07-26-1999

ACCESS/QUALITY/COST - RURAL HEALTH: STUDY CITES DEFICIENCIES, LIMITATIONS

 
      Rural health providers are often forced to give care in a
 "quality vacuum," devoid of the "supporting systems and tools
 that, ideally, help HMOs and other health care systems coordinate
 care in urban areas," according to a report to be released today. 
 Dr. Andrew Balas, director of the Center for Health Care Quality
 at the University of Missouri-Columbia, and colleagues, in
 analyzing previous studies of rural health in the U.S. and
 Europe, found that staffing shortages force rural doctors to
 "spend 16% more time doing direct patient care" and see 38% more
 patients than their urban counterparts.  Thus, they have "less
 time to manage their practices, educate patients and provide
 preventive care."  The study adds that rural residents "tend to
 be older and poorer" than city dwellers, and less likely to be
 covered under managed care, as "Medicare HMOs have pulled out of
 more than 100 rural counties in the past two years."  Balas said,
 "For all the attacks on their practices, managed care plans do
 pay some attention to quality and at least in some areas do make
 systematic efforts to improve their services."  The result of all
 these factors, the study notes, is deficiencies in rural health. 
 Balas said, "Because of the shortcomings in preventive services
 and care coordination, people who live in rural areas are more
 vulnerable to developing serious illness.  And when they do
 become sick, it is more difficult for them to actually get the
 health care services they need, so that their condition worsens." 
 For example, rural patients are 10% less likely "to receive
 screening such as mammograms, Pap smears and diabetic eye exams,"
 and rural mothers are almost "twice as likely to deliver babies
 by Cesarean section (31%) than moms in urban hospitals (19%)." 
 Balas said, "There's this whole world of health care outside
 managed care, and this world shouldn't be forgotten in debates on
 the quality of health care. ... It's clear that managed care is
 not going to provide the framework for quality improvement in
 these areas, so we need to try some new solutions and see what
 models really might work for these areas" (Bowman, Scripps
 Howard/Denver Rocky Mountain News, 7/25).
 



American Healthline