Early this summer I had the opportunity to attend a two-day meeting sponsored by the White House Rural Council. The Council is overseen by the Secretary of Agriculture in collaboration with the Executive Office of the President and includes leadership from over two-dozen federal agencies, including the Federal Office of Rural Health.
We began our work at the Eisenhower Executive Office Building and ended up at a nearby historic hotel, The Hay-Adams. I have been to Washington many times but I am always fascinated by the history and promise of our nation’s capital, even with today’s dysfunctional Congress.
The meeting was useful with a focus on potential opportunities to advance rural health through new partnerships between the private and public sectors, in particular the role of private foundations.
I am still struck by a question from another participant on the first day. I was all the more troubled as the questioner seemed well motivated and totally reasonable. These may not be the exact words, but they convey the sense as I remember it: “What is the ‘right model’ for rural health care so that we can be sure we are not ‘over-investing?’ ”
To quote an old friend, “I couldn’t have disagreed more” with the assumptions behind that question.
I responded as tactfully as I could by saying, “I couldn’t really worry about this until our country got a lot closer to making an equitable investment in rural health.” For me the question highlighted a dangerous myth–that we are spending too much on rural health.
The use of scarce dollars for rural health obviously must be done wisely. But given the studies and numbers I have seen, I don’t believe we are even close to needing to worry about “over-investing.”
Rural can do much better, as can the whole healthcare system. But rural is already doing more with less according to a report issued last December by the federal Department of Health & Human Services’ National Advisory Committee on Rural Health and Human Services:
“The people served by rural hospitals are more likely to report a fair to poor health status, suffer from chronic diseases, lack health insurance, and be heavier, older, and poorer than residents of urban areas. Yet overall, the average cost per Medicare beneficiary is 3.7 percent lower in rural areas than in urban areas, and rural hospitals perform better than urban hospitals on three out of the four cost and price efficiency measures on Medicare Cost Reports.”
In the same vein, the Alliance for Health Reform, supported by the Robert Wood Johnson Foundation, says, “Rural residents have rates of chronic disease such as diabetes, heart disease, high blood pressure and obesity that are greater than urban or suburban populations.” So we have much to still accomplish.
It doesn't sound to me that rural health is receiving an unfairly high share quite yet. What about the first half of the question at The Hay Adams–“What is the right rural model?” Simply put, there is no “single” or “right” model for America’s diverse array of rural communities, but there are key questions to guide each community in seeking their own answers.
For me the “model of care” question falls into four buckets:
1. How do we provide local patient-centered care that is team based and outcome focused?
2. How do we collaborate with regional organizations to emphasize value of care over volume of care?
3. How do we partner with others locally and regionally to foster healthy communities?
4. How do we adapt urban-based federal models to the unique characteristics of our rural communities?
These are the questions we need to be addressing and I have no doubt that in most communities this is work increasingly under way.
In a key way, I do admit that rural has a real advantage. Rural physicians, clinics and hospitals have the advantage of being able to make change more quickly. There is a depth of passion and dedication when neighbors are quite literally caring for each other.
I have no doubt that we have a hometown advantage in that rural communities want rural providers to succeed and to keep local care local.