TEXAS JOURNAL OF RURAL HEALTH

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ISSUE 18(3), 2000

TABLE OF CONTENTS
 
Guest Editorial
Patti Patterson
FULL TEXT

Notes From the Field

Are you an Eagle or a Goose?
Leslie Furlow, R.N., M.P.H., M.S.N., C-F.N.P.
Texas Journal of Rural Health 2000; 18(3): 2-5
ABSTRACT
 
Project Jump Start: A Community College and AHEC Partnership Initiative for Community Health Worker Education
Donald E. Proulx, M.Ed.
Texas Journal of Rural Health 2000; 18(3): 6-16
ABSTRACT

Policy and Law

The Future of Healthcare Access in Rural Texas: A Short-Term Economic Perspective
M. Ray Perryman, Ph.D.
Texas Journal of Rural Health 2000; 18(3): 17-26
ABSTRACT
The Texas Children's Health Insurance Program: Achievements and Challenges in Implementation
Carl H. Rush, M.R.P.
Texas Journal of Rural Health 2000; 18(3): 27-37
ABSTRACT
Anti-Trust and Physician Networks: Expansion of the Rule of Reason
Doug Boysen, J.D., M.A., Peter Hilsenrath, Ph.D.
Texas Journal of Rural Health 2000; 18(3): 38-44
ABSTRACT

Research

The Economic Impact of Texas Hospital Closures in the 1980s
Janice C. Probst, Ph.D., Michael E. Samuels
Texas Journal of Rural Health 2000; 18(3): 45-57
ABSTRACT
Empowered by the Internet: Good News/Bad News for Rural Pharmacies
Carolyn Tripp, Ph.D., LaVonne Straub, Ph.D.
Texas Journal of Rural Health 2000; 18(3): 58-65
ABSTRACT

Brief Reports

Risk Factors For Hospital Admission of Long-Term Dementia Patients
James E. Rohrer, Ph.D., Ke Tom Xu, Ph.D., Randolph B. Schiffer, M.D.
Texas Journal of Rural Health 2000; 18(3): 66-71
ABSTRACT
Chronic Lung Disease in Texas: The Quiet Epidemic
James E. Rohrer, Ph.D.
Texas Journal of Rural Health 2000; 18(3): 72-78
ABSTRACT

ABSTRACTS

Are you an Eagle or a Goose?
Leslie Furlow, R.N., M.P.H., M.S.N., C-F.N.P.
Texas Journal of Rural Health 2000; 18(3): 2-5

Notes From the Field

"It is a terrible thing to look over your shoulder when you are trying to lead and find no one there."

-Franklin D. Roosevelt

See it? It soars above the clouds and makes effortless circles with widely spread wings that carry it higher and higher. The Eagle, symbol of power, grace, and independence, flying alone, and admirable by any standard.

Now, look again at the sky. Is it a spearhead or a "V" in the sky? No, it's a flock of geese, making their annual trek across the continent. Not very regal or even very pretty, the goose is rather non-descript and is even laughed at sometimes. When someone is awkward, we call the person a "Goose." The Goose, seemingly not what we want to be compared with, is certainly not in the same category as the Eagle.

There are new leadership lessons to be learned from the "birds." Current leadership displays some changes from the past. The "rugged individualist" may not experience a following as past leaders have enjoyed. Both culturally and behaviorally, employees were willing to accept some degree of authoritarianism, because they felt that the "leader" had better access to knowledge or greater skills. This is not necessarily the case with today's information explosion.

Author Affiliations

  • Leslie Furlow, R.N., M.P.H., M.S.N., C-F.N.P., President, AchieveMentors, Inc., Tolar, Texas

Project Jump Start: A Community College and AHEC Partnership Initiative for Community Health Worker Education
Donald E. Proulx, M.Ed.
Texas Journal of Rural Health 2000; 18(3): 6-16

Notes From the Field

The University of Arizona Rural Health Office has a long history of developing and implementing lay health worker programs to improve access to health care among under-served populations. In September 1998, the United States Department of Education awarded a Fund for the Improvement of Post-secondary Education (FIPSE) grant to the Rural Health Office to develop a statewide community college education program for community health workers. This project created a partnership among four community colleges, three rural Area Health Education Centers, and multiple community health and human service agencies to establish a competency-based and college credit-bearing core curriculum for community health workers. The resulting 16-credit basic certificate program is currently being implemented and evaluated, and the core curriculum is being validated by the project.

Author Affiliations

  • Donald E. Proulx, M.Ed., Associate Director of the Arizona Area Health Education Center Program, FIPSE Project Director for "Jump Start," Rural Health Office, Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona

The Future of Healthcare Access in Rural Texas: A Short-Term Economic Perspective
M. Ray Perryman, Ph.D.
Texas Journal of Rural Health 2000; 18(3): 17-26

Abstract

What does the next decade hold for rural healthcare in Texas? An analysis of the current economic conditions and a forecast of the future situation should provide some insights. Primarily focused on the issue of access to care (though quality of care is also addressed), this economic perspective is presented in three parts: (1) an examination of the current economic and healthcare situation, (2) a discussion of probable trends impacting the future, and (3) a ten-year forecast of the healthcare services sector comparing the projected access growth in rural areas to that of the state. Findings suggest that access to healthcare will improve, though only slightly.

Key words: access, economic forecast, healthcare, income, rural Texas, RGP. (Texas Journal of Rural Health 2000; 18(3): 17-26)

Author Affiliations

  • M. Ray Perryman, Ph.D., President & CEO, The Perryman Group, Institute Distinguished Professor of Economic Theory and Method, International Institute for Advanced Studies, Waco, Texas

The Texas Children's Health Insurance Program: Achievements and Challenges in Implementation
Carl H. Rush, M.R.P.
Texas Journal of Rural Health 2000; 18(3): 27-37

Abstract

Implementation of the state Children's Health Insurance Program (CHIP) in Texas began on April 3, 2000, capping a feverish ten-month period of preparation. Texas has brought CHIP, children's Medicaid, and the private Texas Healthy Kids Corporation coverage under a single application structure, called the "TexCare Partnership." The first CHIP coverage was to be offered beginning May 1.

Texas CHIP is primarily a separate state-designed non-entitlement program, with benefits differing somewhat from Medicaid, offered under a managed care structure. TexCare accepts applications by mail, and CHIP-eligible families must complete an enrollment package before coverage begins. The TexCare administrative contractor will refer applications apparently eligible for Medicaid to the Texas Department of Human Services (TDHS) for processing.

While it is too early to predict outcomes, certain issues have arisen during the planning process which deserve ongoing attention in the first year of implementation, especially since the 2001 legislative session will examine early results closely, and at a minimum will make decisions on appropriations for state matching funds for the ensuing two years of the program operations. These issues include the enrollment process; the availability of providers, especially those in the "safety net" non-emergency transportation; Medicaid "spillover" enrollment (stimulated by CHIP outreach); concerns with the Medicaid eligibility process itself; the workability of the cost-sharing system; the efficacy of outreach to encourage applications; and the handling of immigration issues.

Key words: CHIP, children, health insurance, Medicaid. (Texas Journal of Rural Health 2000; 18(3): 27-37)

Author Affiliations

  • Carl H. Rush, M.R.P., Chief Operating Officer, Family Health Foundation, San Antonio, Texas

Anti-Trust and Physician Networks: Expansion of the Rule of Reason
Doug Boysen, J.D., M.A., Peter Hilsenrath, Ph.D.
Texas Journal of Rural Health 2000; 18(3): 38-44

Abstract

In 1996 the Federal Trade Commission and the Department of Justice (FTC/DOJ) jointly issued policy statements concerning physician service networks and antitrust enforcement. The most notable change in policy was expansion of the rule of reason to physician networks that are clinically integrated. According to previous guidelines, physician networks were required to show shared financial risk to gain rule of reason treatment and avoid a per se violation of Section One of the Sherman Act. Recent FTC/DOJ decisions indicate that clinical integration has become a factor in enforcement decisions. But case law is still evolving in this dynamic part of the antitrust environment.

Key words: antitrust, FTC, clinical integration, DOJ, rule of reason, Sherman Act (Texas Journal of Rural Health 2000; 18(3): 38-44)

Author Affiliations

  • Doug Boysen, J.D., M.A., Milwaukee, Wisconsin
  • Peter Hilsenrath, Ph.D., Associate Professor, College of Public Health, University of North Texas, Health Science Center, Fort Worth, Texas

The Economic Impact of Texas Hospital Closures in the 1980s
Janice C. Probst, Ph.D., Michael E. Samuels
Texas Journal of Rural Health 2000; 18(3): 45-57

Abstract

During the 1980s, rural hospitals across the country closed in record numbers. Prior to 1986, rural community hospitals had been less likely to close than urban hospitals, in part because many are owned or subsidized by local government (American Hospital Association, 1989; Berry, Shelby, Seavey, & Tucker, 1988; Mullner, Rydman, Whiteis, & Rich, 1989). Rural hospital closures, which were at their lowest nationally in 1983 (seven hospitals closing), rose to 46 in 1988; in 1989, 43 closed, and in 1990, 29 closed (Burda, 1992). Texas hospitals reflected this trend, with 32 closures across 30 small rural counties between 1984 and 1988. The effects of these closures are the subject of this article.

Key words: economic, hospital closures, rural, Texas counties. (Texas Journal of Rural health 2000; 18(3): 45-57)

Author Affiliations

  • Janice C. Probst, Ph.D., Clinical Associate Professor, Department of Family & Preventive Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina
  • Michael E. Samuels, Dr.P.H., Associate Professor, Department of Health Administration, School of Public Health, Univeristy of South Carolina, Columbia, South Carolina

Empowered by the Internet: Good News/Bad News for Rural Pharmacies
Carolyn Tripp, Ph.D., LaVonne Straub, Ph.D.
Texas Journal of Rural Health 2000; 18(3): 58-65

Abstract

A survey of Illinois pharmacists about how use of the Internet affects rural pharmacy practice revealed 70% of them were currently using it. It is seen more as an opportunity to expand markets than as a threat, and most see it as becoming more important in the future. Over 70% of the respondents consider Internet use by consumers a concern due to safety reasons; it is also considered a good source of information for consumers.

Key words: Consumers, drugs, Internet, MUA, pharmacies, rural (Texas Journal of Rural Health 2000; 18(3): 58-65)

Author Affiliations

  • Carolyn Tripp, Ph.D., Associate Professor, Western Illinois University, Department of Marketing & Finance, Macomb, Illinois
  • LaVonne Straub, Ph.D., Professor, Department of Economics, Assistant Administrator, Illinois Institute for Rural Affairs, Western Illinois University, Macomb, Illinois

Risk Factors For Hospital Admission of Long-Term Dementia Patients
James E. Rohrer, Ph.D., Ke Tom Xu, Ph.D., Randolph B. Schiffer, M.D.
Texas Journal of Rural Health 2000; 18(3): 66-71

Abstract

The purpose of this study was to estimate relationships between hospital admission of dementia patients and several risk factors (Hispanic ethnicity, being a nursing home patient, and using office visits). The study design was a cross-sectional analysis of billing data. Patients with primary or secondary diagnosis of dementia who were seen by Texas Tech University Health Science Center (TTUHSC) physicians at least three consecutive years (n=113) were studied. Age, gender, Hispanic ethnicity, receiving care in a nursing home, and use of medical office care were entered into stepwise logistic regression models to estimate risk factors for hospital admission. Among long-term dementia patients treated at this institution, being Hispanic increases the risk of being hospitalized for dementia, controlling for use of other medical services, age, and gender. The reasons why being Hispanic increases the risk of hospital admission should be investigated and interventions designed.

Key words: dementia, hospitalization, Hispanic. (Texas Journal of Rural Health 2000; 18(3): 66-71)

Author Affiliations

  • James E. Rohrer, Ph.D., Professor & Chairman, Department of Health Services Research & Management, Texas Tech University, Health Sciences Center, Lubbock, Texas
  • Ke Tom Xu, Ph.D., Assistant Professor, Department of Health Services Research & Management, Texas Tech University Health Sciences Center, Lubbock, Texas
  • Randolph B. Schiffer, M.D., Chairman, Department of Neuropsychiatry, Texas Tech University Health Sciences Center, Lubbock, Texas

Chronic Lung Disease in Texas: The Quiet Epidemic
James E. Rohrer, Ph.D.
Texas Journal of Rural Health 2000; 18(3): 72-78

Abstract

Chronic lung disease afflicts millions of people in the United States. Chronic Obstructive Pulmonary Disease (COPD) suddenly moved into the top ten causes of death in the state of Texas in 1980, when it appeared in fifth place. In 1990, heart disease, cancer, stroke, and accidents were more common causes of death than COPD. However, pneumonia and influenza, diabetes mellitus, homicide, suicide, and human immunodeficiency virus (HIV) were less frequent causes of death than COPD.

Taken together, the above facts create the impression that an epidemic of chronic lung disease is ravaging both the state and the nation. However, the average person is largely unaware of the risk. In comparison to some other causes of death, such as highway accidents and AIDS, lung disease has been relatively unnoticed. Yet, by 1995, chronic lung disease was the fourth leading cause of death in the United States (Brownson, Remington, & Davis, 1998). About 5% of the population have chronic lung disease and about 5% of deaths are caused by it. About 5000 people die each year of COPD in Texas.

The purpose of this article is to provide a descriptive analysis of published information about COPD so that policy suggestions can be developed. A COPD policy that is practical for rural areas will be difficult to implement, due to the obvious access barriers. However, a case will be made for the importance of developing such a policy.

Key words: chronic, COPD, lung disease, respiratory risks, smoking. (Texas Journal of Rural Health 2000; 18(3): 72-78)

Author Affiliations

  • James E. Rohrer, Ph.D., Professor & Chairman, Department of Health Services Research & Management, Texas Tech University, Health Sciences Center, Lubbock, Texas
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