion, effective strategies and actions are needed to provide more health resources and strengthen the rural health infrastructure. The electronic version of this dissertation is accessible from http://hdl.handle.net/1969.1/151969
With an increase in aging and uninsured in the U.S. population, there has been an increase in individuals seeking primary health care. In addition,many physicians have left rural communities or only stay a short time and many independent Nurse Practitioners (NPs) have started their own practices. In many instances, nurse practitioners have identified difficulties in the management aspect of their businesses as well as problems meeting the need to increase health care access and satisfaction for the clients. While many authors have discussed satisfaction and access to health care, the financial difficulties that arise in a private practice often need improvements for the enterprise to be sustainable. Approximately 30 years of comparison studies have demonstrated NPs are equitable to physicians concerning quality of care, satisfaction, and cost effectiveness. The purpose of this project is to ascertain if the NP owned Rural Health Care (RHC), a Limited Liability Company (LLC) located in rural New Mexico (NM), will meet the objectives in providing better access to care and client satisfaction by improving the business management systems and thus increase profits compared to the past performance. With more management efficiency and profits, it is expected that access to care and client satisfaction will be improved and will add to the retention of clients and ultimately, revenues. The market and risk analysis revealed the need for a NP enterprise and the study demonstrated a good outcome. After an evaluation of the positive results, a repeat study is recommended to test the vailidity and reliability of the modified survey.
Americans living in rural areas face a shortage of primary care physicians and specialists, and often must travel large distances to obtain medical care. The increasing cost of providing health care and the demands of an aging population also put pressures on rural health care providers, many of which struggle to keep their doors open.The Federal Communications Commission (Commission or FCC) has implemented the statutory mandate for universal service by, among other things, creating the Rural Health Care (RHC) program to improve access to communications services for eligible health care providers. In recent years, broadband has become increasingly vital to the effective delivery of health care, and it can be uniquely transformative in rural areas, where distance poses a substantial challenge. In recognition of this, the Commission in 2006 launched the Rural Health Care Pilot Program (Pilot Program), which awarded 69 projects one-time funding for a defined period of time (a total of $418 million) to cover up to 85 percent of the cost of construction and deployment of broadband networks that connect participating health care providers in rural and urban areas. The Pilot Program currently supports 50 active projects in 38 states (the “Pilot projects”) and the territories of Guam, American Samoa and the Northern Mariana Islands. Many of the Pilot broadband networks have been established and are now delivering the benefits of telemedicine and other telehealth applications to their patients.In creating the Pilot Program, the Commission sought to harness the potential of broadband health care provider networks to improve the quality and reduce the cost of health care in rural areas, while drawing on that experience to inform the redesign of its permanent RHC program. A key component of any pilot program is the opportunity to evaluate what has been learned and how those experiences can inform future work – in this case, the Commission's ongoing oversight and management of its universal service programs. This Staff Report provides an evaluation of the successes and challenges of the Pilot projects to date. The Report describes the projects, their broadband networks, and the financial and telehealth benefits generated by their broadband connectivity. The Report presents data through January 31, 2012, except where otherwise noted.This Report also summarizes key observations from the Pilot Program, to assist the Commission as it considers potential changes to the permanent rural health care program. In the 2010 Notice of Proposed Rulemaking (NPRM), the Commission proposed a number of changes to improve access to broadband services and broadband infrastructure for health care providers, building on the recommendations of the 2010 National Broadband Plan.As is clear from this Report, the Pilot Program provides fertile ground to help the Commission determine how best to reform the existing rural health care program, which provides ongoing support for telecommunications and Internet access services. The following are key facts, benefits, and lessons of the Pilot Program to date: