A familiar theme in health carereform is that with partisan gridlock in Washington, D.C., it hasfallen to the states to experiment with legislative solutions tohealth care shortages. (Image: Shutterstock)

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A number of states are experimenting with new ideas to addressthe rural health care crisis in American. Hospitalclosings, provider shortages, lack of insurance options; all arecontributing to a bleak picture for rural health care ingeneral.

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A recent article from Stateline, part of thePew Charitable Trusts, explored the issue and found a number ofstates trying different approaches to address rural health careproblems.

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Related: 4 ways health care access ischanging

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Policy experts have noted an increasing number of red flagsaround the issue. Mortality rates for the leading causes of deathin the U.S. (such as cancer and heart disease) are higher in ruralareas. Suicide rates are also higher, and access to mental healthservices is an ongoing challenge. Telemedicine, once thought to bea promising strategy for providing better access to providers andspecialists, has had only limited success, in part because of thelack of broadband services in rural areas.

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States take the lead

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

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

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"They have defined populations and identifiablecharacteristics," said Slabach, a former rural hospitaladministrator. "That means when you are trying an intervention, youcan see whether it's working without all the variables you mighthave in urban areas. In that way, rural areas are the perfectlaboratories."

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

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"Over time the idea is to devote more resources to populationhealth measures and put less emphasis on trying to fill theirbeds," said Rachel Levine, M.D., the Pennsylvania secretary ofhealth.

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Access remains a pressing problem

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

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

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

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That study said patients living in rural areas traveled, onaverage, nearly three times as far as woman living in urban areasfor 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 4.8miles.

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Help from the Trump administration?

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

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However, presidential budgets are famous for being more of awish list than a practical framework for government spending. Untilour federal lawmakers find a way to compromise, state programs suchas those outlined in the Stateline article may be the best hope forbringing some improvement in health care services to ruralcommunities.

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