Rural Health Care

David Mayer
December 27, 2011 — 1,093 views  
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The majority of us abandoned the land some generations ago and moved into the cities. Since most people live in these convenient groups, it's efficient. Suppliers of goods and services have a captive market even allowing for the internet introducing more people across greater distances. We still need local shops and people to repair our homes when they are damaged. So what's happened back in the countryside? Sadly, it's mostly bad news. With fewer people spread over bigger distances, access to goods and services has dropped dramatically. Now add in the budget deficits affecting almost every state and you won't find business as usual. Even essential services like the fire departments and law enforcement are stretched to breaking.

In the midst of all this, you have the problem of health care. Takes states like Kentucky, North Carolina and Tennessee where up to 40% of the population live in rural communities. With due respect given to these states, there's real poverty in many of these areas and, as a result, higher levels of chronic disease among people less likely to carry current insurance. This places a heavy burden on Medicare and Medicaid at a time when the tax revenue collected by both the federal and state governments is falling. This loss in revenue comes against a background of consistently rising costs. It's not just the rise in the retail prices for prescription drugs. With few doctors prepared to provide care to dispersed rural communities, financial incentives have been offered. The for-profit clinics and hospitals are struggling because of the high number of uninsured and so charge higher rates.

This is the time for local communities to encourage the creation of more non-profit hospitals offering benefit plans to their local communities. In policy terms, this requires local government to map where everyone lives and what their needs are both now and in the future. Only then can there be proper planning. One of the key issues is going to be changing attitudes and lifestyles. With fewer resources, there must be greater emphasis on preventative medicine. There are major benefits if more people can be persuaded to eat a healthy diet, exercise more, drink less and quit smoking. Only when people help themselves and are routinely screened for the more common illnesses, can we make the most effective use of the scarce resources. This is being backed up by the larger employers who are struggling with the rising premium rates as we only slowly pull out of the recession.

More employers are now working with local government to establish their own health insurance plans. In some cases, this means setting up clinics inside large industrial or commercial buildings. Employing medical staff directly represents a big saving. If this waits for Washington to move, these states will be waiting indefinitely. It's all going to come down to self-help on a limited budget. Obamacare is, of course, going to produce a crisis as more people gain access to individual health insurance plans. This commitment could not have come at a worse economic time for the poorer rural states. If the best decisions are going to be taken, all the stakeholders must come together to discuss how to make the best use of the scarce resources. Hopefully, the can-do spirit will get things done.


David Mayer

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