Rural health care in crisis

August 10, 2018

Rural health care is in serious trouble.

The crisis goes far beyond increasing premiums, higher deductibles and the uncertain future of the Affordable Care Act, commonly called Obamacare.

One measurement of health care’s struggles is found in how many rural hospitals have closed in recent years and how many more are at risk of doing so. More than 80 rural hospitals across the country have closed since 2010 and the National Rural Health Care Association has identified 673 others of being in danger of going under.

Most of the closed hospitals are in the South, but Minnesota and Iowa institutions haven’t been immune. The endangered hospitals are in 42 states. Sixty-eight percent of the threatened institutions are considered critical access hospitals — a designation that requires certain essential care conditions to be met.

The problem, as many health officials say, is rural areas are both poorer and older than the overall U.S. population, which means rural residents are more dependent on Medicare. The expansion of Medicare coverage helped rural hospitals in both Iowa and Minnesota, but several other states have refused to expand the program.

iVantage Health Analytics, which works with hospitals nationwide to increase efficiency and performance, reports that the uneven adoption of the Medicare expansion and cuts in share payments are two of the most important factors contributing to the crisis.

The situation is made worse by the shortage of doctors and health care professionals in rural America. Several states have implemented college loan deferral agreements with doctors who agree to practice in underserved rural areas. These patchwork programs need to be expanded under the federal government’s umbrella.

Iowa and Minnesota state lawmakers should investigate to see what can be done to help struggling volunteer ambulance services in rural America. Life-saving equipment and training on it is expensive and can be intimidating for potential volunteers. Given that volunteers are vital to rural health care, state governments must look at incentives to encourage greater participation.

Rural hospitals and the care they provide are vital to quality and length of life in rural America. Access to health care ought not be limited by a person’s address. If hundreds of rural hospitals close, access to adequate health care will be severely and unnecessarily limited.

Midwestern states should work to create a partnership among themselves to address rural health issues so that shared solutions can be implemented.

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