Advancing the Transition to a High Performance Rural Health System

There are growing concerns about the current and future state of rural health. Despite decades of policy efforts to stabilize rural health systems through a range of policies and loan and grant programs, accelerating rural hospital closures combined with rapid changes in private and public payment strategies have created widespread concern that these solutions are inadequate for addressing current rural health challenges. The rural health system of today is the product of legacy policies and programs that often do not “fit” current local needs. Misaligned incentives undermine high-value and efficient care delivery. While there are limitations related to scalability in rural health system development, rural communities do have enormous potential to achieve the objectives of a high performance rural health system. This brief (and a companion paper at http://www.rupri.org/areas-of-work/health-policy/) discusses strategies and options for creating a pathway to a transformed, high performing rural health system

Pursuing High Performance in Rural Health Care

Rural Futures Lab Foundation Papers are intended to present current thinking on the economic drivers and opportunities that will shape the future of rural America. They provide the foundation upon which it will be possible to answer the question that drives the Lab’s work—What has to happen today in order to achieve positive rural outcomes tomorrow

Patterns of health insurance coverage among rural and urban children [Article]

Despite the potential for the State Children\u27s Health Insurance Program to improve the health care coverage of rural children, the expansion of public health insurance to children in rural areas may be hampered by a lack of understanding about the patterns of insurance coverage they experience. This study uses the Census Bureau\u27s 1993-1996 panel of the Survey of Income and Program Participation to evaluate differences in the duration of, and in their entry into and exit from, uninsured spells. While the average duration of new spells was shorter for rural children and most regained coverage quickly, rural children were also more likely than urban children to experience protracted spells of uninsurance. Moreover, rural children were more likely than urban children to move between public and private coverage. These findings have important implications for designing insurance expansion programs and outreach strategies to effectively enroll and retain rural children

Patterns of Individual Health Insurance Coverage, 1996-2000

Information about patterns of individual health insurance coverage is limited. Knowledge gaps include the extent to which individual insurance provides transitional versus long-term coverage, and participants\u27 insurance status before and after being covered by an individual plan. In this study we use data from the 1996-2000 Survey of Income and Program Participation (SIPP) to examine how long the individually insured maintain their coverage; sources of coverage before and after enrolling in an individual health plan; and characteristics of those who rely on individual insurance coverage. Understanding the dynamics of this market will better inform federal and state insurance reform efforts

Assuring Health Coverage for Rural People Through Health Reform

Rural residents of the United States have a higher uninsured rate than their urban counterparts, and therefore have the most to gain from efforts to reform the U.S. health care system. The differences in health insurance status between those living in rural and urban areas are important to consider in the debate over national reform. Released by the Rural Policy Research Institute and funded by the Robert Wood Johnson Foundation, the Assuring Health Coverage for Rural People through Health Reform brief suggests that the challenges that rural people face in obtaining health insurance are partly due to the structure of the rural economy: 64 percent of adults working in rural are employed in jobs where health insurance is provided, compared to 71 percent of their urban counterparts. At the same time, rural workers are far more likely to be self-employed. Rural businesses also pay higher premium costs than urban businesses for similar health insurance plans. Researchers found that health reform proposals that include (i) a subsidy for individual purchase, (ii) availability of insurance plans to individuals and small groups through exchanges, and (iii) expansion of Medicaid would significantly improve coverage for rural populations. In fact, the total number of uninsured people in rural areas would decrease to 1.9 million from the current 8.1 million – leaving only 4.2 percent of rural Americans without insurance, less than the 5.9 percent projected in urban areas

A Rural Perspective/Commentary Regarding (Description of Policy Options) Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans , Senate Finance Committee, May 14, 2009

This document includes commentary from the Rural Health Panel on proposed options we feel have special, significant meaning for rural areas. An appendix describes proposed options for which we are not offering commentary at this time

Bridging Health Research and Policy: Effective Dissemination Strategies

UNLABELLED: INVESTIGATED: This study presents findings from a series of focus groups, composed of stakeholders both on Capitol Hill and among national stakeholder organizations, used to identify strategies health services researchers can use for the effective dissemination and expanded use of health services research in health policy. METHODS: Focus groups were created to assess the usefulness of rural health research products and approaches for disseminating information, and in each focus group, respondents were asked for their evaluation of several types of dissemination products and approaches, as well as participants\u27 utilization of research findings. CONCLUSIONS: The focus groups identify strategies that include tailoring products to policymakers\u27 needs, making Research products accessible, expanding working relationships with end users, and investing in greater capacity for dissemination. Implications are drawn for researchers who need to be proactive in thinking about the applications of their research to health policy, and who need to identify and seek resources to help them fund dissemination efforts

Designating Health Professional Shortage Areas and Medically Underserved Populations/Medically Underserved Areas: A Primer on Basic Issues to Resolve

The purpose of this paper is to help interested parties consider issues related to the designation of Medically Underserved Areas (MUAs), Medically Underserved Populations (MUPs), and Health Professional Shortage Areas (HPSAs). The paper includes narrative describing key issues and a table summarizing how the designations establish eligibility for programs important to rural medical care delivery

Rural Policy Research Institute Health Panel Response to CMS\u27 Report to Congress: Plan to Implement a Medicare Hospital Value-based Purchasing Program

Comprehensive quality improvement programs are an important advance in US health care policy. Patients deserve to be safe in our nation’s hospitals and should demand that their health care providers place quality care above all other priorities. Quality improvement should be of critical strategic importance to hospitals. Yet, hospital-based quality improvement efforts may be costly and can negatively impact hospital profitability. This financial reality is unacceptable in a health care system that strives to be safe, effective, patient-centered, timely, efficient, and equitable. Therefore, the Rural Policy Research Institute (RUPRI) Health Panel (Panel) strongly supports the Centers for Medicare and Medicaid Services’ (CMS’) exploration of payment alternatives designed to improve the quality of hospital care—including value-based purchasing (VBP)