Rural Healthcare Access in the US

Nicole WirthHCM 3010-001

MSU DenverSummer 2013

Introductionbull Access to quality healthcare in rural areas continues to be an area of

concern among rural residents policy makers and healthcare professionals

bull According to Dr Kathy Reavy Associate Professor in Nursing at Boise State University ldquoThe distribution of physicians has remained skewed toward urban areas rural American has 20 of the nationrsquos population but less than 11 of its physiciansrdquo (2009)

bull McLaughlin Stokes and Nonoyanta state ldquoRural populations have lower average incomes higher percentages of persons living in poverty lower levels of health insurance less preventive health care and poorer health status Each of these factors is commonly related to higher mortality among rural populationsrdquo (2001)

bull This presentation will explore issues related to social political economic technological and legal aspects of rural healthcare access in the United States

Social Aspects of Rural Healthcarebull Rural populations tend to view and utilize healthcare differently due to their

social and cultural structures bull ldquoThere is evidence that perceptions of health and use of the health system are

different for people in rural communities Rural people may more often tend to delay treatment Perceiving that work is more important than health care they tend to use health care more when there are lower demands on their time from seasonal workrdquo (Ricketts 2000)

bull An additional issue is that the supply of available physicians and specialists is sparse in rural areas of the country

bull Dr Ted Epperly former President of the American Academy of Family Physicians says ldquoRural areas often lack an adequate supply of primary care physicians and general surgeons General surgeons working in rural areas sometimes are the only source for such primary care services that usually fall under the purview of primary care physiciansrdquo

Social Aspects of Rural Healthcarebull Even when specialists are available within a rural area some studies have

shown that insured residents prefer to see specialists outside of their own geographical areas

bull ldquoFindings suggest that health care managers may need to consider whether rural specialty physicians are meeting the preferences of consumers who have higher quality insurance coverage Individuals who rated their insurance coverage as the best or second best possible were significantly more likely to migrate for specialty physician servicesrdquo (Borders and Rohrer 2001)

Larger Specialty Care CenterSmall Rural Clinic

Rural Residence and Migration for Specialty Physician CareBorders Tyrone Rohrer James

Health Care Management Review 26(3)40-49 Summer 2001

FIGURE 1 ODDS RATIOS FOR VARIABLES SIGNIFICANTLY ASSOCIATED WITH MIGRATION

Rural Residence and Migration for Specialty Physician CareBorders Tyrone Rohrer James

Health Care Management Review 26(3)40-49 Summer 2001

FIGURE 2 LOCATION OF SPECIALTY PHYSICIAN

Copyright copy 2001 by Aspen Publishers Inc Published by Lippincott Williams amp Wilkins Inc

Political Aspects of Rural Healthcarebull Many policies have been implemented over the years that have attempted

to improve rural access the healthcare

bull ldquoSeveral federal policies designed to sustain or improve the delivery of healthcare services in rural areas One such policy (PL 95-210) signed into law in 1977 established the Rural Health Clinic (RHC) program RHCs are intended to improve access to healthcare services for rural residents living in designated shortage areasrdquo (General Accounting Office 1990)

bull ldquoAfter 30 years of policy initiatives incentives and rural-focused programs the number of physicians in rural practice remains virtually unchanged and insufficient for the needs of rural communities The successful training recruitment and retention of rural practitioners continues to elude policy makersrdquo (Longnecker 2008)

Political Aspects of Rural Healthcare

bull Private and government-funded grants for rural community research projects and development of new health facilities can be difficult to come by in rural areas The communities must demonstrate the ability to sustain projects after funding has run out which can be extremely difficult in poorer communities

bull ldquoGrant-funded community research projects are primarily interested in answering one question Does the intervention have an effect The efficacy or effectiveness of an intervention may lead to related questions Will the effect last Will long-term behavior change be seen Will the intervention program endure The last question is very important as funding agencies increasingly view their resources as seed money to support intervention while a community builds an infrastructure to continue activities after the external funding endsrdquo (Thompson Coronado Snipes et Al 2003)

Hayfork Community Health ClinicA small community health clinic in Hayfork California

Economic Aspects of Rural Healthcare

bull Rural hospitals and healthcare centers continue to face challenges in staying profitable and even in staying in business

bull ldquoIn 1997 market-driven changes were more dominant than policy-directed reform integrated delivery systems were a growing phenomenon and the cost-saving potential of managed care was being realized Well before the time when national health reform was high on the political agenda rural hospitals were faced with a prospective payment system under Medicare that paid them less than urban hospitals for the same serviceshellipMedicare payments for rural hospitals have been consistently lower because of adjustment for lower wage levels in rural communitiesrdquo (Ricketts 2000)

bull Those facilities that are able to stay in business are critical to providing adequate healthcare as well as being a substantial employer in the community

bull ldquoAbout two-thirds of (rural hospitals) are critical-access hospitals They are the mainstays of their communities the first or second (largest) employer in their communitiesldquo (Arvantes 2011)

Rural Emergency Department in a Small Oklahoma Town

Technology Aspects of Rural Healthcarebull Limited resources in remote areas of the country make the need for

technology even greater Telehealth is one emerging area that could help with rural healthcare access

bull ldquoAlthough the physical presence of physicians at the bedside cannot and should not be supplanted an aging population rise in chronic illness and the need for the limited number of specialists to be everywhere at once are key drivers in the development of telemedicinetelehealthrdquo (Brown 2013)

Technology Aspects of Rural Healthcarebull One issue of technology in rural settings is

the startup costs which many rural facilities are unable to afford on their own One solution may be utilizing universal software systems for electronic medical records

bull ldquoHealthcare professionals with the proper credentials a PC and Internet access could view critical patient information from any location Likewise patients with access via an Internet-connected PC could review and retrieve their medical records and be more involved with their healthcare decisions Patients who do not have or cannot afford Internet access would still be able to request access to their records by giving key pieces of information such as Social Security number and date of birth Every stakeholder in healthcare must ensure the security of the health information network nationwide no matter how big or small the healthcare providers are We must level the virtual playing fieldrdquo (Patalano 2006)

Legal Aspects of Rural Healthcare

bull Policies and laws passed in the United States arguably have an even greater significance when it comes to rural facilities Policies may not take into account the limited resources present in rural communities which may ultimately put them out of business or into great financial hardship

bull ldquoChanges in healthcare delivery and financing affect both urban and rural hospitals However rural hospitals are especially vulnerable because they tend to be smaller in size have a smaller patient base serve a proportionately larger Medicare population and have a smaller operating budget relative to their urban counterpartsrdquo (Hart Amundson and Rosenblatt 1990)

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Introductionbull Access to quality healthcare in rural areas continues to be an area of

concern among rural residents policy makers and healthcare professionals

bull According to Dr Kathy Reavy Associate Professor in Nursing at Boise State University ldquoThe distribution of physicians has remained skewed toward urban areas rural American has 20 of the nationrsquos population but less than 11 of its physiciansrdquo (2009)

bull McLaughlin Stokes and Nonoyanta state ldquoRural populations have lower average incomes higher percentages of persons living in poverty lower levels of health insurance less preventive health care and poorer health status Each of these factors is commonly related to higher mortality among rural populationsrdquo (2001)

bull This presentation will explore issues related to social political economic technological and legal aspects of rural healthcare access in the United States

Social Aspects of Rural Healthcarebull Rural populations tend to view and utilize healthcare differently due to their

social and cultural structures bull ldquoThere is evidence that perceptions of health and use of the health system are

different for people in rural communities Rural people may more often tend to delay treatment Perceiving that work is more important than health care they tend to use health care more when there are lower demands on their time from seasonal workrdquo (Ricketts 2000)

bull An additional issue is that the supply of available physicians and specialists is sparse in rural areas of the country

bull Dr Ted Epperly former President of the American Academy of Family Physicians says ldquoRural areas often lack an adequate supply of primary care physicians and general surgeons General surgeons working in rural areas sometimes are the only source for such primary care services that usually fall under the purview of primary care physiciansrdquo

Social Aspects of Rural Healthcarebull Even when specialists are available within a rural area some studies have

shown that insured residents prefer to see specialists outside of their own geographical areas

bull ldquoFindings suggest that health care managers may need to consider whether rural specialty physicians are meeting the preferences of consumers who have higher quality insurance coverage Individuals who rated their insurance coverage as the best or second best possible were significantly more likely to migrate for specialty physician servicesrdquo (Borders and Rohrer 2001)

Larger Specialty Care CenterSmall Rural Clinic

Rural Residence and Migration for Specialty Physician CareBorders Tyrone Rohrer James

Health Care Management Review 26(3)40-49 Summer 2001

FIGURE 1 ODDS RATIOS FOR VARIABLES SIGNIFICANTLY ASSOCIATED WITH MIGRATION

Rural Residence and Migration for Specialty Physician CareBorders Tyrone Rohrer James

Health Care Management Review 26(3)40-49 Summer 2001

FIGURE 2 LOCATION OF SPECIALTY PHYSICIAN

Copyright copy 2001 by Aspen Publishers Inc Published by Lippincott Williams amp Wilkins Inc

Political Aspects of Rural Healthcarebull Many policies have been implemented over the years that have attempted

to improve rural access the healthcare

bull ldquoSeveral federal policies designed to sustain or improve the delivery of healthcare services in rural areas One such policy (PL 95-210) signed into law in 1977 established the Rural Health Clinic (RHC) program RHCs are intended to improve access to healthcare services for rural residents living in designated shortage areasrdquo (General Accounting Office 1990)

bull ldquoAfter 30 years of policy initiatives incentives and rural-focused programs the number of physicians in rural practice remains virtually unchanged and insufficient for the needs of rural communities The successful training recruitment and retention of rural practitioners continues to elude policy makersrdquo (Longnecker 2008)

Political Aspects of Rural Healthcare

bull Private and government-funded grants for rural community research projects and development of new health facilities can be difficult to come by in rural areas The communities must demonstrate the ability to sustain projects after funding has run out which can be extremely difficult in poorer communities

bull ldquoGrant-funded community research projects are primarily interested in answering one question Does the intervention have an effect The efficacy or effectiveness of an intervention may lead to related questions Will the effect last Will long-term behavior change be seen Will the intervention program endure The last question is very important as funding agencies increasingly view their resources as seed money to support intervention while a community builds an infrastructure to continue activities after the external funding endsrdquo (Thompson Coronado Snipes et Al 2003)

Hayfork Community Health ClinicA small community health clinic in Hayfork California

Economic Aspects of Rural Healthcare

bull Rural hospitals and healthcare centers continue to face challenges in staying profitable and even in staying in business

bull ldquoIn 1997 market-driven changes were more dominant than policy-directed reform integrated delivery systems were a growing phenomenon and the cost-saving potential of managed care was being realized Well before the time when national health reform was high on the political agenda rural hospitals were faced with a prospective payment system under Medicare that paid them less than urban hospitals for the same serviceshellipMedicare payments for rural hospitals have been consistently lower because of adjustment for lower wage levels in rural communitiesrdquo (Ricketts 2000)

bull Those facilities that are able to stay in business are critical to providing adequate healthcare as well as being a substantial employer in the community

bull ldquoAbout two-thirds of (rural hospitals) are critical-access hospitals They are the mainstays of their communities the first or second (largest) employer in their communitiesldquo (Arvantes 2011)

Rural Emergency Department in a Small Oklahoma Town

Technology Aspects of Rural Healthcarebull Limited resources in remote areas of the country make the need for

technology even greater Telehealth is one emerging area that could help with rural healthcare access

bull ldquoAlthough the physical presence of physicians at the bedside cannot and should not be supplanted an aging population rise in chronic illness and the need for the limited number of specialists to be everywhere at once are key drivers in the development of telemedicinetelehealthrdquo (Brown 2013)

Technology Aspects of Rural Healthcarebull One issue of technology in rural settings is

the startup costs which many rural facilities are unable to afford on their own One solution may be utilizing universal software systems for electronic medical records

bull ldquoHealthcare professionals with the proper credentials a PC and Internet access could view critical patient information from any location Likewise patients with access via an Internet-connected PC could review and retrieve their medical records and be more involved with their healthcare decisions Patients who do not have or cannot afford Internet access would still be able to request access to their records by giving key pieces of information such as Social Security number and date of birth Every stakeholder in healthcare must ensure the security of the health information network nationwide no matter how big or small the healthcare providers are We must level the virtual playing fieldrdquo (Patalano 2006)

Legal Aspects of Rural Healthcare

bull Policies and laws passed in the United States arguably have an even greater significance when it comes to rural facilities Policies may not take into account the limited resources present in rural communities which may ultimately put them out of business or into great financial hardship

bull ldquoChanges in healthcare delivery and financing affect both urban and rural hospitals However rural hospitals are especially vulnerable because they tend to be smaller in size have a smaller patient base serve a proportionately larger Medicare population and have a smaller operating budget relative to their urban counterpartsrdquo (Hart Amundson and Rosenblatt 1990)

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Social Aspects of Rural Healthcarebull Rural populations tend to view and utilize healthcare differently due to their

social and cultural structures bull ldquoThere is evidence that perceptions of health and use of the health system are

different for people in rural communities Rural people may more often tend to delay treatment Perceiving that work is more important than health care they tend to use health care more when there are lower demands on their time from seasonal workrdquo (Ricketts 2000)

bull An additional issue is that the supply of available physicians and specialists is sparse in rural areas of the country

bull Dr Ted Epperly former President of the American Academy of Family Physicians says ldquoRural areas often lack an adequate supply of primary care physicians and general surgeons General surgeons working in rural areas sometimes are the only source for such primary care services that usually fall under the purview of primary care physiciansrdquo

Social Aspects of Rural Healthcarebull Even when specialists are available within a rural area some studies have

shown that insured residents prefer to see specialists outside of their own geographical areas

bull ldquoFindings suggest that health care managers may need to consider whether rural specialty physicians are meeting the preferences of consumers who have higher quality insurance coverage Individuals who rated their insurance coverage as the best or second best possible were significantly more likely to migrate for specialty physician servicesrdquo (Borders and Rohrer 2001)

Larger Specialty Care CenterSmall Rural Clinic

Rural Residence and Migration for Specialty Physician CareBorders Tyrone Rohrer James

Health Care Management Review 26(3)40-49 Summer 2001

FIGURE 1 ODDS RATIOS FOR VARIABLES SIGNIFICANTLY ASSOCIATED WITH MIGRATION

Rural Residence and Migration for Specialty Physician CareBorders Tyrone Rohrer James

Health Care Management Review 26(3)40-49 Summer 2001

FIGURE 2 LOCATION OF SPECIALTY PHYSICIAN

Copyright copy 2001 by Aspen Publishers Inc Published by Lippincott Williams amp Wilkins Inc

Political Aspects of Rural Healthcarebull Many policies have been implemented over the years that have attempted

to improve rural access the healthcare

bull ldquoSeveral federal policies designed to sustain or improve the delivery of healthcare services in rural areas One such policy (PL 95-210) signed into law in 1977 established the Rural Health Clinic (RHC) program RHCs are intended to improve access to healthcare services for rural residents living in designated shortage areasrdquo (General Accounting Office 1990)

bull ldquoAfter 30 years of policy initiatives incentives and rural-focused programs the number of physicians in rural practice remains virtually unchanged and insufficient for the needs of rural communities The successful training recruitment and retention of rural practitioners continues to elude policy makersrdquo (Longnecker 2008)

Political Aspects of Rural Healthcare

bull Private and government-funded grants for rural community research projects and development of new health facilities can be difficult to come by in rural areas The communities must demonstrate the ability to sustain projects after funding has run out which can be extremely difficult in poorer communities

bull ldquoGrant-funded community research projects are primarily interested in answering one question Does the intervention have an effect The efficacy or effectiveness of an intervention may lead to related questions Will the effect last Will long-term behavior change be seen Will the intervention program endure The last question is very important as funding agencies increasingly view their resources as seed money to support intervention while a community builds an infrastructure to continue activities after the external funding endsrdquo (Thompson Coronado Snipes et Al 2003)

Hayfork Community Health ClinicA small community health clinic in Hayfork California

Economic Aspects of Rural Healthcare

bull Rural hospitals and healthcare centers continue to face challenges in staying profitable and even in staying in business

bull ldquoIn 1997 market-driven changes were more dominant than policy-directed reform integrated delivery systems were a growing phenomenon and the cost-saving potential of managed care was being realized Well before the time when national health reform was high on the political agenda rural hospitals were faced with a prospective payment system under Medicare that paid them less than urban hospitals for the same serviceshellipMedicare payments for rural hospitals have been consistently lower because of adjustment for lower wage levels in rural communitiesrdquo (Ricketts 2000)

bull Those facilities that are able to stay in business are critical to providing adequate healthcare as well as being a substantial employer in the community

bull ldquoAbout two-thirds of (rural hospitals) are critical-access hospitals They are the mainstays of their communities the first or second (largest) employer in their communitiesldquo (Arvantes 2011)

Rural Emergency Department in a Small Oklahoma Town

Technology Aspects of Rural Healthcarebull Limited resources in remote areas of the country make the need for

technology even greater Telehealth is one emerging area that could help with rural healthcare access

bull ldquoAlthough the physical presence of physicians at the bedside cannot and should not be supplanted an aging population rise in chronic illness and the need for the limited number of specialists to be everywhere at once are key drivers in the development of telemedicinetelehealthrdquo (Brown 2013)

Technology Aspects of Rural Healthcarebull One issue of technology in rural settings is

the startup costs which many rural facilities are unable to afford on their own One solution may be utilizing universal software systems for electronic medical records

bull ldquoHealthcare professionals with the proper credentials a PC and Internet access could view critical patient information from any location Likewise patients with access via an Internet-connected PC could review and retrieve their medical records and be more involved with their healthcare decisions Patients who do not have or cannot afford Internet access would still be able to request access to their records by giving key pieces of information such as Social Security number and date of birth Every stakeholder in healthcare must ensure the security of the health information network nationwide no matter how big or small the healthcare providers are We must level the virtual playing fieldrdquo (Patalano 2006)

Legal Aspects of Rural Healthcare

bull Policies and laws passed in the United States arguably have an even greater significance when it comes to rural facilities Policies may not take into account the limited resources present in rural communities which may ultimately put them out of business or into great financial hardship

bull ldquoChanges in healthcare delivery and financing affect both urban and rural hospitals However rural hospitals are especially vulnerable because they tend to be smaller in size have a smaller patient base serve a proportionately larger Medicare population and have a smaller operating budget relative to their urban counterpartsrdquo (Hart Amundson and Rosenblatt 1990)

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Social Aspects of Rural Healthcarebull Even when specialists are available within a rural area some studies have

shown that insured residents prefer to see specialists outside of their own geographical areas

bull ldquoFindings suggest that health care managers may need to consider whether rural specialty physicians are meeting the preferences of consumers who have higher quality insurance coverage Individuals who rated their insurance coverage as the best or second best possible were significantly more likely to migrate for specialty physician servicesrdquo (Borders and Rohrer 2001)

Larger Specialty Care CenterSmall Rural Clinic

Rural Residence and Migration for Specialty Physician CareBorders Tyrone Rohrer James

Health Care Management Review 26(3)40-49 Summer 2001

FIGURE 1 ODDS RATIOS FOR VARIABLES SIGNIFICANTLY ASSOCIATED WITH MIGRATION

Rural Residence and Migration for Specialty Physician CareBorders Tyrone Rohrer James

Health Care Management Review 26(3)40-49 Summer 2001

FIGURE 2 LOCATION OF SPECIALTY PHYSICIAN

Copyright copy 2001 by Aspen Publishers Inc Published by Lippincott Williams amp Wilkins Inc

Political Aspects of Rural Healthcarebull Many policies have been implemented over the years that have attempted

to improve rural access the healthcare

bull ldquoSeveral federal policies designed to sustain or improve the delivery of healthcare services in rural areas One such policy (PL 95-210) signed into law in 1977 established the Rural Health Clinic (RHC) program RHCs are intended to improve access to healthcare services for rural residents living in designated shortage areasrdquo (General Accounting Office 1990)

bull ldquoAfter 30 years of policy initiatives incentives and rural-focused programs the number of physicians in rural practice remains virtually unchanged and insufficient for the needs of rural communities The successful training recruitment and retention of rural practitioners continues to elude policy makersrdquo (Longnecker 2008)

Political Aspects of Rural Healthcare

bull Private and government-funded grants for rural community research projects and development of new health facilities can be difficult to come by in rural areas The communities must demonstrate the ability to sustain projects after funding has run out which can be extremely difficult in poorer communities

bull ldquoGrant-funded community research projects are primarily interested in answering one question Does the intervention have an effect The efficacy or effectiveness of an intervention may lead to related questions Will the effect last Will long-term behavior change be seen Will the intervention program endure The last question is very important as funding agencies increasingly view their resources as seed money to support intervention while a community builds an infrastructure to continue activities after the external funding endsrdquo (Thompson Coronado Snipes et Al 2003)

Hayfork Community Health ClinicA small community health clinic in Hayfork California

Economic Aspects of Rural Healthcare

bull Rural hospitals and healthcare centers continue to face challenges in staying profitable and even in staying in business

bull ldquoIn 1997 market-driven changes were more dominant than policy-directed reform integrated delivery systems were a growing phenomenon and the cost-saving potential of managed care was being realized Well before the time when national health reform was high on the political agenda rural hospitals were faced with a prospective payment system under Medicare that paid them less than urban hospitals for the same serviceshellipMedicare payments for rural hospitals have been consistently lower because of adjustment for lower wage levels in rural communitiesrdquo (Ricketts 2000)

bull Those facilities that are able to stay in business are critical to providing adequate healthcare as well as being a substantial employer in the community

bull ldquoAbout two-thirds of (rural hospitals) are critical-access hospitals They are the mainstays of their communities the first or second (largest) employer in their communitiesldquo (Arvantes 2011)

Rural Emergency Department in a Small Oklahoma Town

Technology Aspects of Rural Healthcarebull Limited resources in remote areas of the country make the need for

technology even greater Telehealth is one emerging area that could help with rural healthcare access

bull ldquoAlthough the physical presence of physicians at the bedside cannot and should not be supplanted an aging population rise in chronic illness and the need for the limited number of specialists to be everywhere at once are key drivers in the development of telemedicinetelehealthrdquo (Brown 2013)

Technology Aspects of Rural Healthcarebull One issue of technology in rural settings is

the startup costs which many rural facilities are unable to afford on their own One solution may be utilizing universal software systems for electronic medical records

bull ldquoHealthcare professionals with the proper credentials a PC and Internet access could view critical patient information from any location Likewise patients with access via an Internet-connected PC could review and retrieve their medical records and be more involved with their healthcare decisions Patients who do not have or cannot afford Internet access would still be able to request access to their records by giving key pieces of information such as Social Security number and date of birth Every stakeholder in healthcare must ensure the security of the health information network nationwide no matter how big or small the healthcare providers are We must level the virtual playing fieldrdquo (Patalano 2006)

Legal Aspects of Rural Healthcare

bull Policies and laws passed in the United States arguably have an even greater significance when it comes to rural facilities Policies may not take into account the limited resources present in rural communities which may ultimately put them out of business or into great financial hardship

bull ldquoChanges in healthcare delivery and financing affect both urban and rural hospitals However rural hospitals are especially vulnerable because they tend to be smaller in size have a smaller patient base serve a proportionately larger Medicare population and have a smaller operating budget relative to their urban counterpartsrdquo (Hart Amundson and Rosenblatt 1990)

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Rural Residence and Migration for Specialty Physician CareBorders Tyrone Rohrer James

Health Care Management Review 26(3)40-49 Summer 2001

FIGURE 1 ODDS RATIOS FOR VARIABLES SIGNIFICANTLY ASSOCIATED WITH MIGRATION

Rural Residence and Migration for Specialty Physician CareBorders Tyrone Rohrer James

Health Care Management Review 26(3)40-49 Summer 2001

FIGURE 2 LOCATION OF SPECIALTY PHYSICIAN

Copyright copy 2001 by Aspen Publishers Inc Published by Lippincott Williams amp Wilkins Inc

Political Aspects of Rural Healthcarebull Many policies have been implemented over the years that have attempted

to improve rural access the healthcare

bull ldquoSeveral federal policies designed to sustain or improve the delivery of healthcare services in rural areas One such policy (PL 95-210) signed into law in 1977 established the Rural Health Clinic (RHC) program RHCs are intended to improve access to healthcare services for rural residents living in designated shortage areasrdquo (General Accounting Office 1990)

bull ldquoAfter 30 years of policy initiatives incentives and rural-focused programs the number of physicians in rural practice remains virtually unchanged and insufficient for the needs of rural communities The successful training recruitment and retention of rural practitioners continues to elude policy makersrdquo (Longnecker 2008)

Political Aspects of Rural Healthcare

bull Private and government-funded grants for rural community research projects and development of new health facilities can be difficult to come by in rural areas The communities must demonstrate the ability to sustain projects after funding has run out which can be extremely difficult in poorer communities

bull ldquoGrant-funded community research projects are primarily interested in answering one question Does the intervention have an effect The efficacy or effectiveness of an intervention may lead to related questions Will the effect last Will long-term behavior change be seen Will the intervention program endure The last question is very important as funding agencies increasingly view their resources as seed money to support intervention while a community builds an infrastructure to continue activities after the external funding endsrdquo (Thompson Coronado Snipes et Al 2003)

Hayfork Community Health ClinicA small community health clinic in Hayfork California

Economic Aspects of Rural Healthcare

bull Rural hospitals and healthcare centers continue to face challenges in staying profitable and even in staying in business

bull ldquoIn 1997 market-driven changes were more dominant than policy-directed reform integrated delivery systems were a growing phenomenon and the cost-saving potential of managed care was being realized Well before the time when national health reform was high on the political agenda rural hospitals were faced with a prospective payment system under Medicare that paid them less than urban hospitals for the same serviceshellipMedicare payments for rural hospitals have been consistently lower because of adjustment for lower wage levels in rural communitiesrdquo (Ricketts 2000)

bull Those facilities that are able to stay in business are critical to providing adequate healthcare as well as being a substantial employer in the community

bull ldquoAbout two-thirds of (rural hospitals) are critical-access hospitals They are the mainstays of their communities the first or second (largest) employer in their communitiesldquo (Arvantes 2011)

Rural Emergency Department in a Small Oklahoma Town

Technology Aspects of Rural Healthcarebull Limited resources in remote areas of the country make the need for

technology even greater Telehealth is one emerging area that could help with rural healthcare access

bull ldquoAlthough the physical presence of physicians at the bedside cannot and should not be supplanted an aging population rise in chronic illness and the need for the limited number of specialists to be everywhere at once are key drivers in the development of telemedicinetelehealthrdquo (Brown 2013)

Technology Aspects of Rural Healthcarebull One issue of technology in rural settings is

the startup costs which many rural facilities are unable to afford on their own One solution may be utilizing universal software systems for electronic medical records

bull ldquoHealthcare professionals with the proper credentials a PC and Internet access could view critical patient information from any location Likewise patients with access via an Internet-connected PC could review and retrieve their medical records and be more involved with their healthcare decisions Patients who do not have or cannot afford Internet access would still be able to request access to their records by giving key pieces of information such as Social Security number and date of birth Every stakeholder in healthcare must ensure the security of the health information network nationwide no matter how big or small the healthcare providers are We must level the virtual playing fieldrdquo (Patalano 2006)

Legal Aspects of Rural Healthcare

bull Policies and laws passed in the United States arguably have an even greater significance when it comes to rural facilities Policies may not take into account the limited resources present in rural communities which may ultimately put them out of business or into great financial hardship

bull ldquoChanges in healthcare delivery and financing affect both urban and rural hospitals However rural hospitals are especially vulnerable because they tend to be smaller in size have a smaller patient base serve a proportionately larger Medicare population and have a smaller operating budget relative to their urban counterpartsrdquo (Hart Amundson and Rosenblatt 1990)

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Political Aspects of Rural Healthcarebull Many policies have been implemented over the years that have attempted

to improve rural access the healthcare

bull ldquoSeveral federal policies designed to sustain or improve the delivery of healthcare services in rural areas One such policy (PL 95-210) signed into law in 1977 established the Rural Health Clinic (RHC) program RHCs are intended to improve access to healthcare services for rural residents living in designated shortage areasrdquo (General Accounting Office 1990)

bull ldquoAfter 30 years of policy initiatives incentives and rural-focused programs the number of physicians in rural practice remains virtually unchanged and insufficient for the needs of rural communities The successful training recruitment and retention of rural practitioners continues to elude policy makersrdquo (Longnecker 2008)

Political Aspects of Rural Healthcare

bull Private and government-funded grants for rural community research projects and development of new health facilities can be difficult to come by in rural areas The communities must demonstrate the ability to sustain projects after funding has run out which can be extremely difficult in poorer communities

bull ldquoGrant-funded community research projects are primarily interested in answering one question Does the intervention have an effect The efficacy or effectiveness of an intervention may lead to related questions Will the effect last Will long-term behavior change be seen Will the intervention program endure The last question is very important as funding agencies increasingly view their resources as seed money to support intervention while a community builds an infrastructure to continue activities after the external funding endsrdquo (Thompson Coronado Snipes et Al 2003)

Hayfork Community Health ClinicA small community health clinic in Hayfork California

Economic Aspects of Rural Healthcare

bull Rural hospitals and healthcare centers continue to face challenges in staying profitable and even in staying in business

bull ldquoIn 1997 market-driven changes were more dominant than policy-directed reform integrated delivery systems were a growing phenomenon and the cost-saving potential of managed care was being realized Well before the time when national health reform was high on the political agenda rural hospitals were faced with a prospective payment system under Medicare that paid them less than urban hospitals for the same serviceshellipMedicare payments for rural hospitals have been consistently lower because of adjustment for lower wage levels in rural communitiesrdquo (Ricketts 2000)

bull Those facilities that are able to stay in business are critical to providing adequate healthcare as well as being a substantial employer in the community

bull ldquoAbout two-thirds of (rural hospitals) are critical-access hospitals They are the mainstays of their communities the first or second (largest) employer in their communitiesldquo (Arvantes 2011)

Rural Emergency Department in a Small Oklahoma Town

Technology Aspects of Rural Healthcarebull Limited resources in remote areas of the country make the need for

technology even greater Telehealth is one emerging area that could help with rural healthcare access

bull ldquoAlthough the physical presence of physicians at the bedside cannot and should not be supplanted an aging population rise in chronic illness and the need for the limited number of specialists to be everywhere at once are key drivers in the development of telemedicinetelehealthrdquo (Brown 2013)

Technology Aspects of Rural Healthcarebull One issue of technology in rural settings is

the startup costs which many rural facilities are unable to afford on their own One solution may be utilizing universal software systems for electronic medical records

bull ldquoHealthcare professionals with the proper credentials a PC and Internet access could view critical patient information from any location Likewise patients with access via an Internet-connected PC could review and retrieve their medical records and be more involved with their healthcare decisions Patients who do not have or cannot afford Internet access would still be able to request access to their records by giving key pieces of information such as Social Security number and date of birth Every stakeholder in healthcare must ensure the security of the health information network nationwide no matter how big or small the healthcare providers are We must level the virtual playing fieldrdquo (Patalano 2006)

Legal Aspects of Rural Healthcare

bull Policies and laws passed in the United States arguably have an even greater significance when it comes to rural facilities Policies may not take into account the limited resources present in rural communities which may ultimately put them out of business or into great financial hardship

bull ldquoChanges in healthcare delivery and financing affect both urban and rural hospitals However rural hospitals are especially vulnerable because they tend to be smaller in size have a smaller patient base serve a proportionately larger Medicare population and have a smaller operating budget relative to their urban counterpartsrdquo (Hart Amundson and Rosenblatt 1990)

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Political Aspects of Rural Healthcare

bull Private and government-funded grants for rural community research projects and development of new health facilities can be difficult to come by in rural areas The communities must demonstrate the ability to sustain projects after funding has run out which can be extremely difficult in poorer communities

bull ldquoGrant-funded community research projects are primarily interested in answering one question Does the intervention have an effect The efficacy or effectiveness of an intervention may lead to related questions Will the effect last Will long-term behavior change be seen Will the intervention program endure The last question is very important as funding agencies increasingly view their resources as seed money to support intervention while a community builds an infrastructure to continue activities after the external funding endsrdquo (Thompson Coronado Snipes et Al 2003)

Hayfork Community Health ClinicA small community health clinic in Hayfork California

Economic Aspects of Rural Healthcare

bull Rural hospitals and healthcare centers continue to face challenges in staying profitable and even in staying in business

bull ldquoIn 1997 market-driven changes were more dominant than policy-directed reform integrated delivery systems were a growing phenomenon and the cost-saving potential of managed care was being realized Well before the time when national health reform was high on the political agenda rural hospitals were faced with a prospective payment system under Medicare that paid them less than urban hospitals for the same serviceshellipMedicare payments for rural hospitals have been consistently lower because of adjustment for lower wage levels in rural communitiesrdquo (Ricketts 2000)

bull Those facilities that are able to stay in business are critical to providing adequate healthcare as well as being a substantial employer in the community

bull ldquoAbout two-thirds of (rural hospitals) are critical-access hospitals They are the mainstays of their communities the first or second (largest) employer in their communitiesldquo (Arvantes 2011)

Rural Emergency Department in a Small Oklahoma Town

Technology Aspects of Rural Healthcarebull Limited resources in remote areas of the country make the need for

technology even greater Telehealth is one emerging area that could help with rural healthcare access

bull ldquoAlthough the physical presence of physicians at the bedside cannot and should not be supplanted an aging population rise in chronic illness and the need for the limited number of specialists to be everywhere at once are key drivers in the development of telemedicinetelehealthrdquo (Brown 2013)

Technology Aspects of Rural Healthcarebull One issue of technology in rural settings is

the startup costs which many rural facilities are unable to afford on their own One solution may be utilizing universal software systems for electronic medical records

bull ldquoHealthcare professionals with the proper credentials a PC and Internet access could view critical patient information from any location Likewise patients with access via an Internet-connected PC could review and retrieve their medical records and be more involved with their healthcare decisions Patients who do not have or cannot afford Internet access would still be able to request access to their records by giving key pieces of information such as Social Security number and date of birth Every stakeholder in healthcare must ensure the security of the health information network nationwide no matter how big or small the healthcare providers are We must level the virtual playing fieldrdquo (Patalano 2006)

Legal Aspects of Rural Healthcare

bull Policies and laws passed in the United States arguably have an even greater significance when it comes to rural facilities Policies may not take into account the limited resources present in rural communities which may ultimately put them out of business or into great financial hardship

bull ldquoChanges in healthcare delivery and financing affect both urban and rural hospitals However rural hospitals are especially vulnerable because they tend to be smaller in size have a smaller patient base serve a proportionately larger Medicare population and have a smaller operating budget relative to their urban counterpartsrdquo (Hart Amundson and Rosenblatt 1990)

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Hayfork Community Health ClinicA small community health clinic in Hayfork California

Economic Aspects of Rural Healthcare

bull Rural hospitals and healthcare centers continue to face challenges in staying profitable and even in staying in business

bull ldquoIn 1997 market-driven changes were more dominant than policy-directed reform integrated delivery systems were a growing phenomenon and the cost-saving potential of managed care was being realized Well before the time when national health reform was high on the political agenda rural hospitals were faced with a prospective payment system under Medicare that paid them less than urban hospitals for the same serviceshellipMedicare payments for rural hospitals have been consistently lower because of adjustment for lower wage levels in rural communitiesrdquo (Ricketts 2000)

bull Those facilities that are able to stay in business are critical to providing adequate healthcare as well as being a substantial employer in the community

bull ldquoAbout two-thirds of (rural hospitals) are critical-access hospitals They are the mainstays of their communities the first or second (largest) employer in their communitiesldquo (Arvantes 2011)

Rural Emergency Department in a Small Oklahoma Town

Technology Aspects of Rural Healthcarebull Limited resources in remote areas of the country make the need for

technology even greater Telehealth is one emerging area that could help with rural healthcare access

bull ldquoAlthough the physical presence of physicians at the bedside cannot and should not be supplanted an aging population rise in chronic illness and the need for the limited number of specialists to be everywhere at once are key drivers in the development of telemedicinetelehealthrdquo (Brown 2013)

Technology Aspects of Rural Healthcarebull One issue of technology in rural settings is

the startup costs which many rural facilities are unable to afford on their own One solution may be utilizing universal software systems for electronic medical records

bull ldquoHealthcare professionals with the proper credentials a PC and Internet access could view critical patient information from any location Likewise patients with access via an Internet-connected PC could review and retrieve their medical records and be more involved with their healthcare decisions Patients who do not have or cannot afford Internet access would still be able to request access to their records by giving key pieces of information such as Social Security number and date of birth Every stakeholder in healthcare must ensure the security of the health information network nationwide no matter how big or small the healthcare providers are We must level the virtual playing fieldrdquo (Patalano 2006)

Legal Aspects of Rural Healthcare

bull Policies and laws passed in the United States arguably have an even greater significance when it comes to rural facilities Policies may not take into account the limited resources present in rural communities which may ultimately put them out of business or into great financial hardship

bull ldquoChanges in healthcare delivery and financing affect both urban and rural hospitals However rural hospitals are especially vulnerable because they tend to be smaller in size have a smaller patient base serve a proportionately larger Medicare population and have a smaller operating budget relative to their urban counterpartsrdquo (Hart Amundson and Rosenblatt 1990)

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Economic Aspects of Rural Healthcare

bull Rural hospitals and healthcare centers continue to face challenges in staying profitable and even in staying in business

bull ldquoIn 1997 market-driven changes were more dominant than policy-directed reform integrated delivery systems were a growing phenomenon and the cost-saving potential of managed care was being realized Well before the time when national health reform was high on the political agenda rural hospitals were faced with a prospective payment system under Medicare that paid them less than urban hospitals for the same serviceshellipMedicare payments for rural hospitals have been consistently lower because of adjustment for lower wage levels in rural communitiesrdquo (Ricketts 2000)

bull Those facilities that are able to stay in business are critical to providing adequate healthcare as well as being a substantial employer in the community

bull ldquoAbout two-thirds of (rural hospitals) are critical-access hospitals They are the mainstays of their communities the first or second (largest) employer in their communitiesldquo (Arvantes 2011)

Rural Emergency Department in a Small Oklahoma Town

Technology Aspects of Rural Healthcarebull Limited resources in remote areas of the country make the need for

technology even greater Telehealth is one emerging area that could help with rural healthcare access

bull ldquoAlthough the physical presence of physicians at the bedside cannot and should not be supplanted an aging population rise in chronic illness and the need for the limited number of specialists to be everywhere at once are key drivers in the development of telemedicinetelehealthrdquo (Brown 2013)

Technology Aspects of Rural Healthcarebull One issue of technology in rural settings is

the startup costs which many rural facilities are unable to afford on their own One solution may be utilizing universal software systems for electronic medical records

bull ldquoHealthcare professionals with the proper credentials a PC and Internet access could view critical patient information from any location Likewise patients with access via an Internet-connected PC could review and retrieve their medical records and be more involved with their healthcare decisions Patients who do not have or cannot afford Internet access would still be able to request access to their records by giving key pieces of information such as Social Security number and date of birth Every stakeholder in healthcare must ensure the security of the health information network nationwide no matter how big or small the healthcare providers are We must level the virtual playing fieldrdquo (Patalano 2006)

Legal Aspects of Rural Healthcare

bull Policies and laws passed in the United States arguably have an even greater significance when it comes to rural facilities Policies may not take into account the limited resources present in rural communities which may ultimately put them out of business or into great financial hardship

bull ldquoChanges in healthcare delivery and financing affect both urban and rural hospitals However rural hospitals are especially vulnerable because they tend to be smaller in size have a smaller patient base serve a proportionately larger Medicare population and have a smaller operating budget relative to their urban counterpartsrdquo (Hart Amundson and Rosenblatt 1990)

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Rural Emergency Department in a Small Oklahoma Town

Technology Aspects of Rural Healthcarebull Limited resources in remote areas of the country make the need for

technology even greater Telehealth is one emerging area that could help with rural healthcare access

bull ldquoAlthough the physical presence of physicians at the bedside cannot and should not be supplanted an aging population rise in chronic illness and the need for the limited number of specialists to be everywhere at once are key drivers in the development of telemedicinetelehealthrdquo (Brown 2013)

Technology Aspects of Rural Healthcarebull One issue of technology in rural settings is

the startup costs which many rural facilities are unable to afford on their own One solution may be utilizing universal software systems for electronic medical records

bull ldquoHealthcare professionals with the proper credentials a PC and Internet access could view critical patient information from any location Likewise patients with access via an Internet-connected PC could review and retrieve their medical records and be more involved with their healthcare decisions Patients who do not have or cannot afford Internet access would still be able to request access to their records by giving key pieces of information such as Social Security number and date of birth Every stakeholder in healthcare must ensure the security of the health information network nationwide no matter how big or small the healthcare providers are We must level the virtual playing fieldrdquo (Patalano 2006)

Legal Aspects of Rural Healthcare

bull Policies and laws passed in the United States arguably have an even greater significance when it comes to rural facilities Policies may not take into account the limited resources present in rural communities which may ultimately put them out of business or into great financial hardship

bull ldquoChanges in healthcare delivery and financing affect both urban and rural hospitals However rural hospitals are especially vulnerable because they tend to be smaller in size have a smaller patient base serve a proportionately larger Medicare population and have a smaller operating budget relative to their urban counterpartsrdquo (Hart Amundson and Rosenblatt 1990)

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Technology Aspects of Rural Healthcarebull Limited resources in remote areas of the country make the need for

technology even greater Telehealth is one emerging area that could help with rural healthcare access

bull ldquoAlthough the physical presence of physicians at the bedside cannot and should not be supplanted an aging population rise in chronic illness and the need for the limited number of specialists to be everywhere at once are key drivers in the development of telemedicinetelehealthrdquo (Brown 2013)

Technology Aspects of Rural Healthcarebull One issue of technology in rural settings is

the startup costs which many rural facilities are unable to afford on their own One solution may be utilizing universal software systems for electronic medical records

bull ldquoHealthcare professionals with the proper credentials a PC and Internet access could view critical patient information from any location Likewise patients with access via an Internet-connected PC could review and retrieve their medical records and be more involved with their healthcare decisions Patients who do not have or cannot afford Internet access would still be able to request access to their records by giving key pieces of information such as Social Security number and date of birth Every stakeholder in healthcare must ensure the security of the health information network nationwide no matter how big or small the healthcare providers are We must level the virtual playing fieldrdquo (Patalano 2006)

Legal Aspects of Rural Healthcare

bull Policies and laws passed in the United States arguably have an even greater significance when it comes to rural facilities Policies may not take into account the limited resources present in rural communities which may ultimately put them out of business or into great financial hardship

bull ldquoChanges in healthcare delivery and financing affect both urban and rural hospitals However rural hospitals are especially vulnerable because they tend to be smaller in size have a smaller patient base serve a proportionately larger Medicare population and have a smaller operating budget relative to their urban counterpartsrdquo (Hart Amundson and Rosenblatt 1990)

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Technology Aspects of Rural Healthcarebull One issue of technology in rural settings is

the startup costs which many rural facilities are unable to afford on their own One solution may be utilizing universal software systems for electronic medical records

bull ldquoHealthcare professionals with the proper credentials a PC and Internet access could view critical patient information from any location Likewise patients with access via an Internet-connected PC could review and retrieve their medical records and be more involved with their healthcare decisions Patients who do not have or cannot afford Internet access would still be able to request access to their records by giving key pieces of information such as Social Security number and date of birth Every stakeholder in healthcare must ensure the security of the health information network nationwide no matter how big or small the healthcare providers are We must level the virtual playing fieldrdquo (Patalano 2006)

Legal Aspects of Rural Healthcare

bull Policies and laws passed in the United States arguably have an even greater significance when it comes to rural facilities Policies may not take into account the limited resources present in rural communities which may ultimately put them out of business or into great financial hardship

bull ldquoChanges in healthcare delivery and financing affect both urban and rural hospitals However rural hospitals are especially vulnerable because they tend to be smaller in size have a smaller patient base serve a proportionately larger Medicare population and have a smaller operating budget relative to their urban counterpartsrdquo (Hart Amundson and Rosenblatt 1990)

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Legal Aspects of Rural Healthcare

bull Policies and laws passed in the United States arguably have an even greater significance when it comes to rural facilities Policies may not take into account the limited resources present in rural communities which may ultimately put them out of business or into great financial hardship

bull ldquoChanges in healthcare delivery and financing affect both urban and rural hospitals However rural hospitals are especially vulnerable because they tend to be smaller in size have a smaller patient base serve a proportionately larger Medicare population and have a smaller operating budget relative to their urban counterpartsrdquo (Hart Amundson and Rosenblatt 1990)

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Legal Aspects of Rural Healthcarebull State and local policies may never be created to provide comprehensive

care to rural residents due to cultural perceptions and preferences within individual communities Laws that are beneficial to community health in more urbanized areas such as smoking bans may be shunned in rural communities

bull ldquoThe personalities and attitudes of rural residents who tend to be more resistant to accepting diagnoses such as depression also play an important role in the perceptions of mental illness and substance abuse and in shaping local policy to treat these conditions as well as to fund programs and organizations that address these problems in the communityrdquo (Johnsen Morrissey Calloway et al 1997)

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Conclusion

Legislatures community members and healthcare professionals need to continue to address the special issues faced by rural healthcare facilities One issue is the specific beliefs and values held by each rural community regarding healthcare and healthcare services The continuing shortage of providers in these areas as well as limited financial and technological resources should continue to be at the forefront of policymakers minds Better technology with the use of Telehealth and universal electronic medical records will help bring these communities better advances and treatment options The bottom line is that rural communityrsquos best interests should be examined and taken into account when passing healthcare laws and examining funding strategies

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Sources Cited

Arvantes James (July 20 2011) ldquoCross-training FPs General Surgeons Could Enhance Health Care in Rural Americardquo AAFP News Now American Academy of Family Physicians Washington Retrieved From httpwwwaafporgnews-noweducationprofessionaldevelopment20110720ruralgcforumhtml

Brown E Victor (July 2008) Robotic assistance remedy the Michigan Stroke Network utilizes remote presence robots to bring needed specialists to stroke patients at remote hospitals Health

Management Technology Retrieved From Academic OneFile Web 04 July 2013

General Accounting Office (November 1996) ldquoRural Health Clinics Rising Program Expenditures Not Focused on Improving Care in Isolated Areas Report to the Chairman Subcommittee on Human Resources and Intergovernmental Relations Committee on Government Reform and Oversight House of Representatives Washington DC GAO Novemberrdquo Public Document Retrieved From httpwwwgaogovarchive1997he97024pdf

Hart L G Amundson BA and Rosenblatt R A (1990) Is There a Role for the Small Rural Hospital Journal of Rural Health 6 (21 101-18)

Johnsen MC Morrissey JP Calloway MO Fried BJ Bank M et al (1997) ldquoRural mental health leaderrsquos perceptions of stigma and community issuesrdquo Journal of Rural Health 1359-70

McLaughlin D K Stokes C amp Nonoyanta A (2001) ldquoResidence and Income Inequality Effects on Mortality Among US Countiesrdquo Rural Sociology 66(4) 579-598

Sources Cited (cont)

Longenecker Randall Rosenthal Tom Stearns Jeff Woods Michael and staff of the NRHA and the AAFP ldquoRural Practice Graduate Medical Education for (Position Paper) A joint statement of the National Rural Health Association and the American Academy of Family Physicians July 2008rdquo Retrieved from httpwwwaafporgaboutpoliciesallrural-practicehtml

Patalano Ray (May 2006) Dont forget about connecting smaller healthcare providers Health Management Technology May 2006 44+ Academic OneFile Web 04 July 2013

Reavy K (2009) ldquoThe impact of recession on the health care of rural citizens in the northwest United Statesrdquo Rural and Remote Health 9 1270 (Online) 2009 Para 6 Retrieved From httpwwwrrhorgau

Ricketts Thomas C (2000) ldquoThe Changing Nature of Rural Health Carerdquo Annual Review on Public Health 2000 21639-57 2000 by Annual Reviews Retrieved From wwwannualreviewsorg by University of Colorado ndash Denver on 070413 Thompson Bet Coronado Gloria Snipes Shedra A amp Puschel Klaus (2003) ldquoMethodologic Advances and Ongoing Challenges in Designing Community-Based Health Promotion Programsrdquo Annual Review on Public Health 2003 24 pp 326 para 3-4 Retrieved From wwwannualreviewsorg by University of Colorado ndash Denver on 070413