US Policy on Providing High Quality Care to Remote Rural Locations - Assignment Example

US POLICY ON PROVIDING HIGH QUALITY CARE TO REMOTE RURAL LOCATIONS. Faculty Institute I. Introduction II. Policy Goals III. Alternative Responses IV. Policy Choice V. Implementation VI. Results VII. Conclusions VIII. References I. Introduction United States of America has its 20% population living in rural areas. This rural population is facing several problems. These problems range from financial, mental, emotional and health related problems. There are various reasons why people are not getting the required health services. The most important reasons are lack of service providers, proper health clinics and professionals. Prior to 1988 rural policy focused on the supply of National Health Service Corps and Community Health Centers. This was different during the post 1988 era. It was multi focus now. It started Medicare PPS for rural hospital payments. It focused on rural health clinics, created federal office of Rural Health Policy to monitor various policy implementations and control them. Balance Budget Act was passed during this period to fund Medicare. There were several other focus areas like home health, hospitals, ambulance and infrastructure improvements. The first segment of the assignment discusses about the policy, its focus area and need. This is followed by the results of the policy implementation. II. Policy Goals Apart from these many of people live in interior areas. People from these areas find it difficult to reach to the clinic and medical professionals due to the inadequate transportation facilities. There is various works going on to facilitate health services to this group of people. People in rural areas suffer from various problems. One of the major issues of concerns for government is Insurance. The choice of medical treatment depends upon the finance available or the ability to manage best services in the available funds. The choice and use of better medical professional and health care service will depend on this. Approximately 41.2 million people under the age of 65 years are uninsured today. This is a serious issue of concern for government1. Figure: 2.1 Population Age 65 and Above2 The policy we will be discussing here is Rural Health Policy. It covers following range of issues3: II.i. Availability and financial stability of rural health care facilities II.ii. Health care workforce in rural communities II.iii. Adequate Medicare and Medicaid reimbursement for rural areas. II.iv. Rural health care quality II.v. Rural public health The mortality rate from all causes during 1990-94 was mentioned in the diagram below. Susceptibility to death increases in rural area than the urban due to unavailability of adequate medical services. This is one of the focus areas of the policy. Figure 2.2 Mortality Rates4 II.vi. Emergency Medical Services in Rural Areas In rural area people are involved in various hazardous occupations like farming, mining and so on. More than 60% of the accident deaths happen in the rural areas. 5 Most of the emergency service providers in the rural area are volunteers. The inadequate number of ambulances, staff and infrastructures adds more vulnerability to the emergency cases. This calls for better emergency services in rural areas. I.i. Availability and Financial Stability of Rural Health Care Facilities One of the major issues which this policy covers is about the funding. This policy does it through the help of Medicare and Medicaid reimbursement. These two are responsibility of Federal Office of Rural Health. It will be reviewing all the Medicare policies and regulations which have direct impact on Rural Health Care. The Medicare policy covers a large section of society. It has been implemented on the basis of need. It does not cover full range of preventive health care services. It does not include dental and oral care and preventive care. Medicare Policy covers a broad range of population. It amounts a huge share of the overall heath budget. It provides direct subsidies to community and direct subsidies to community and migrant health clinics. It provides indirect subsidies to both the private and non-profit sectors to encourage continued care to the poor.6 I.ii. Health Care Workforce in Rural Communities The health care workforce in the rural area is not adequate. Due to this fact the people in rural area are not able to get the proper healthcare services. This is one area of concern. There are worsening shortages of health, mental health, and allied health personnel in rural areas. Currently there is an acute shortage of family practice, obstetric, pediatric, geriatric, emergency, and mental health professionals. It is estimated that 45 percent of family and general practitioners in rural areas will retire in the next ten years. Many physicians who had previously provided obstetric care have ceased to do so because of high malpractice costs, leaving large geographic areas without any prenatal or obstetric care providers.7 I.iii. Adequate Medicare and Medicaid Reimbursement for Rural Areas This is also one of the areas of concern in this policy. The medical facilities are expensive and unaffordable for the poor rural area. These places the earnings are seasonal or source of income is not regular. People find it difficult to pay for their insurance services as well. The quality and frequency of medical services depends upon the economic power they have. Due to this Government has focused on this area. This has been the most attractive feature of the Rural Health Policy. The medical service will be improved with the process of smooth, clear and adequate payment system. The reimbursement rates are lesser than the urban service providers. The working conditions in the rural area is difficult than the urban environment. It’s due to lack of resources, higher transportation cost and unavailability of professional in this areas. Medicare remains the primary source of health care reimbursement in rural areas with Medicare patient expenses in 1998 accounting for 47 percent of total patient care expenses for rural hospitals, compared to 36 percent for urban hospitals. The transition to prospective payment and fee schedules beginning with legislation in 1983 and most recently in 1997 and 1999 has threatened rural hospitals. Because rural hospitals have lower volumes of patients with higher fixed costs, they often require special payment arrangements under prospective payment systems. Furthermore, poor financial status limits a hospitals ability to recruit and retain qualified health care providers; accesses needed capital and maintain other services like home health and skilled long-term care.8 I.iv. Rural Health Care Quality The quality of rural health care and education about healthcare is lesser than in urban area. There is always funding problems in order to improve the availability and service standard of the medical service in the rural area. Insurance cost is higher for the people in the rural area due to the kind of employment they are in. Usually the rural population is dependent on self employment. This is also one area of concerns. Recent infant mortality rates for the United States already lag behind many industrialized countries, and those rates are even higher in rural areas (10.8 versus 10.4 per 1,000 births in 1987)9. I.v. Rural Public Health To improve overall health of people in rural area and provide them adequate health services this policy has been framed. People in rural areas suffer from various health related problem which ranges from mental and physical health to the problems of allied health personnel in rural areas. The short supply of professionals in the filed of family practice, pediatric, obstetric, emergency, geriatric, and mental health are not adequate. The population living in rural area requires support on various bases. There are various diseases like cancer, hepatitis, AIDS/HIV, obesity to name a few which are causing problems. The heath care facilities in rural areas are not in a shape to meet the health related requirements of people. These places have poor infrastructure and transportation facilities to reach to the medical services when required. The 18% of populations living in rural area are old. The new generation is moving towards the urban area for better opportunities. Looking at the issue and the large section of population living in the rural of United States of America it was required to work upon a policy which covers all the problems. The Rural Health Policy is aimed at improving the overall healthcare services. The Office of Rural Health Policy (ORHP) is responsible for the success of this policy. It shapes rural health policy in a variety of ways. III. Alternative Responses The Rural healthcare policy is comprehensive enough and includes almost all the areas where the rural health care system lacks. Health care generates job opportunities in the rural area. This accounts around 15-20% jobs. This includes rural healthcare and rural social services in the area of health care. Different studies are being conducted in the area of Rural Health Care to improve the services. Rural Health care policy is a comprehensive policy which includes various small policies for different problems. If this policy is not implemented, that will be the situation of no policy. The ‘No Policy’ situation will worsen the condition of the health, heath care problems, economy, employment opportunity and standard of healthy life for a large section of the population in the country. This policy requires various changes and improvements but still it is changing lives of many people. IV. Policy Choice The policy choice for rural heath issues depends upon various factors. The results of policies in the past, standard of the health care. Improvement in the health care facilities from the past, mortality rates, population pattern, expected requirement of the health care services in the future etc. At present Office of Rural Health Care Policy has been working on various rural health care programs, conducting studies, managing the Medicaid programs and funds. Medicaid has been one of the major areas of success for the government in ensuring improvement in the healthcare programs. A per the data available the percentage of insured population through various agencies was as follow in 1997. Rural Countries Adjacent to Urban Rural Countries Adjacent to non Urban Uninsured 17.5% 21.9% Public: Medicaid and Other 11.0% 15.5% Other Private insurance 05.6% 07.6% Employer sponsored insurance 65.9% 55.0% Figure: Health Insurance Coverage of non elderly across US (1997)10 V. Implementation The financing policy of federal government has always been an issue of controversy for the policy like this. The implementation of this kind of policy is ongoing process which required support of several different departments and organizations. The Office of Rural Health Policy serves as a focal point for rural health issues within the Department. The Office, which was created in 1987, is charged in its authorizing language in the Social Security Act with advising the Secretary and the Department on rural health issues. ORHP reviews key Medicare and Medicaid regulations to assess the impact on rural providers and beneficiaries and also funds rural focused health services research. ORHP currently administers eight grant programs designed to expand rural health capacity at the State and local level.11 Office of Rural Health Policy is responsible for the proper implementation of the policy and monitoring its effectiveness. VI. Results According to the studies done by Agency for Health Care Policy and Research Medicaid coverage of rural poor families has shown positive results in the rural areas. There is more likelihood now to use medical services due to this coverage among all the sections of rural economy children, women and old people. At least 703,000 Medicaid beneficiaries in rural areas now participate in capitated managed care, and even more participate in primary care case management (PCCM) programs. States most often cite potential cost savings and hopes of improving access to care as the major reasons for implementing rural managed care programs. These researchers did a case study of 10 States that have already implemented Medicaid managed care programs to discern the feasibility of these programs and their impact on access to care. In 1997, they conducted telephone interviews with 130 key informants in the 10 States, including State agency representatives, rural providers, representatives of managed care organizations, and consumer advocates12. There have been several efforts to support the rural population to get proper and adequate health care services. The budget required for it and the spending is considerable. The Office of Rural Health Policy supports the Rural Health Policy and monitors it against the desired results. VII. Conclusions  So far the rural policy has been showing consistent results. It has been criticized on the various grounds. It also have been fail to deliver results in some of its objectives. 1. It does not cover preventive care. 2. The payment through Medicare program does not follow equal payment for the rural area hospitals as compared to the counterparts in the urban area. This is creating problems and alleviating the hospitals from the rural to urban areas. Rural Health Policies is not been able to address the problems and issues for which it was formed. More attention is towards Medicare program, which is also one key segment. People in rural areas lack financial resources hence providing them this has encouraged many people to opt for medical treatment processes. The policy needs further improvements. These improvements should be in area of providing proper infrastructure resources and making the professional services available for the rural population. It can happen only when operating funds are available. Emphasis on long term changes would help the overall process. The health sector can provide a good job opportunity option to the young population of rural areas. The policy focuses on the various health care issues and trying to understand the problems and challenging issues in providing adequate health care services. VIII. References Gleich Patricia K.: Health care Issues and Accesses to Care in Rural Areas. http://www.pcusa.org/health/usa/healthinfo/ruralhealthissues.pdf accessed on 14 January 2006 Felt-Lisk, S., Silberman, P., Hoag, S., and Slifkin, R. (1999, March). "Medicaid managed care in rural areas: A ten-State follow-up study." Health Affairs 18(2), pp. 238-245. Rural Healthy People 2010, Volume 2: 2003The Texas A&M University System Health Science Center ONE DEPARTMENT SERVING RURAL AMERICA HHS Rural Task Force Report to the Secretary July 2002, US Department of Health and Human Services Rural Health and People, A Companion Document to Healthy People 2010, Volume 2, Southwest Health Rural Research Center. The National Advisory Committee on Rural Health and Human Services : April 2005, The 2005 Report to the Secretary: Rural Health and Human Service Issues, ftp://ftp.hrsa.gov/ruralhealth/publichealth.pdf http://ruralhealth.hrsa.gov/policy/StrategicPlan.asp Office of Rural Health Policy accessed on 14 January 2006 http://muskie.usm.maine.edu/Publications/rural/ResearchInProgress2005.pdf accessed on 14 January 2006 http://www.hr.state.nv.us/directors/SP-AccComm04/Documents/StatusRHealth2004-06.pdf accessed on 14 January 2006 http://www.raconline.org/info_guides/ruralhp/ruralhpfaq.php#issues accessed on 14 January 2006 http://www.rupri.org/ruralHealth/presentations/mcbride022505.pdf accessed on 14 January 2006 Rural Health Goals: Guaranteeing a Future published: 1995, accessed on 14 January 2006. http://www.apha.org/legislative/policy/policysearch/index.cfm?fuseaction=view&id=117 http://www.rupri.org/ruralHealth/presentations/mcbride022505.pdf accessed on 14 January 2006 Read More