Health Care Reform And Rural Health Networks

Prologue: Rural areas pose a unique challenge to health care reform. Rural populations require more medical attention since they are older, poorer, and more hazardously employed than their urban/suburban counterparts. Yet rural areas contain only half as many primary care physicians per capita, and specialized facilities are scarce. Does managed competition adequately address rural concerns? Some believe that meaningful competition among providers cannot occur in areas that often contain only one provider; that state-specific global budgets may lock in historical inequities, thus punishing poorer rural states; and that managed competition s cost containment focus does not address the greater rural problem of improving delivery systems. Rep. Fortney (Pete) Stark (D-CA), chair of the House Ways and Means Subcommittee on Health, said in a 24 June 1993 hearing that “the managed competition approach … could exacerbate the problems of underserved inner-city and rural areas.” Authors Jon Christianson and Ira Moscovice take a different view. Moscovice has described managed competition as “a real opportunity to help improve rural health care,” primarily through encouragement of network building and an emphasis on bolstering primary care. In this paper the authors neither champion nor criticize managed competition but take a systematic look at the shape managed competition will likely assume in rural areas. Christianson is a professor at the Institute for Health Services Research at the University of Minnesota's School of Public Health; he directs the university's Health Care Financing Administration Research Center. He holds a doctorate in economics from the University of Wisconsin. Moscovice is a professor and associate director of the Institute for Health Services Research at the University of Minnesota and directs the university's federally funded Rural Health Research Center. He earned his doctorate in operations research at Yale University. Abstract: Health care reform is likely to raise unique issues for rural communities and providers. This paper identifies and discusses several of these issues, with a particular focus on the potential relationship between health care reform and rural health networks. Topics addressed include the likely impact of health reform on the organization and development of rural health networks, the reimbursement of rural providers, rural medical practice, and state roles in the organization, delivery, and oversight of rural health care.