Rural Health Care and Opportunities for Improvement

By Stephen F Hightower MD FACP

“Never tell people how to do things. Tell them what to do and they will

surprise you with their ingenuity” George Patton

fixingushealthcare.com

Tuesday, November 12, 2024

Dear Mr. President, Honorable Members of Congress and Distinguished Staff,

The most recent estimate of the United States rural population was placed at 60 million people or about 1 in 5 of our current United States citizens.  Rural is defined as sparsely populated with low housing density, displaced from urban centers, and in the United States encompasses about 97% of the country’s land mass with about 19.3% of the population.  Urban centers on the other hand, make up only 3% of the entire land area of the country, and support about 80% of the population.  To meet urban criteria certification from the Census bureau, a city must have at least 2,000 housing units, and encompass residential, commercial and other urban land uses with a minimum population of 5,000.

Not surprisingly, our rural communities struggle to provide adequate health care on a consistent basis. Fortunately, however, innovations from rural communities are beginning to improve health care for the citizens of those communities, and their ideas may even provide insights for their urban neighbors.  A home-grown obstetrician set up a virtual prenatal care program with a clinic-provided home –monitoring kit which connected to the Sanford Bemidji Medical Center in rural Minnesota. For many of the expectant mothers there was no access to running water or transportation for prenatal care.  Home BP-cuffs were loaned, as well as bathroom scales, and fetal heart monitors, and checkups over loaned phones allowed easier access and if needed ultrasounds or blood work could be arranged. 

Dr. David Driscoll, director of the Healthy Appalachia Institute at the University of Virginia, notes that for significant health inequities, his team is developing innovative solutions to advance the well-being of many.  Programs being worked on include doctor visits via video call, which do not work well without strong internet connections in the outlying communities, and thus are being transferred to the hospital and clinics which have better connection services to outlying patients. This can provide the link to assist the patients in their communities.  They are also seeking grants from the federal government’s Rural Maternity and Obstetric Management Strategies Program, to cover an in-hospital food pantry, transportation services, and a visiting-nurse program in multiple areas.

Health care micro- sites can be a bridge between major medical centers and small communities and are showing huge promise in rural health by combining telemedicine and in person care.  Those without broadband, or internet can go to a local clinic and talk to a specialist online.  Nurses at the local clinic can do requested blood work, vitals, and help nurture the patient doctor relationship. This process has been positively validated with the University of Wisconsin’s rural health partnership with the Mayo Clinic.  This was described as the way they can deliver health care in a cost-effective way to people who cannot come to a traditional clinic.

Different rural communities will have different needs. Local input and insight will determine what help the people need.  It is critical to start by asking questions and listening to feedback. The goal is to use successful interventions as creative inspirations for solving multiple issues in rural health care, and in rural health equity.

Sincerely,

Stephen F Hightower MD FACP

fixingushealthcare.com

Copy to: We The People at fixingushealthcare.com