Rural Health Care: Challenges & Opportunities

Issues & Research

Presenter: W. David Helms, Ph.D., President, Alpha Center, Washington, DC.

Toward the end of the workshop, participants met in regional delegations to assess the rural health infrastructure in their States and communities and to identify the needs of rural health policymakers to assist them in their decisionmaking. Participants were asked to discuss the key challenges and opportunities they face regarding various components of the rural health infrastructure covered in this workshop, such as:

• Health care workforce.
• Public health and occupational health.
• Emergency medical services.
• Hospitals and critical access hospitals.
• Long-term care services.
• Managed care.
• Networking and possible strategies for addressing these policy issues.

Health care workforce challenges in rural areas included aging providers and shortages of health care professionals and paraprofessionals in areas such as:

• Health care administration.
• Mental health.
• Dental health.
• Nursing staff in remote nursing homes.
• Private duty nursing (e.g., for children).
• Physical therapy.

Possible strategies to address these problems include:

• Using Medicaid/Temporary Assistance to Needy Families to extend health insurance to those paraprofessionals.
• Increasing recruitment and retention efforts.
• Establishing standards for population needs to support different levels of services.

Policy and research issues to be addressed included ensuring adequate supply of primary care physicians in rural areas.

There is lack of data on rural issues with regard to public health and occupational health. Further research is needed to differentiate rural from urban data; find models that work; and study border health and immigration. One possible strategy for improving public health in rural areas would be linking local public health to rural hospitals.

Challenges for emergency medical services (EMS) in rural areas include:

• Lack of consistency in training.
• Need for more volunteers, especially in remote rural areas.
• Inadequate financing for remote areas.

Possible strategies include:

• Educating the county commissioners.
• Developing a broader health system that those services can fit into.
• Improving EMS system direction.

More research is needed on the effectiveness of regionalization, research on community models of EMS (e.g., immunization program), and finding models that work.

With regard to hospitals, although rural providers can showcase what they do with critical access hospitals (CAHs), there is a need for comparative quality studies on services. In particular, research is needed on how the volume/quality tradeoff plays out in a rural setting given that the basic medical services provided by most CAHs are not as volume-sensitive as those provided at larger hospitals.

Several participants mentioned that the delivery of long-term care services could be improved through the development of rural health networks. They warned, however, that it may be difficult to involve home care services in some networks. Another challenge for network development in long-term care services is knowing how to choose the right partner. A policy and research issue to be addressed is documentation that home care is not necessarily cheaper care.

Participants identified a host of other concerns related to rural health care:

• Health Insurance Portability and Accountability Act (HIPAA) and confidentiality requirements.
• Providers sharing their data.
• Transportation.
• Need for new geographic criteria.
• Sharing data across systems and States.
• What works and what does not.
• Research on criteria to access availability/need.
• Research on certificate of need.

Current as of May 2001

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Internet Citation:

Rural Health Care: Challenges and Opportunities. Workshop Brief, March 6-8, 2000, User Liaison Program. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/rural/ulprurl.htm

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