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Rural Health

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Unique challenges face those trying to improve health care quality in rural areas

The United States is renowned for its high-quality health care. However, the Nation's smaller towns and rural communities often face problems assuring adequate health care services. Unless rural providers can document that the quality of local care meets objective external standards, third-party payers may refuse to contract with them, and increasingly sophisticated consumers may leave their rural communities to seek basic medical care services elsewhere, notes a recent monograph authored by Ira Moscovice, Ph.D., of the University of Minnesota Rural Health Research Center (RHRC) and Roger Rosenblatt, M.D., M.P.H., of the University of Washington RHRC.

To improve the health care quality in a rural setting, several issues must be addressed, say the authors, whose work was supported by a cooperative agreement with the Health Resources and Services Administration (Agreement No. 97-239F-97) funded in part by the Agency for Health Care Policy and Research. They emphasize that it is unrealistic to have one national standard for health care quality. The spectrum and content of rural health care is different from that provided in large cities. To have one standard apply to both urban and rural areas might mean closing rural hospitals and practices and forcing rural citizens to travel to distant sites, which in itself might lead to poorer outcomes.

The authors suggest addressing the following issues in developing rural health care quality standards that are practical, useful, and affordable. Guarantee core services in rural areas with an adequate cadre of well-trained, stable providers, working in well-equipped and well-managed ambulatory and inpatient settings. Such programs as Medicare should be involved in the training, deployment, and ongoing support of health care professionals. Rural residents must have some ability to shape the system that provides their care, or remote health care organizations may design systems that are unresponsive to the rural people they serve. Finally, accrediting bodies should create rural standards that reflect the realities of health care in these sparsely populated and remote areas.

More details may be found in the monograph Quality of Care Challenges for Rural Health by Drs. Moscovice and Rosenblatt, which was published by the Rural Health Research Centers at the University of Minnesota and the University of Washington. Single copies are available from Jane Raasch at (612) 624-6151.

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