More than 51 million Americans
live in areas classified by the US Office of Management and Budget (OMB) as
non-metropolitan. This comprises
one-fifth of the US population. This
population is generally older, poorer, sicker, less educated and in worse
health than those living in metropolitan areas.
They also are more likely to need health care, have fewer hospital beds,
lower physician per capita, lower access to health care and are less likely to
have adequate health insurance.
When people think about the health care infrastructure in many rural areas, they think about physician shortages, isolation, struggling small hospitals, aging equipment, lack of capital for investment, high uninsured population among residents and the list goes on. This is certainly true in some rural areas. While physical isolation and economic circumstances certainly play a role in rural community challenges, they do not pose insurmountable challenges. Healthy does not require advanced medical technology such as open MRI and CAT scan capacity in every community. What is necessary, is to make major inroads to ensure that rural communities have adequate access to those primary health care services which can address the major health needs of that community.
What are the health needs of
small communities? More often than not
health is acknowledged more in its absence than its presence. However, when a
family member, a friend or a colleague does become sick what is the expectation
of care for a rural community resident?
To a large extent unrealistic and inappropriate community expectations
are often driven by media reports that focus on expensive state-of-the-art
equipment and promote dependency on immediate 24 hour-a-day services. The notion of better health care is
different from simply providing more health care. Bearing in mind that resources are finite and
relatively scarce, it is important for hospitals to target those services that
are likely to yield the greatest health gain for their community.
Health promotion and illness prevention
programs that fall within a public health approach can complement the provision
of primary care in a small community.
Some of the greatest improvements in health status result from simply
changing human behavior. Mandatory wearing of seat belts has drastically reduced
the mortality rates associated with rural road trauma. Annual checkups, cancer screens, lower
alcohol consumption and taking greater responsibility for ones own health can
minimize preventable ill health. These
efforts combined with primary care services enable a rural community hospital
to cater realistic health care to its residents.
Maybe this niche is to provide the best primary care possible for its small town residents. Rural hospitals don’t have to compete with their urban counterpart but rather focus on a solid, long-term positioning in its community as the best and preferred place to receive primary care.
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