I’m going to leave the current news cycle, in which Sen. McConnell is trying to get another proposal to repeal the PPACA through a reluctant Senate. I’ve been thinking about what we ought to do about healthcare in rural America. Here is a link to a good article on the closures of rural hospitals from the Kaiser Family Foundation a year ago:
Rural hospitals face a lot of challenges to their survival. First, much of rural America is losing population. Since hospitals’ revenue is still based largely on the volume of services they provide, it is hard to pour money into building or maintaining the capital-intensive resources of a traditional hospital when the need for the resources is likely to decline. Lack of investment in resources, though, leaves these hospitals unable to do some of the high-tech, high margin care such as major orthopedic cases and invasive cardiology that supports money-losing lines of business. Also, the lack of resources causes patients with private insurance to avoid these hospitals and drive to bigger hospitals for all but truly emergency care. The patients left to use the rural hospitals are those with Medicare, Medicaid, or no insurance at all.
The rural population is older than the nationwide average, and they are more likely to be on Social Security, either due to age or disability, which means that the patients in rural America are likely to be sicker than average, and less likely to have private insurance. The question is, as hospitals close and access to medical care disappears, will these patients have to leave the country and move to more urban areas in order to access care? I think the loss of population will accelerate with the loss of access to healthcare and the disappearance of healthcare jobs from these communities.
A supporter of stringent free-market economics will view the collapse of rural healthcare, economies, and populations as the working of the invisible hand, inevitable and perhaps only mildly regrettable. For those not so completely sold on this philosophy, the article above details some interesting ideas on how to maintain access to healthcare in rural areas. What I think is most important is that we recognize that we will not serve patients in rural areas best by tweaking the current system of payment for individual services, nor can we expect a commercial market to create access where there is so little demand. The solution will be a political decision that the government will have to simply commit to having healthcare in rural communities, and then decide how it will be delivered.