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Rural Health Care: Challenges & Opportunities

A Workshop for State and Local Health Officials

This workshop was designed for State and local health officials responsible for strengthening the rural health care infrastructure and improving the health of rural populations. The workshop was held in San Francisco, California, March 6-8, 2000.

About the Workshop Sponsor.


Challenges posed by the rural environment often exacerbate already complex health policy problems. Our Nation as a whole is struggling with issues related to:

  • Providing access to care for the large and growing number of uninsured persons.
  • Caring for an aging population.
  • Aligning financial incentives for payers, providers, and patients.
  • Integrating population-based services with personal health care services.

In rural areas, these problems are further complicated by:

  • Geographic isolation.
  • Transportation barriers.
  • Populations that are generally older and less affluent.
  • Shortages of financial, human, and capital resources.

Although the challenges facing rural communities are formidable, the opportunities for improving health and health care services are also great. Many believe that government at all levels will continue to play a crucial role in providing targeted subsidies or enhanced payments to providers located in rural areas.

Supporting educational and incentive programs (such as the National Health Service Corps and related State initiatives) for training, recruiting, and retaining physicians and other professionals in underserved areas is an important public sector responsibility. States and communities can also promote the development of rural health networks and integrated systems that seek to coordinate service delivery, reduce administrative costs, and provide new services.


The objectives for participants in this workshop included:

  • Assessing how geographic isolation, low population density and other "rural" factors contribute to and often exacerbate already complex health policy problems, such as providing access to care for persons without health insurance.
  • Understanding problems related to the supply and distribution of health care personnel in rural areas and the various approaches for recruiting and retaining health care professionals.
  • Determining the role of States and communities in organizing public health services and addressing occupational health and safety issues for agricultural workers and other rural residents.
  • Discussing public policy issues related to the organization, financing, and delivery of emergency medical services in rural areas.
  • Assessing the status of rural hospitals in their area and options for strengthening smaller, low-volume facilities.
  • Understanding the evolving continuum of long-term care services in rural areas, including ways to provide assisted living and home health services to the elderly and persons with chronic conditions and disabilities.
  • Recognizing factors needed to support the growth of managed care in rural areas, and the experience to date of Medicaid and Medicare managed care programs in serving rural populations.
  • Identifying resources and strategies for promoting the development of rural health networks and integrated systems.


Workshop participants included representatives from both State and county health departments, State Senate staff, senior executives in health departments, Medicaid agencies, licensure and certification departments; and rural health care coordinators and policy advisors. Twenty-seven States were represented.

AHRQ's User Liaison Program (ULP) disseminates health services research findings in easily understandable and usable formats through interactive workshops. Workshops and other support are planned to meet the needs of Federal, State, and local policymakers, and other health services research users, such as purchasers, administrators, and health plans.

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