Tim Size

What is the “right model” for rural health care to ensure that we are not “over investing” in rural areas?

[imgcontainer left][img:TS174.jpg]Tim Size[/imgcontainer]

That question came from a well meaning participant at a White House Rural Council meeting I attended early this summer.

It’s a troubling inquiry, made all the more problematic because the questioner seemed well motivated and totally reasonable.

But the question highlights a dangerous myth – that we are spending too much on rural health.

When the questioner finished, I responded as tactfully as I could.

“I couldn’t really worry about this until our country got a lot closer to making an equitable investment in rural health,” I said.

The use of scarce dollars for rural health obviously must be done wisely. But given the studies and numbers I have seen, I don’t believe we are even close to needing to worry about “over-investing.”

Rural can do much better, as can the whole healthcare system. But rural is already doing more with less, according to a report issued last December by the federal Department of Health & Human Services’ National Advisory Committee on Rural Health and Human Services:

The people served by rural hospitals are more likely to report a fair to poor health status, suffer from chronic diseases, lack health insurance, and be heavier, older, and poorer than residents of urban areas. Yet overall, the average cost per Medicare beneficiary is 3.7 percent lower in rural areas than in urban areas, and rural hospitals perform better than urban hospitals on three out of the four cost and price efficiency measures on Medicare Cost Reports.

In the same vein, the Alliance for Health Reform, supported by the Robert Wood Johnson Foundation, says, “Rural residents have rates of chronic disease such as diabetes, heart disease, high blood pressure and obesity that are greater than urban or suburban populations.” So we have much to still accomplish.

It doesn’t sound to me that rural health is receiving an unfairly high share quite yet.

What about the first half of the question: “What is the right rural model?” Simply put, there is no “single” or “right” model for America’s diverse array of rural communities, but there are key questions to guide each community in seeking their own answers.

For me the “model of care” question falls into four buckets:

  1. How do we provide care that centers on patients, coordinates clinicians and other caregivers into a team and focuses on results? 
  2. How do we collaborate with regional organizations like hospitals, clinics and, in some cases their affiliated insurance companies, to emphasize value of care over volume of care?
  3. How do we work as partners with others locally and regionally to foster healthy communities?
  4. How do we adapt urban-based federal models to the unique characteristics of our rural communities?

These are the questions we need to be addressing, and I have no doubt that in most communities this is work increasingly under way.

Although we’re not “over investing” in rural health care, I do admit that rural has a real advantage. Rural physicians, clinics and hospitals have the advantage of being able to make change more quickly. And there is a depth of passion and dedication when neighbors are quite literally caring for each other.

I have no doubt that we have a hometown advantage in that rural communities want rural providers to succeed and to keep local care local.

Tim Size is executive director of Rural Wisconsin Health Cooperative in Sauk City and former National Rural Health Association president.

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