The Center for Rural Health Initiatives

Mike Easley, Executive Director, Center for Rural Health Initiatives, Austin, Texas

The Center for Rural Health Initiatives is a unique state agency, because it has among its duties and powers wording such as, "educate the public and recommend appropriate public policies regarding the continued viability of rural health care delivery in this state;" "promote and develop community involvement and community support in maintaining, rebuilding and diversifying local health services;" and "promote and develop diverse and innovative health care service models in rural areas." From all of this I glean that the Center has the duty to be creative, innovative, and proactive when carrying out its mission. Therefore, over the next year we plan work to:

1. Identify areas of critical need. There are pressing health care needs in most of rural Texas. However, with limited resources, it is important to address areas in order of importance. For example, the physician to resident population is too high in rural Texas, but it is not too high in all rural Texas. There are pockets with an adequate number of physicians and even a few areas with an oversupply. We need to focus on areas of critical need and bring resources to bear on those problems rather than "shotgunning" all rural counties. This is a prime example where one size does not fit all.
2. Recognize and measure the economic impact of health care in rural Texas. The economic impact of health care in rural Texas is not fully appreciated. In many counties, health care may be one of the largest industries. We need better tools to help us monitor and assess the economic impact of health care. As we can do this, we can better understand how health care impacts local economies to better explain and support the need for local control.
3. Recruitment/retention of primary care physicians, nursing, and other allied health professionals. Rural communities have a difficult time recruiting and retaining health care professionals. Numerous studies have demonstrated the most effective way to successfully recruit and retain providers in rural areas is training residents of rural communities and returning them to these communities to practice. We need more scholarships and loan forgiveness programs to educate these rural scholars.
4. Provision of trauma/EMS services. A significant amount of Trauma/EMS service in rural counties is provided by volunteers. These volunteers struggle greatly to maintain the quality and viability of their services. Additional funding is needed to meet this need.
5. Access to health care. Over 50% of the babies born in this state have the cost of delivery paid by Medicaid. At the same time, 22% of all babies born in rural Texas have late or no prenatal care. Rural counties have more children and elderly people living on an income that is less than the poverty level as compared to their urban counterparts. Income status is a prime predictor of access to health care, which is exacerbated when combined with a shortage of providers and the fact that some rural counties have not only lost population, but have also seen a loss in per capita income. We need more economic development to raise the income levels of our rural counties.
6. Telemedicine. These applications offer great potential in terms of reduced staff costs and travel as well as quality improvements in care. However, we need planning to ensure that the implementation of telemedicine meets the needs of providers in a rural setting and results in cost savings.
7. Aging facilities. Many rural/small hospitals were built originally 25 to 30 years ago with federal funds. Since then, they have moved from inpatient care to outpatient services as a primary focus of patient care services. Thus, many of the buildings, which have aged considerably, are no longer suited for their purpose. Rural hospitals need access to capital for major renovation or construction projects.
8. Informing community leaders about the role and importance of health care in their localities. We have not done a good job giving them the information they need to understand the impact, both economically and socially, of health care in their communities.

Over the last ten years, there has been a lot of progress made in improving the status of health care delivery in rural Texas. The rate of closure of rural hospitals has slowed and there are new programs to educate and recruit providers to rural areas. Perhaps most importantly there is an increased awareness of rural Texas as a unique part of the state with unique needs.