We must make rural health care a high priority

Health Progress, Sep/Oct 2001 by Place, Michael D

Political Clout Counts Many rural health ministries are disproportionately vulnerable to economic forces because they lack the political clout enjoyed by urban ministries.

The Closing of a Rural Hospital Affects the Whole Community The closing of a rural hospital (or even the scaling back of its services) is not, in rural areas, a "neighborhood" issue. It can affect the health status of the population of an entire county-or counties. Such closings can be especially damaging because rural physicians are more likely than their urban counterparts to be affiliated with (perhaps even employed by) the local hospital. Moreover, primary care clinics and other facilities are more likely in rural areas to be owned by such hospitals.

The Needs of the Elderly Are Increasing The growth of the elderly rural population, on top of a general "graying of America," means that the United States must develop rural health care services outside the traditional hospital setting to effectively address rural chronic care needs.

Small Does Not Necessarily Mean Less Smaller hospitals, patient populations, and cash flows do not always equal fewer mission challenges. In fact, they may mean more mission challenges.

The Impact Will Be Immediate Because rural hospitals are often one of an area's larger employers (if not the largest), decisions its leaders make to preserve long-term viability will have an immediate impact on the community. And that impact can cause the community to become alienated from the hospital.

By the same token, rural people are often more aware than their urban counterparts of the hospital's value to the community. They will be quick to protest any proposal to "downsize" the rural health care mission.

Staffing Problems Can Affect Everyone Because rural hospitals are so vital to their communities, staffing shortages that result in either short-term or longterm service reductions are likely to turn into community health status issues.

CHA Must Pay Attention to Rural Health Just as we have given a high priority to advocacy efforts on behalf of disproportionate share issues, we must work similarly on equivalent rural issues.

In closing, let me offer two images:

At one point during my visit to Mercy Cadillac's newly relocated and renovated obstetrics unit, my hosts and I happened to find ourselves standing just outside the doors of an operating room. The doors opened for a gurney bearing a woman who had just delivered a baby by C-section. Behind the gurney came a man in scrubs carrying the child. I, who was then unaware of OB practice, assumed that the man in scrubs was a staff member. Admiring the care with which he held the newborn, I thought, "What a picture of mission!" Just then, I heard the "staff person" ask a nurse if he could show the baby to "the kids." As we passed by, I saw him showing this new life to its siblings-and heard one of them, a six- or seven-year-old, remark: "The head looks funny." This is Catholic health care: rural, urban, and suburban.

My second image is of a hospital door shattered by the deer that has just crashed through it. I'll bet that few in the urban and suburban health care ministry have problems like that.