At the Intersection of Health, Health Care and Policy Cite this article as: Janice C. Probst Health Care Providers In Rural America Health Affairs, 33, no.2 (2014):346 doi: 10.1377/hlthaff.2013.1389
The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/33/2/346.1.full.html
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Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2014 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
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doi:
10.1377/hlthaff.2013.1389
Health Care Providers In Rural America The South Carolina Rural Health Research Center produced two reports cited by Jeffrey Stensland and coauthors (Nov 2013). I would like to comment briefly on their conclusions, on behalf of the center’s faculty and associates. The methodology of the Health Affairs article is sound, and no one can question the need to target federal expenditures carefully. However, we are concerned that casual readers may be left with the impression that programs designed to retain health care providers in rural America are no longer needed. The modest rural differences that the investigators found could be interpreted as success: Rural support programs are effective in giving rural Medicare recipients access to care and therefore should be retained. To use a simple analogy, when a person with diabetes takes insulin and attains a correct blood sugar level, the physician does not conclude that the patient no longer needs insulin. Examining only Medicare beneficiaries does not provide a full assessment of rural populations’ access to health care. Although the Medicare Payment
346
Health Affai rs
Advisory Commission focuses on Medicare, the Centers for Medicare and Medicaid Services also funds Medicaid. Rural populations are more likely to be insured by Medicaid, underinsured, or uninsured than are urban residents. Stensland and coauthors did not assess the health status and health services use of these populations. Finally, rural minority populations were not addressed in the article. Rural minority adults disproportionately live in persistent poverty and in lowresource counties, where patterns of health and service use may differ markedly from those in predominantly white counties of the Midwest. Adjusted analyses conceal disparities between rural minorities and other groups and do not provide valid information for remedial action. Retaining physicians and providers in rural America is a chronic problem, not a short-term issue. Broad cuts could trigger unintended consequences, as happened during the 1980s when a poorly considered rural payment differential tipped rural hospitals across the nation into closure.
January 2014
Janice C. Probst South Carolina Rural Health Research Center COLUMBIA , SOUTH CAROLINA
33:2
Downloaded from content.healthaffairs.org by Health Affairs on April 10, 2015 by guest
The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/33/2/346.1.full.html
For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2014 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on April 10, 2015 by guest
Letters There is a limit of 300 words for letters to the editor. Health Affairs reserves the right to edit all letters for clarity, length, and tone. Letters can be submitted by e-mail, [email protected], or the Health Affairs website, http:// www.healthaffairs.org.
doi:
10.1377/hlthaff.2013.1389
Health Care Providers In Rural America The South Carolina Rural Health Research Center produced two reports cited by Jeffrey Stensland and coauthors (Nov 2013). I would like to comment briefly on their conclusions, on behalf of the center’s faculty and associates. The methodology of the Health Affairs article is sound, and no one can question the need to target federal expenditures carefully. However, we are concerned that casual readers may be left with the impression that programs designed to retain health care providers in rural America are no longer needed. The modest rural differences that the investigators found could be interpreted as success: Rural support programs are effective in giving rural Medicare recipients access to care and therefore should be retained. To use a simple analogy, when a person with diabetes takes insulin and attains a correct blood sugar level, the physician does not conclude that the patient no longer needs insulin. Examining only Medicare beneficiaries does not provide a full assessment of rural populations’ access to health care. Although the Medicare Payment
346
Health Affai rs
Advisory Commission focuses on Medicare, the Centers for Medicare and Medicaid Services also funds Medicaid. Rural populations are more likely to be insured by Medicaid, underinsured, or uninsured than are urban residents. Stensland and coauthors did not assess the health status and health services use of these populations. Finally, rural minority populations were not addressed in the article. Rural minority adults disproportionately live in persistent poverty and in lowresource counties, where patterns of health and service use may differ markedly from those in predominantly white counties of the Midwest. Adjusted analyses conceal disparities between rural minorities and other groups and do not provide valid information for remedial action. Retaining physicians and providers in rural America is a chronic problem, not a short-term issue. Broad cuts could trigger unintended consequences, as happened during the 1980s when a poorly considered rural payment differential tipped rural hospitals across the nation into closure.
January 2014
Janice C. Probst South Carolina Rural Health Research Center COLUMBIA , SOUTH CAROLINA
33:2
Downloaded from content.healthaffairs.org by Health Affairs on April 10, 2015 by guest
