Posted: November 19, 2020
The below op-ed appeared in the Louisville Courier-Journal Nov. 19, 2020, and was written by Dr. Tyrone F. Borders, a professor in the College of Nursing and director of the Rural and Underserved Health Research Center at the University of Kentucky.
Rural areas of Kentucky and the U.S. face considerable health and health care delivery challenges. As many readers know, rural areas of Appalachian Kentucky have some of the nation’s highest rates of cancer, opioid use and overall premature mortality. Unfortunately, government and private industry have been slow to meet the health care needs of rural citizens. In observance of National Rural Health Day, I would like to offer several suggestions for further advancing innovation in rural health, especially new ideas and approaches for rural health policy and delivery.
First, federal and state policymakers must allow more flexibility in the financing, organization and delivery of rural health services. The federal government, which through Medicare pays for a large part of rural medical care, has been hesitant to change its financing rules to help rural communities. For example, most rural hospitals are designated “critical access” hospitals, which requires that the hospital offer emergency services but limit inpatient stays and bed numbers in return for more reimbursement. Some rural communities have populations big enough to support a full-fledged hospital, but others simply need primary and urgent care. Policy makers have proposed alternative delivery arrangements, such as an emergency department attached to a physician clinic, thereby assuring access to urgent and primary care, but they have debated such alternatives for decades with little action.
Second, the private sector must recognize the unique needs of rural consumers. Health care systems have become regionalized through mergers and acquisitions, but efficiencies gained by market concentration are too often at the expense of rural communities. For example, closures of rural hospitals have become more common, in part because some urban-based hospital systems have shuttered their rural facilities.
Third, more rural-focused research is needed to inform decision-makers about how to better finance, organize and deliver services for rural citizens. Because most studies are conducted in urban settings and among urban populations, their findings may not be applicable to rural patients with different health beliefs, health conditions or financial means and to rural hospitals and clinics with lower levels of resources. For example, suicide rates have been much higher in rural areas for decades, but most suicide prevention programs have been developed and implemented in urban areas and may simply not be effectively delivered in rural areas lacking adequate supplies of mental health professionals. Yet, the federal government targets a relatively small amount of research dollars toward rural health.
A notable exception is support from the Health Services Resources and Administration, which gives the University of Kentucky and only six other institutions funding for rural health research and policy centers. The UK Rural and Underserved Health Research Center has brought together faculty members from the colleges of nursing, medicine, pharmacy and communication as well as researchers from the Lexington-headquartered American Board of Family Medicine to advance knowledge about how to improve rural citizens’ health care access and population health. Working closely with the Federal Office of Rural Health Policy, the center disseminates research findings to a wide audience of elected officials, governmental administrators and health care leaders.
There is hope for the future of rural health and health care. In response to the COVID-19 pandemic, the federal government and private insurers relaxed numerous regulations restricting the use of telehealth visits (by video or audio). Even diagnoses and prescriptions for opioid use disorder are now allowed via telehealth. Rapid changes in telehealth visits underscore that new ideas and approaches are possible, as long as government and private industry continue to support innovation in the financing, organization, and delivery of health services for rural citizens.