TEXAS JOURNAL OF RURAL HEALTH

PREVIOUS

ISSUE 19(1), 2001

TABLE OF CONTENTS
 
Editor’s Comments
James E. Rohrer, Ph.D.
FULL TEXT

Interview

Interview with Keith Mueller
Lee Ann Paradise
Texas Journal of Rural Health 2001; 19(1): 5-12
ABSTRACT

Notes From the Field

Drawing on Local Expertise to Meet Mental Health Needs After a School Shooting
Judith A. Lyons, Ph.D.
Texas Journal of Rural Health 2001; 19(1): 6-13
ABSTRACT
Conversion to a Critical Access Hospital (CAH)
William M. Parrish, Jr., CPA
Texas Journal of Rural Health 2001; 19(1): 14-18
ABSTRACT
The Second Annual Rural Health Summit: Setting a Rural Health Agenda for Texas
Jill A. McFarren
Texas Journal of Rural Health 2001; 19(1): 19-27
ABSTRACT

Policy and Law

Mobilizing Private Capital for South Africa's Health Sector
Peter Hilsenrath, Ph.D., David Wyant, Ph.D., Christopher Klitgaard, M.H.A., M.B.A.
Texas Journal of Rural Health 2001; 19(1): 28-39
ABSTRACT

Research

Profitability of Rural Hospitals in Texas: Implications for Access to Charity Care
Janet P. Sutton, Ph.D., Bonnie B. Blanchfield, Sc.D., Meredith Milet
Texas Journal of Rural Health 2001; 19(1): 40-48
ABSTRACT
Evaluation of Medicaid Status, Race, and Urbanicity as Risk Factors for Asthma Hospitalization
Shadi S. Saleh, M.P.H., Kirk T. Phillips, M.S.W., Mario Schootman, Ph.D., Laurence Fuortes, M.D.
Texas Journal of Rural Health 2001; 19(1): 49-56
ABSTRACT
Progressive Medical Care in Non-Metropolitan Areas
James E. Rohrer, Ph.D.,Tyrone F. Borders, Ph.D.
Texas Journal of Rural Health 2001; 19(1): 57-66
ABSTRACT
Rural Adults with Poor Mental Health: Findings from a National Study
Michael S. Hendryx, Ph.D.
Texas Journal of Rural Health 2001; 19(1): 67-73
ABSTRACT

ABSTRACTS

Interview with Keith Mueller
Lee Ann Paradise
Texas Journal of Rural Health 2001; 19(1): 5-12

Keith Mueller, Ph.D. is a professor and the Director of the Nebraska Center for Rural Health Research, University of Nebraska. He was the 1996 to 1997 President of the National Rural Health Association, and the recipient of the Association's Distinguished Rural Health Researcher Award in 1998. Dr. Mueller's Ph.D. is from the University of Arizona in Political Science. He is the author of a University of Nebraska Press book, Health Care Policy in the United States, and has published more than 30 articles on health planning, access to care for vulnerable populations, rural health, and access to care among the uninsured. He is the Chair of the Health Panel, Rural Policy Research Institute, and primary author of a number of its publications dealing with rural implications of health reform legislation, analysis of legislation focused on rural health, analysis of the Balanced Budget Act of 1997and the Balanced Budget Refinement Act of 1999, and analysis of changes in Medicare policy. Dr. Mueller has directed major health services studies funded by the Unites States Agency for Health Care Policy and Research, the Federal Office of Rural Health Policy, and the Robert Wood Johnson Foundation. He has testified on numerous occasions before committees of Congress and in other forums, including the Bipartisan Commission on the Future of Medicare and the Medicare Payment Advisory Commission.

LP: There's been a lot of talk lately about the future of managed care in rural areas. What role do you think managed care will play in rural areas over the next five years? Will it expand?

KM: Without legislative change, the role will be very minimal. It will not go completely away, however. There will be some residents enrolled in plans offered through regional and national employers. A lot depends, though, on future changes in the Medicare program.

Author Affiliations

  • Lee Ann Paradise, Managing Editor, Texas Journal of Rural Health, Texas Tech University Health Sciences Center, Lubbock, Texas

Drawing on Local Expertise to Meet Mental Health Needs After a School Shooting
Judith A. Lyons, Ph.D.
Texas Journal of Rural Health 2001; 19(1): 6-13

Abstract

Following a shooting at the high school in Pearl, Mississippi, local resources were quickly convened to address mental health needs. The present article provides an overview of the interventions organized by the school district. Strategies for addressing concerns regarding the intervention philosophy, credentials, and liability coverage of volunteers are discussed. The roles played by emergency services critical incident debriefing team members, mental health professionals, school counselors, teachers, school nurses, and local clergy are described.

Key words: mental health, Mississippi, psychological counseling, rural, school shooting, trauma recovery. (Texas Journal of Rural Health 2001; 19(1): 6-13)

Author Affiliations

  • Judith A. Lyons, Ph.D., Clinical Psychologist, Trauma Recovery Program, G. V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, Mississippi

Conversion to a Critical Access Hospital (CAH)
William M. Parrish, Jr., CPA
Texas Journal of Rural Health 2001; 19(1): 14-18

Abstract

Should you take a chance on a roll of the dice? This "roll of the dice" is deciding whether or not to become a Critical Access Hospital (CAH). There is a lot at stake in this issue, the chief matter being reimbursement. The issues that may help or hurt your facility as you consider the overall impact on reimbursement to your hospital will be dicussed in this article. A hospital can, in fact, survive and thrive under cost-based reimbursement. The description of a typical CAH will be discussed as well as how and why cost-based reimbursement works, the characteristics of reimbursement, and an explanation of what the Balanced Budget Refinement Act (BBRA) has done for CAHs.

Key words: BBA, BBRA, Critical Access Hospitals, health care costs, rural hospitals. (Texas Journal of Rural Health 2001; 19(1): 14-18)

Author Affiliations

  • William M. Parrish, Jr., CPA, Parrish, Moody & Fikes, p.c., Waco, Texas

The Second Annual Rural Health Summit: Setting a Rural Health Agenda for Texas
Jill A. McFarren
Texas Journal of Rural Health 2001; 19(1): 19-27

Abstract

The Second Annual Texas Rural Health Summit, sponsored by the Center for Rural Health Initiatives, provided a forum for stakeholders to discuss rural Texas health care. The forum brought together over 150 key state leaders, state health regulators, policy experts, and rural health professionals to collaboratively identify rural Texas' top health care issues, barriers to addressing those issues, and possible solutions. The results outline a program for action in the further development of Texas' rural health agenda.

Key words: Center for Rural Health Initiatives, rural caucus, rural health summit, Texas, TORCH, TRHA. (Texas Journal of Rural Health 2001; 19(1): 19-27)

Author Affiliations

  • Jill A. McFarren, Public Information Specialist, Center for Rural Health Initiatives, Texas State Office of Rural Health, Austin, Texas

Mobilizing Private Capital for South Africa's Health Sector
Peter Hilsenrath, Ph.D., David Wyant, Ph.D., Christopher Klitgaard, M.H.A., M.B.A.
Texas Journal of Rural Health 2001; 19(1): 28-39

Abstract

South Africa has a relatively large private health sector that is expected to grow to meet the needs of the more affluent. It is possible to use private funds to improve health services in rural areas. Low premium products being developed by Health Maintenance Organizations (HMOs) and other forms of managed care can help meet the health needs of those of more modest means in both rural and urban environments. Capital formation can be facilitated with the introduction of a health mutual fund.

Key words: dual economy, economics, health care investment, HMOs, mutual fund, rural, stock exchange. (Texas Journal of Rural Health 2001; 19(1): 28-39)

Author Affiliations

  • Peter Hilsenrath, Ph.D., Associate Professor, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
  • David Wyant, Ph.D., Assistant Professor, Xavier University, Cincinnati, Ohio
  • Christopher Klitgaard, M.H.A., M.B.A., Program Associate, University of Iowa, Hospitals & Clinics, Iowa City, Iowa

Profitability of Rural Hospitals in Texas: Implications for Access to Charity Care
Janet P. Sutton, Ph.D., Bonnie B. Blanchfield, Sc.D., Meredith Milet
Texas Journal of Rural Health 2001; 19(1): 40-48

Abstract

Despite the relief afforded to hospitals by the Balanced Budget Refinement Act of 1999 (BBRA), the Balanced Budget Act of 1997 (BBA) is expected to have a disproportionately negative impact on rural hospitals. Increased financial pressure on hospitals could lead to closures and effectively erode the health care safety net for the nearly 30% of rural Texans who are uninsured and rely on hospital charity care. This study analyzes the financial vulnerability of rural hospitals in Texas and attempts to measure the risk of losing charity care services if vulnerable hospitals were to close.

Key words: BBA, BBRA, charity care, non-profit, Medicare, rural, Texas hospitals. (Texas Journal of Rural Health 2001; 19(1): 40-48)

Author Affiliations

  • Janet P. Sutton, Ph.D., Senior Research Director, Project HOPE, Center for Health Affairs, Bethesda, Maryland
  • Bonnie B. Blanchfield, Sc.D., Senior Research Director, Project HOPE, Center for Health Affairs, Bethesda, Maryland
  • Meredith Milet, Research Assistant, Project HOPE, Center for Health Affairs, Bethesda, Maryland

Evaluation of Medicaid Status, Race, and Urbanicity as Risk Factors for Asthma Hospitalization
Shadi S. Saleh, M.P.H., Kirk T. Phillips, M.S.W., Mario Schootman, Ph.D.,
Laurence Fuortes, M.D.
Texas Journal of Rural Health 2001; 19(1): 49-56

Abstract

This study was undertaken to evaluate associations between selected demographic groups (race, payer status, and urban vs. rural residence) and hospitalization rates for asthma. Asthma hospitalizations were identified from the 1997 Iowa hospital discharge database. Hospitalization rates were compared by payer status, race, and urban versus rural residence. Age, gender (females), non-White status, and Medicaid eligibility were found univariately to be risk factors for asthma hospitalization. The increased rate of asthma hospitalization for the Medicaid eligible population was specific to urban residents and no differences persisted between Whites and non-Whites controlling for insurance payer. The disparities noted between hospitalization rates for asthma across ethnic groups, urban-rural residence, and Medicaid coverage versus other insurance are most consistent with differences in environmental quality and clinical care for these demographic groups.

Key words: asthma, insurance status, hospitalizations, Medicaid, urban, gender, race, age. (Texas Journal of Rural Health 2001; 19(1): 49-56)

Author Affiliations

  • Shadi S. Saleh, M.P.H., Doctoral Candidate, Department of Health, Management and Policy, University of Iowa, Iowa City, Iowa
  • Kirk T. Phillips, M.S.W., Graduate Student, Department of Preventive Medicine and Environmental Health, University of Iowa, Iowa City, Iowa
  • Mario Schootman, Ph.D., Associate Professor, Division of Health Behavior Research Department of Pediatrics and Medicine Washington, University School of Medicine, St. Louis, Missouri
  • Laurence Fuortes, M.D., Associate Professor, Department of Preventive Medicine and Environmental Health University of Iowa, Iowa City, Iowa

Progressive Medical Care in Non-Metropolitan Areas
James E. Rohrer, Ph.D.,Tyrone F. Borders, Ph.D.
Texas Journal of Rural Health 2001; 19(1): 57-66

Abstract

After presenting a normative model for progressive design of medical care systems, we investigate the possibility that medical care provided in non-metropolitan areas exhibits fewer features that might be described as progressive. The data were limited to cases involving heart disease so as to control for patient differences. Patient visits for heart disease were extracted from the 1998 National Ambulatory Medical Care Survey (NAMCS).

However, progressive medical care, defined as using primary care physicians, group practice, and nurses, along with standardization of service intensity, is more common in non-metropolitan areas than in urban areas.

Key words: heart disease, HMOs, medical care organizations, national ambulatory medical care survey, non-metropolitan areas. (Texas Journal of Rural Health 2001; 19(1): 57-66)

Author Affiliations

  • James E. Rohrer, Ph.D., Professor & Chairman, Department of Health Services Research & Management, Texas Tech University Health Sciences Center, Lubbock, Texas
  • Tyrone F. Borders, Ph.D., Assistant Professor, Department of Health Services Research and Management, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas

Rural Adults with Poor Mental Health: Findings from a National Study
Michael S. Hendryx, Ph.D.
Texas Journal of Rural Health 2001; 19(1): 67-73

Abstract

This study examines the characteristics and predictors of poor mental health status among a national sample of adults in rural areas. Results indicate that rural persons in poor mental health, relative to other rural adults, are more likely to be uninsured, unmarried, and to have problems accessing general health care services. Only 20% of persons in poor mental health received care from a mental health specialist. Logistic regression analysis among this group found that not receiving mental health care was predicted by younger age, being unmarried, and lacking health insurance.

Key words: age, gender, health care access, mental health, race, rural adults, uninsured. (Texas Journal of Rural Health 2001; 19(1): 67-73)

Author Affiliations

  • Michael S. Hendryx, Ph.D., Washington Institute for Mental Illness, Research and Training, Washington State University, Spokane, Washington
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