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ED325285.Pdf DOCUMENT RE3UME ED 325 285 RC 017 863 TITLE Health Care in Rural America. INSTITUTION Congress of the U.S., Washington, D.C. Office of Technology Assessment. REPORT NO OTA-H-434 PUB DATE 90 NOTE 573p.; Some mall type may not reproduce well. AVAILABLE FROMSuperintendent of Documents, U.S. Government Printing Office, Washington, DC 20402-9325 (Stock No. 052-003-01205-7, $22.00). PUB TYPE Reports - Evaluative/Feasibility (142) -- Statistical Data (110) EDRS PRICE MF02/PC23 Plus Postage. DESCRIPTORS Community Health Services; Federal Legislation, *Federal Programs; Federal Regulation; Health Facilities; Health Personnels *Health Programs; *Health Services; *Medical Care Evaluation; Program Evaluations *Public Policy; *Rural Areas; Rural Population IDENTIFIERS Health Delivery Systems ABSTRACT Haalth needs and health serv.ces in runal America are key issilas directly related to education as well as community well-being. This report examines rural America's access to basic health care services and discusses options for congressional consideration. The focus is on trends in availability of primary and acute rural healtn care and on factors affecting those trends. The report describes the characteristics of rural populations and health programs, the availability of rural health services and personnel, and delivery of rural maternal and infant health and mental health care services. Oa each subject, options for congressional action are examined. The federal government currently finances several different types of rural health care programs, and has a strong Interest in health care trends. Major declines in inpatient utilization, compounded by increasing amounts of uncompensated care, have undermined the financial health of many rural hospitals, which also are faced with tne outmigration of rural residents to urban areas for care. Policy reform option3 are presented in regard to: (1) improvement of rural health facilities: (2) availability and training of health professionals in rural areas; and (3) enhancing maternal and infant care programs and mental health care programs in rural areas. This document contains numerous charts, graphics, data tables, and appendices that present background in'ormation about the study. It also Includes a 745-item bibliography and a subject index. (Trs) Reproductions supplied by EDRS are the best that can be made from the origlnal document. ***************************************************IIIRRiult*RRO.RIIIIIIitt** Health Care in Rural America Tr a .4r 15. 10 U S ppARrMEpdToF EOUI . 4.11,1At P.4 4PPP IP VP .44 4P j rO. I `. t , r1 CONGRESS OF THE UNITED STATES OFFICE OF TECHNOLOGY ASSESSMENT 2 _ 0, Office of Technology Assessment Congressional Board of the 101st Congress EDWARD M. KENNEDY.Massachusetts. Chairman CLARENCE E. MILLER.Ohio, Vice Chairman Senste House ERNEST F. HOLLINGS MORRIS K. UDALL South Carolina Arizona CLAIBORNE PELL GEORGE E. BROWN, JR. Rhode island California TED STEVENS JOHN D. OINGELL Alaska Michigan ORRIN G. HATCH DON SUNDQUIST Utah Tennessee CHARLES E. GRASS_EY AMO HOUGHTON Iowa NewYork JOHN H. GIBBONS (Nonvoting) Advisory Council CHASE N. PETERSON.Chairman MICHEL T. HALBOUTY SALLY RIDE University of Utah Michel T. Haibouty Energy Co. California Space instituto JOSHUA LEDERBERG.Vice Chairman NEIL E. HARL JOSEPH E. ROSS Rockefeller University IowaState University Congressional Research Service CHARLES A. BOWSHER JAMES C. HUNT JOHN F.M. SIMS General Accounting Office University of Tennessee Usibeiii Coal Mine, inc. LEWIS BRANSCOMB HENRY KOFFLER MARINA v.N. WHITMAN Harvard University University of Arizona General Motors CIO, Director JOHN N. GIBBONS The Technology Assussment Board approves the release of this report.Theviews expressed In this report are not necessarily those of the Board, OTA Advisory Council, or individual members thereof. ABOUT THE COVER: Population density map of the Unites States (one dot equals 1,000 people). Black areas represent areas of relatively low population density. 3 Health Care in Rural America th,_4111b., -ArikamiL* 1 4. A, CONGRESS OF THE UNITED STATES OFFICE OF TECHNOLOGY ASSESSMENT i 4 Recommended Citation: U.S. Congress, Office of Technology Assessment, rlealth Care in Rural America, OTA-H-434 (Weshington, DC: U.S. Government Printing Office, September 1990). For sale by the Smerintendent of Documents U.S. Government Printing tai'fice, Washington, DC 20402-9325 (order form can be found in the back of this report) 5 il Foreword Federal policies to advance the Nation . aeahh have often included provisions to mitigate the special problems in delivering health care in rural areas. Recently, however, these pclicies have received renewed scrutmy in the face of reported increases in rural hospital closures, ongoing problems in recruiting and retaining health personnel, and difficulty in providing medical technologies commonly available in urban areas. Mounting concerns related to rural residents' access to health care prompted the Senate Rural Health Caucus '....) request that OTA conduct an assessment of these and related issues. This report, Health Care in Rural Amerka, is the fmal product of that assessment. (Two other OTA papers, Rural Emergency Medkal Services and Defining "Rural" Areas. Impact on Health Care Poky and Research. have previously been published in connection with this assessment.) An advisory panel, chaired by Dr. James Bernstein of the North Carolina Office of Rural Health and Resource Development, provided guidance and assistance during the assessment. Also, three public meetings were held (in Scottsdale, Arizona, Bismarck. North Dakota, and Meridian, Mississippi) to provide OTA with the opportunity to discuss wlecific rural health topics with local and regional health practitioners, administrators, and officials. Site visits to local facilities were conducted in association with these activities. A number of individuals from both government and the private sector provided information and rev iewed drafts of the report. OTA gratefully acknowledges the contribution of each of thesc individuals. As with all OTA reports, the content of the assessment is the sole responsibility of OTA and does not necessarily constitute the consensus or endorsttment of the adv isory panel ot the Technology Assessment Board. Key staff responsible for the assessment were Elaine Power, Lawrence Miike, Maria Hewitt, Tim Henderson, Leah Wolfe, Mal C. Zimmerman, and Rita Hughes. JOI-21 H. GIBBONS Director ill Rural Health Care Advisory Panel James Bernstein, Chairman Director, Office of Rural Health and Resource Development North Carolina Department of Human Resources Robert Berg land T. Carter Melton, Jr. Executive Vice President and General Manager President National Rural Electric Cooperative Association Rockingham Memorial Hospital Washington, D.C. Harrisonburg, Virginia James Coleman Jeffrey Merrill Executive Director Vice President West Alabama Health Services, Inc. Robert Wood Johnson Foundation Princeton, New Jersey Sam Cordes Professor & Head Myrna Pickard Department of Agricultural Economics Dean University of Wyoming School of Nursing University of TexasArlington Elizabeth Dichter Senior Vice President for Corporate Strategies Carolyn Roberts Lutheran Health Systems President Denver, Colorado Copley Health Systems, Inc. Monisville, Vermont Mary Ellis Director Roger Rosenblatt Iowa Department of Public Health Professor & Vice Chairman Department of Family Medicine Kevin Fickenscher University of Washington Assistant Dean & Executive Director Center for Medical Studies Peter Sybinsky Michigan State University Deputy Director for Planning, Legislation, and Kalamazoo, Michigan Operations Hawaii Department of Health Roland Gardner President Fred Tinning Beaufort-Jasper (South Carolina) Comprehensive President Health Center Kirksville College of Osteopathic Medicine Kirksville, Missouri Robert Graham Executive Vice President Robert Vraciu American Academy of Family Physicians Vice President Kansas City, Missouri Marketing & Planning Health Trust, Inc. Alice Hersh Nashville, Tennessee Executive Director Foundation for Health Services Research Robert Walker Washington, D.C. Chairman Department of Family and Cc..ununity Health David Kindig Director Marshall University School of Medicine Huntington, West Virginia Programs in Health Management University of WisconsinMadison NOTE' OTA appreciates and is grateful for the oaluabi.t assistance and thoughtful i.ritiques provided by the advismy panel members. The panel does not. however. necessarily approve. disapprove. or endorse this report OTA assumes full responschilny for the rePaa and the accuracy of its contents. iv 7 OTA Project StaffHealth Care in Rural America Roger C. Herdman, Assistant Director, OTA Health and Life Sciences Division Clyde J. Behney, Health Program Menager Project Sterc' Elaine J. Power, P, Lawrence H. Miike, Projt Tim Henderson, Analyst MariaHewitt, Analyst Leah Wolfe, Rese'h Analyst Marc Zimmennan, Analyst3 Rita A. Hughes, Research Assistant4 Sharon Hamilton, Research Assistant5 Katherine Eddy Cox, Research Assistant° Administrative Staff Virginia Cwalina, Office Administrator Carol A. Guntow, P.C. Specialist Carolyn D. Martin, Word Processor Specialist Eileen Murphy, P.C. Specialist Contractors Jonathan Chin, Catonsville. MD Monty Dube, McDermott, Will, and Emery Tom Ricketts, University of North Carolina David Sheridan and Linda Kravitz, Chevy Chase, MD Don Stamper, Univeristy of MissouriColumbia Hospitals and Clinics Harvey Wolfe and Larry Shuman, Monroeville, PA National Rural
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