A number of states are experimenting with new ideas to address the rural health care crisis in American. Hospital closings, provider shortages, lack of insurance options; all are contributing to a bleak picture for rural health care in general.

A recent article from Stateline, part of the Pew Charitable Trusts, explored the issue and found a number of states trying different approaches to address rural health care problems.

Policy experts have noted an increasing number of red flags around the issue. Mortality rates for the leading causes of death in the U.S. (such as cancer and heart disease) are higher in rural areas. Suicide rates are also higher, and access to mental health services is an ongoing challenge. Telemedicine, once thought to be a promising strategy for providing better access to providers and specialists, has had only limited success, in part because of the lack of broadband services in rural areas.

States take the lead

A familiar theme in health care reform is that with partisan gridlock in Washington, D.C., it has fallen to the states to experiment with legislative solutions to health care shortages.

The Stateline story quotes Brock Slabach, senior vice president of the nonprofit National Rural Health Association, who notes that rural states are good testing grounds for innovations around the delivery and financing of health care.

"They have defined populations and identifiable characteristics," said Slabach, a former rural hospital administrator. "That means when you are trying an intervention, you can see whether it's working without all the variables you might have in urban areas. In that way, rural areas are the perfect laboratories."

Among the most promising programs is an effort in Pennsylvania that guarantees some rural hospitals a set amount of revenue for the coming year, giving them stability and certainty with budgeting. The program, called the Pennsylvania Rural Health Model, includes rewards for keeping patients healthy and out of the hospital, the article said.

"Over time the idea is to devote more resources to population health measures and put less emphasis on trying to fill their beds," said Rachel Levine, M.D., the Pennsylvania secretary of health.

Access remains a pressing problem

Recruiting and retaining physicians and other providers to rural areas continues to be a challenge. At least 32 states have programs to help pay off medical school debts for providers who practice in underserved or rural communities. Other efforts are underway, as well. For example, Oklahoma is working on developing a fleet of mobile health clinics to serve rural areas. And Colorado allows paramedics with special training to make house calls in rural areas to monitor patients and make sure they are taking medications properly.

But the access problem is getting worse, experts say. Aside from provider shortages, the data shows that hospitals themselves are having more trouble remaining financially solvent. Of the 163 rural hospitals that have closed since 2005, more than 60 percent have closed since 2012, the Pew article noted.

And a recent study from the University of Minnesota concluded, "The closing of rural hospitals and specialty care units is causing many people, including breast cancer patients, to seek treatment far from home."

That study said patients living in rural areas traveled, on average, nearly three times as far as woman living in urban areas for radiation treatment—40.8 mile, versus 15.4 miles. In addition, the nearest radiation facility for rural women was, on average, four times farther away than for urban women: 21.9 miles versus 4.8 miles.

Help from the Trump administration?

When the Trump Administration rolls out its budget for next year, it is expected to contain billions in dollars for health care improvements, including money for addressing the rural health care shortage. In addition, it will be heavy on infrastructure spending, providing more funding for broadband services such as telehealth to rural areas.

However, presidential budgets are famous for being more of a wish list than a practical framework for government spending. Until our federal lawmakers find a way to compromise, state programs such as those outlined in the Stateline article may be the best hope for bringing some improvement in health care services to rural communities.

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States scramble to address the ongoing rural health care crisis

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