Increasing Access to Health Care in Rural America

Increasing Access to Health Care in Rural America

After using an “all hands on deck approach,” the White House Rural Council was able to produce a package of new job initiatives that were announced at the White House Rural Economic Forum. The Council’s recommendations, which leverage existing programs and funding, include making HHS loans available to help more than 1,300 Critical Access Hospitals recruit additional staff, and helping rural hospitals purchase software and hardware to implement health IT. The specifics are below:

Increasing Rural Access to Health Care Workers and Technology

Increasing Physician Recruitment at Critical Access Hospitals: HHS will issue guidance to expand eligibility for the National Health Service Corps loan repayment program so that Critical Access Hospitals (those with 25 beds or fewer) can use these loans to recruit new physicians. This program will help more than 1,300 CAHs across the country recruit needed staff. The addition of one primary care physician in a rural community generates approximately $1.5 million in annual revenue and creates 23 jobs annually. The average CAH creates 107 jobs and generates $4.8 million in payroll annually.

Expanding Health Information Technology (IT) in Rural America: USDA and HHS will sign an agreement linking rural hospitals and clinicians to existing capital loan programs that enable them to purchase software and hardware needed to implement health information technology (HIT). Under current conditions, rural health care providers face challenges in harnessing the benefits of HIT due to limited access to capital and workforce challenges. Rural hospitals tend to have lower financial operating margins and limited capital to make the investments needed to purchase hardware, software and other equipment.

The health status of rural residents are intertwined with geography, economy, individual habits and genetics as well as access to care. The result of the dynamic interplay between these factors is a population that tends to experience a higher rate of: accidents, suicides, people with low income, public health insurance eligibility and uninsured than their metropolitan counter-parts.

Policy solutions for rural health have taken many forms including: loan repayment programs (Federal and State); construction of schools, hospitals and clinics; National Health Service Corps; J1 visas (non-US trained physicians); and telemedicine. While each of the policy solutions have its merits and effected rural health disparities to varying degrees, the basic mismatch of providers to residents still exist and create a very real access to care problem.

Hopefully this latest package combined with those provided by ACA will increase access to health care in rural areas.

Helpful Rural Health Terms to Know

Rural Health Clinics (RHCs): Clinics in official “rural designated” areas that provide a “safety net” for health care delivery. There are approximately 3,800 Rural Health Clinics nationwide that provide access to primary care services in rural areas[i].

Federally Qualified Health Centers (FQHCs): “Safety net” providers such as community health centers, public housing centers, outpatient health programs funded by the Indian Health Service, and programs serving migrants and the homeless that meet the Centers for Medicare and Medicaid Services (CMS) criteria for FQHC designation. The main purpose of the FQHC Program is to enhance the provision of primary care services in underserved urban and rural communities[ii].

Health Professional Shortage Areas (HPSAs): These areas, designated by Health Resources and Services Administration (HRSA), have shortages of primary medical care, dental or mental health providers and may be geographic (a county or service area), demographic (low income population) or institutional (comprehensive health center, federally qualified health center or other public facility). [iii]

Medically Underserved Areas (MUA): Areas that are designated by HRSA in which residents have a shortage of personal health services. They may be a whole county; a group of contiguous counties, a group of county or civil divisions; or a group of urban census tracts. [iv]

Medically Underserved Populations (MUPs): Groups of people who face economic, cultural or linguistic barriers to health care as defined by HRSA.[v]

Criteria for Rural and Urban Designation

Rural definitions are typically based on the following three concepts; administrative, land-use, or economic[vi]. Each definition provides considerable variation in socio-economic characteristics and well-being of the measured population[vii]. This process becomes more confusing when more than one definition is used during policy creation and evaluation.

However, one of the major criteria for Rural Health Clinics is to meet the Census Bureau’s standard of rural. The standard is straightforward- is a definition based on exclusion. Simply put, in order to meet the definition of rural an area cannot meet the Census Bureau’s definition of urban (see below)[viii].

The Census Bureau does not define suburban[ix].

Urban: All territory, population, and housing units located within an urbanized area (UA) or an urban cluster (UC). UA and UC boundaries encompass densely settled territory, which consist of: 1) core census block groups or blocks that have a population density of at least 1,000 people per square mile and 2) surrounding census blocks that have an overall density of at least 500 people per square mile[x].

Rural: The Census Bureau’s classification of “rural” consists of all territory, population, and housing units located outside of urban areas (UAs and UCs). The rural component contains both place and non-place territories. Geographic entities, such as census tracts, counties, metropolitan areas, and the territory outside metropolitan areas, often are “split” between urban and rural territory, and the population and housing units they contain often are partly classified as urban and partly classified as rural[xi].

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