A few days ago, I was fascinated by a news feature on my local public radio station about a novel way of recruiting doctors and other medical staff to rural Ashland, Kansas (population 855). There the health center director, Benjamin Anderson, realizing that the normal recruiting incentives were not going to work for this small, remote community hit upon the idea of “mission-focused medicine.” Doctors are offered up to eight weeks off each year for missionary work in a developing country – “…a doctor who is willing to sleep on a cot in the Amazon or treat earthquake victims in Haiti is ready to serve in rural Kansas.” The approach has worked and is now being used to attract a nurse and a dentist to the town.
The Ashland, Kansas, medical center (photo: Peggy Lowe/Harvest Public Media)
This story made me think about how the noise and discord around the implementation of the Affordable Care Act or “Obamacare” has pushed to the side serious and informed discussion about how to tackle some of the barriers to an affordable, accessible, high quality health care system. Recruiting doctors is just one symptom of a crisis in rural health care, and it is to be hoped that there are other Benjamin Andersons out there looking for innovative solutions that work for their communities.
Clint MacKinney and Keith Mueller, in a new Rural Futures Lab paper, Pursuing High Performance in Rural Health Care, propose a set of actions that could lead to better and more affordable care and to healthier people and communities.
- Rural residents should have local access to public health, emergency medical, and primary services, as well as access to regional health systems for hospital and specialty care necessary for a continuum of care. How these are designed and delivered needs to respond to the unique local and regional resources in each rural area.
- Primary care has to be expanded and transformed. Current actions to strengthen rural care through clinic payments, bonuses to overcome professional shortages, and training, need to be supplemented by efforts to redesign medical education, reshape payments to providers, and to restructure primary care as patient-centered models such as Medical Home.
- Health information technologies are essential to achieve seamless transfer of clinical and administrative information among providers, and to ensure transparency in cost and quality information. This is especially true in rural areas to achieve a continuum of care.
- Payments for medical services should reflect the value of those services not just their volume. Financing and delivery systems should reward collaborations, efficiencies, quality, and patient care.
- Community health planning is the foundation for healthy communities. This requires primary care providers and their patients to connect to a wide range of community health resources such as public health agencies, school districts, local employers, Area Agencies on Aging, community colleges, social services, and so on.
To keep up with what is happening, both good and bad, in rural health care and in particular to see if MacKinney and Mueller’s ideas are gaining traction, try the National Rural Health Association’s blog.
What does the public health system look like in your region or home community? Do you know innovators in rural health?
Visit the Rural Futures Lab here.