21st Century Rural Health Care Delivery
Reality Check:
The April 20 issue of Common Sense reviewed health care issues in rural areas of the Eastern Shore:
- Community hospitals are closing or reducing services substantially;
- Beds and nursing staff are among the first to go;
- With only temporary overnights possible until helicopter or ambulance takes you to a city;
- Specialized services are often only available by importing doctors once or twice a month, or by patients driving long distances to another facility, e.g. coronary, oncology, pediatrics, endocrinology, gastroenterology, gynecology, urology, or most surgeries;
- Inadequate Public transportation.
How are rural communities dealing with these problems?
First, it’s essential we understand that the small, full-service community hospitals of the 20th Century will not return. For-profit companies own them now and the services they provide are directly related to the profit margin each service delivers. The health care facilities remaining in the nine counties usually offer large emergency clinics or departments, blood, x-ray and scan testing; and possibly 3-5 beds. The latter are not for recovery, healing, or convalescence, because in the 21st Century, these take place in the patient’s home.
Patients requiring diagnostic expertise and hospitalization will be taken to acute care hospitals in Easton, Annapolis, Baltimore, or elsewhere within the local facility’s particular network. So how to get good medical care in a small town?
Seduction and Bribery:
Some rural or isolated US communities have refocused their priorities on the minimum basic services they think are needed instead of trying to revive the old community hospital model.
In recruiting new staff, local authorities have recognized that most young doctors leave medical schools, internships, and advanced training with large debts.Thus they often offer packages of inducements to family practitioners and specialists. These packages may contain:
- Loan repayments in installments determined by the number of years the doctor agrees to stay. If the doctor settles permanently in the community, the norm is to pay the whole balance;
- Free housing and office;
- Loan of a car or van;
- Depending on the quality of the local public schools or any special needs of the doctor’s children, tuition support.
A similar approach is aimed at middle-aged physicians thinking of retiring in 5-10 years and looking for a less frantic life. The methods have also been used to attract nurses, technicians, and other health practitioners, as have on-signing bonuses and moving expenses.
Federal Qualified Health Centers (FQHC):
Section 330 of the Federal Public Health Service Act is aimed at “…enhancing the provision of primary care services in under-served communities.” The Act identifies “Specially Protected Population Segments,” such as agricultural workers, homeless, and public housing residents. These outpatient clinics qualify for specific reimbursements from Medicare and Medicaid. An individual’s ability to pay is matched by a sliding fee discount scale. Once certified by an applicant, the organization (public or non-profit) can receive grants from the U.S. Health Resources Services Administration.
The Eastern Shore is fortunate to have a first class FQHC in the Choptank Community Health Center. It supports the Denton Medical Center, the Easton Pediatric Center, the Fasett Magee Health Center, the Federalsburg Medical and Dental Center, the Bay Hundred Health Center in St. Michaels, and the Goldsboro Medical and Dental Service. The application/approval process is lengthy.In the meantime, the seduction and bribery methods above are being used by many communities seeking to upgrade the healthcare services available to them.
Common Sense for the Eastern Shore
