Rural Health: An Overview

February 1997

From the Federal Office of Rural Health Policy

Dena S. Puskin, Acting Director of the Office of Rural Health Policy

Three cheers for the Capital Area Rural Health Roundtable. This is the forum we have been waiting for. At last, we have a place in Washington, D.C., in which those of us interested in rural health issues can learn from each other and exchange ideas. The Roundtable also provides an opportunity for those not directly involved to learn firsthand from rural experts about rural health care issues.

In the heat of Washington's policy cauldron, it is sometimes easy to forget that the problems affecting health care in rural America have unique characteristics that often require solutions different from those appropriate in urban areas. There should certainly be a forum to discuss these issues at a time when the outcome of the debate over the nation's safety net for the elderly and the poor could have a profound effect on rural communities. But the Roundtable is more than just a forum. It is a means for bringing us together in a stronger working relationship to address the challenges facing our rural constituents. To be successful, therefore, the Roundtable needs you. You cannot sit on the sidelines. The Roundtable needs to know what activities would be helpful to you. It needs your ideas about topics to be included in the forums, people to be involved, and newsworthy items to be included in these notes. This is your forum and it can only be as good as you make it.

Cooperation and collaboration can make the difference. As Martin Luther King once noted of a people and a nation, "We are caught in an inescapable network of mutuality, tied in a single garment of destiny." Let us now work for the health and prosperity of rural Americans, whose lives and destinies are entwined in the whole.

-Dena S. Puskin

 

Capitol Hill Site for First Rural Health Roundtable

The Capital Area Rural Health Roundtable held its first forum on Thursday, February 27, 1997, which was attended by representatives of a wide range of organizations. Mary Wakefield, Ph.D., R.N., Director, Center for Health Policy, George Mason University, Fairfax, Virginia, introduced the purpose of the Roundtable, indicating that it is designed to "serve as a forum for the exchange of ideas and open discussion on important rural health topics. The Roundtable is committed to enlarging the circle of participation in rural health policy; encouraging collaboration through shared knowledge and mutual understanding; and promoting strength through diversity."

The February forum provided an overview of health care problems prevalent in rural populations, information on access to health care services, and projected federal-level policy initiatives.

Senator Craig Thomas (R-WY), Co-chair of the Senate Rural Health Caucus (SRHC), gave a brief overview of the rural health issues of concern to the Senate Caucus. Senator Thomas identified the following issues as having particular relevance to rural health care delivery:

• Medicare reform
• Health insurance (especially with regard to home care)
• Aging rural populations
• HCFA reimbursement rates to hospitals
• Telehealth issues (telecommunications technology and licensing of health care professionals)
• Education of medical residents and other professionals working in rural areas
• Medicaid coverage for children up to 18 years of age.

Representative Jim Nussle (R-IA), Co-chair of the House Rural Health Care Coalition, presented the issues under review by the House Caucus. They include:

• Equalizing AAPCC payments to hospitals in rural areas with payments to hospitals in urban areas;
• Offering incentives to health professionals to practice in rural areas;
• Antitrust relief; and
• Re-introduction of the Rural Health Act of 1996 in the 105th Congress.

Representative Nussle expressed concern regarding the short supply of physicians in rural areas and noted that the number of physicians-in-training should not be reduced. Congressman Nussle also stated that legislative debates over health care issues will be considered less in terms of political party ideology (i.e., Republican versus Democratic views) and more in terms of rural versus urban interests.

Chris Jennings, Special Assistant to President Clinton for Health Care Policy Development, listed the key items being considered by the Administration regarding rural health care policy. The Administration's priorities are to:

Increase funding for the EACH (Essential Access Community Hospital) and RPCH (Rural Primary Care Hospital) programs and increase funding for sole community hospitals;

Increase funding for rural referral centers;

Increase AAPCC payments to encourage expansion of managed care options for rural Medicare beneficiaries;

Restructure graduate medical education to encourage people to return to their rural communities after completing their medical educations;

Offer rural health care providers increased opportunities for continuing education and interaction with professional peers;

Support greater coordination among all rural programs and funding sources to better determine the available resources supporting rural health services; and

Provide Medicare reimbursement to nurse practitioners (N.P.s), clinical nurse specialists (C.N.S.s), and physician assistants (P.A.s), in all geographic areas and all practice settings.

 

Ciro Sumaya, M.D., Administrator, Health Resources and Service Administration, Department of Health and Human Services, underscored the importance of education for health professionals and the need to monitor how health care services are reaching rural populations. Other services important to rural areas include the following:

• Child abuse programs
• Immunizations programs
• Ryan White funding programs

Regarding telemedicine, Dr. Sumaya foresees advanced telecommunications technologies being used mostly for education of both professionals and consumers. Dena Puskin, Sc.D., Acting Director, Office of Rural Health Policy, Department of Health and Human Services, noted the importance of sharing information on issues of concern to the rural health community.

Denise Denton, Executive Director, Colorado Rural Health Resource Center, pointed to the diversity of rural areas in the United States and linked this diversity to the need for policies that are designed to meet the unique challenges of these varied communities and regions. Specifically noted were the special needs of "frontier" counties, defined as having fewer than six persons per square mile. Other issues of concern include the following:

• Diversity of people
• Diversity of geography
• Variations in health care facilities
• Nature of education and training of health professionals
• Impact of developing telehealth technologies

Ms. Denton reminded the group to focus on the quality of health care provided to rural residents, stating that it must be equivalent to care available to urban populations. Finally, Ms. Denton stated that while approximately 25 percent of the U.S. population now resides in rural areas, it may not be common knowledge that additionally, tens of thousands of people either drive through, fly over, camp in, or visit rural areas. Available health care in rural areas is important to both rural residents as well as to individuals traveling through rural regions.

Capital Area Rural Health Roundtable
Center for Health Policy Research & Ethics
George Mason University
Fairfax, Virginia
703-993-1907