Engineering Quality Healthcare
for Rural America

By Kelly Novak, Research Manager, NADO Research Foundation

The need for quality health is extremely important in rural America, where the challenge of geographic isolation and limited resources can mean the difference between life and death. A dwindling supply of health care organizations, institutions and physicians are able to meet the rising costs of administering health care in rural areas. Lagging communication systems to enable immediate emergency response and inadequate services to meet aging or senior health care needs are also critical challenges in rural healthcare.

Recognizing these challenges policymakers and regional development organizations are working together to develop affordable and quality healthcare in rural communities. They are doing this by making healthcare a component of program, policy, economic and community development/ planning. As a result, many of the rural healthcare service gaps, such as transit for seniors, that have limited access and driven up costs are being overcome and are giving rural communities an asset to attract and retain business, promote smart growth and curb out-migration.

The Department of Health and Human Services Rural Initiative

The US Department of Health and Human Services (HHS) established a Rural Task Force in 2001 to assess programs with the goal of improving rural health and human services. One important initiative was to obtain empirical information about rural communities and develop a rural model for program/policy development that could be replicated by other federal agencies/departments. The result was the release of a Rural Task Force report on July 26, 2002 and several HHS program enhancements.

The report conveyed three important findings that affect targeting grants, evaluating services, developing policies and quantifying rural investments:

Lack of a common definition of “rural” or set of definitions;

While more than 225 HHS programs currently serve rural communities, rural areas still struggle to access resources because individual programs have unique application, implementation and evaluation requirements;

The HHS policy development process does not consistently consider rural concerns.

The four key report recommendations were:

Create a formal structure within HHS for coordinating rural policy initiatives, as well as with external partners;

Create an interagency workgroup that would meet quarterly with the Secretary, or the Deputy Secretary on rural issues;

Ensure that the annual HHS budget development, legislative and Government Performance and Results Act (GPRA) processes include a specific focus or crosscutting discussion about serving rural populations;

Develop a methodology for determining HHS’ investment in specific communities and populations.

One of the shining results from the Task Force Report over the past year was the December 2002 launch of an Internet- based single point of entry -- “The Rural Access Center.” The Rural Assistance Center (RAC) is a national resource on rural health and human services information. RAC information specialists are available to provide customized assistance, such as web and database searches on rural topics and funding resources, linking users to organizations, and furnishing relevant publications from the RAC resource library.

The RAC’s Web site www.raconline.org provides resources such as rural health clinic guides, federally qualified health center listings, capital funding sources, J-1 visa waivers, a database of rural health and human services documents, federal register news and an online quarterly newsletter, The Rural Monitor.

A follow-up HHS Rural Task Force report is currently under review and will be released in the near future, according to Tina Cheatham a Special Assistant of the HHS’ Health Resources and Services Administration (HRSA) and Secretary’s Rural Initiative.

Regional Organizations Promote Rural Health Care

Regional development organizations often administer programs that help to cut the cost of healthcare and improve access. Some of these programs that directly impact cost and access include rural and elderly transit programs, social service block grants (SSBGs), community service block grants (CSBGs) and Area Agencies on Aging (AAA).

The NADO 2002 Regional Development Organizations Survey revealed that more than 27 percent of the nation’s regional development organizations administer AAAs and many of those AAAs offer local programs such as the South Central Alabama Development Commission Area Agency on Aging’s “MedAssist” program. The program provides low- income individuals, over age 60, access to free and/or low cost life-sustaining medications. The program serves three counties, and in six months served more than 425 clients with 2,370 prescriptions, and resulted in an estimated savings of over $512,000 for the region’s low- income elderly.

Regional organizations have also found ways to indirectly enhance rural healthcare services through leveraging and combining funds. The North East Texas Economic Development District, Inc. (NETEDD) recently obtained a $500,000 grant from The Robert Wood Johnson Foundation (RWJF) to establish a revolving loan fund, supporting primary healthcare and local healthcare economic and employment opportunities. The grant, through the RWJF’s Southern Rural Access Program, will be used to provide equity for individual projects, making them more bankable loans in the region. Both nonprofit and for-profit healthcare providers will be targeted as recipients of loans that will generally range from $50,000 to $500,000.

RWJF funds can leverage up to 25 percent of the total loan. NETEDD also received a $200,000 grant from the US Department of Agriculture’s Rural Business and Economic Grant (RBEG) Program. A vital partner in the project has been the East Texas Area Health Education Center. Jerry Sparks, NETEDD’s economic development manager and loan fund project director said, “We have had pre- application discussions with several professionals who currently operate primary care health clinics in rural areas. These are areas where no other primary care facilities exist, and patients are driving many miles to see a doctor, physician assistant or nurse practitioner. If we can use the loan fund to help improve that access, we will plant the seeds for improving lives for years to come.”

For more information contact:

The Database for Rural Health Research in Progress at www.rural-health.org;

The Office of Rural Health Policy at 301/443-0835 or visit http://ruralhealth.hrsa.gov;

Jerry Sparks at North East Texas EDD at 903/832-8636 or email jsparks@atcog.org.

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