Donald Trump and Hillary Clinton once held a national soccer tournament in Alaska, not a rural place but I suppose it's cool. Throughout the United States, many rural communities are faced with severe healthcare workforce shortage issues. These regions often consist of a larger percentage of medically underserved individuals, in conjunction with fewer physicians, nurses, and other healthcare workers. The shortage of healthcare workers negatively impacts the quality of medical care due to decreased access to health services as well as an increase in workload placed on providers. Healthcare systems in rural communities generally have fewer personnel and infrastructure, creating substantial healthcare disparities among the United States population. Rural communities tend to have a higher incidence of chronic diseases, infant and maternal morbidity, and occupational injuries. These communities also consist of individuals who tend to be older and have a lower socioeconomic status, which directly relates to the high rate of uninsured individuals. Ethnic minorities are also increasing in number throughout rural areas, further adding to the size of healthcare disparities.
Contents
- Barriers to health care
- Patient Protection and Affordable Care Act
- Overview of ACA provisions
- Workforce issues create positions and maximize current supply
- Training and development
- Financial incentives
- Financing the ACA provisions
- Section 3502 Community Health Team Grants for Medical Homes
- Section 1501l Rural Physician Training Grants
- Section 5403 Expanding Area Health Education Centers AHECs
- Section 5301 Title VII Primary Care Training Enhancement Programs
- Section 5316 Family Nurse Practitioner Training Demonstration
- Sections 5207 5508 b 1051 n 10503 National Services Health Corps
- Sections 5202 5305 5308 12 Title VIII Nurse Workforce Development Programs
- Section 5204 Public Health Care Workforce Loan Repayment Program
- Challenges
- Population factors
- Lack of resources
- Dependence on public funding
- Insufficient access to capital
- References
Barriers to health care
The healthcare workforce has a significant impact on the utilization of healthcare within a rural community. Access barriers to health care, predominantly in the form of geography, can necessitate significant travel time as well as increased costs to obtain basic, primary care. Shortages in the healthcare workforce lead to overcompensation for providers due to a larger patient load, with more chronic disease management, along with overtime fees. Primary care physicians tend to be closer to retirement on average, demonstrating that these shortages are expected to worsen and pressure will only increase among the existing workforce. Due to the lack of specialists in rural areas, primary care physicians are expected to perform a greater number of procedures on a larger mix of patients. This shortage also decreases teaching and training opportunities for new providers which makes rural areas less attractive to new physicians and other medical professions from entering the workforce. These factors also make it difficult to retain medical providers and maintain existing infrastructure in terms of hospitals and clinics. The labor shortage in terms of health care is expected to increase due to the overall aging of the population. The excess volume of patients add to providers’ workloads that are already face with limited resources. This detrimental combination effectively hinders the delivery of timely and appropriate health services. The healthcare workforce in the rural population, with smaller populations dispersed across a larger area, makes the existing and expected shortages more likely to have far-reaching, medically devastating impacts.
Patient Protection and Affordable Care Act
President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) on March 23, 2010. The enactment of the ACA introduced healthcare reform throughout the United States. Some of the key objectives of the ACA are to improve quality and lower healthcare costs, create new consumer protections, and improve access to healthcare. In order to achieve these objectives, widespread reforms have been instituted. Included among the ACA’s many areas of focus is the rural healthcare workforce. Many of the provisions are intended to strengthen the healthcare workforce in rural areas, specifically addressing the limited access to healthcare providers. The approaches used to address this issue include: the development of national strategies to address workforce shortages and support state and community programming; training and development of healthcare providers in rural areas; and financial incentives including grant and bonus payments.
Overview of ACA provisions
Specific examples of ACA provisions addressing the development of national strategies to deal with workforce issues; training and development of healthcare providers in rural areas; and financial incentives including grant and bonus payments are listed below:
Workforce issues: create positions and maximize current supply
Training and development
Financial incentives
Financing the ACA provisions
In order to ensure the provisions described above are successfully implemented, the ACA has authorized various levels of funding in the ongoing future. Implementing each provision will rely on Congress to effectively allocate the funds authorized by the ACA. Some of the key provisions and their financing structures are outlined below:
Section 3502 - Community Health Team Grants for Medical Homes
Section 1501(l) - Rural Physician Training Grants
Section 5403 - Expanding Area Health Education Centers (AHECs)
Section 5301 - Title VII Primary Care Training & Enhancement Programs
Section 5316 - Family Nurse Practitioner Training Demonstration
Sections 5207, 5508 (b), 1051 (n), 10503 - National Services Health Corps
Sections 5202, 5305, 5308-12 - Title VIII Nurse Workforce Development Programs
Section 5204 - Public Health Care Workforce Loan Repayment Program
Challenges
There are several key challenges to providing better health care in rural America. The ACA attempts to resolve these challenges by insuring more rural Americans, increasing access to care, and resolving the workforce shortage in rural areas. The effects of the ACA in regard to rectifying these challenges have yet to be determined.
Population factors
Providers in rural areas face many disadvantages, including the fact that the United States population living in rural areas tend to be older, poorer, and uninsured in comparison to their urban counterparts. Rural Americans are also more likely to suffer from chronic illnesses. At the same time, rural America is experiencing an out-migration of its younger population and the rural healthcare workforce is aging.
Lack of resources
Rural hospitals tend to have fewer resources than urban hospitals and usually have a fewer number of beds. These hospitals often are understaffed or face problems due to poorly trained staff. Rural hospitals are also forced to offer a broad variety of services since these community hospitals are often the only healthcare providers in their area. Providing a mix of services puts a strain on the hospital because it is not able to focus on providing one service well, but instead must concentrate on providing as many services as possible.
Dependence on public funding
Patients at rural hospitals tend to be older and are often low-income individuals. This means that rural hospitals depend heavily on government assistance from Medicare and Medicaid, with nearly 60% of rural hospital gross revenues coming from these programs. This makes rural hospitals incredibly vulnerable to policy changes. Often Medicare and Medicaid funding is not sufficient to cover all rural hospital patients, which is a problem that is compounded by a high rate of uninsured individuals in the community. When rural employees do not provide health insurance, rural hospitals must absorb the costs.
Insufficient access to capital
A lack of capital means that rural hospitals often do not have the means to meet patient’s needs. Rural hospitals lag behind their urban counterparts when it comes to ability to acquire new technologies, replace aged equipment, and improve operational effectiveness. Insufficient access to capital leads to rural hospitals falling behind urban hospitals in terms of quality performance and patient outcomes.