Rural health care: good for the economy?Saving a rural hospital or building a health center in small towns brings more than health care to a community. It's "economic development."
The early '80s were bleak for Southern Illinois. Factories closed, unemployment burgeoned, property values plummeted and there weren't enough doctors for rural residents. Today, however, the area enjoys a strong economy and there's better health care for everyone. What happened?
The turnaround can be credited, in part, to a small group of community members who got together with two goals: bring desperately needed physicians to the area and beef up the economy.
The town of Centerville, population 10,000, had a hospital and a health department, but neither provided basic services basic services,
n.pl frequently insurance companies split dental procedures into basic and major categories. Basic services usually consist of diagnostic, preventive, and routine restorative dental services. like checkups, immunizations or treatments for colds. Residents traveled to another town to see a doctor or went to the local hospital emergency room, an expensive and inefficient place to have minor ailments treated. In 1985, the local health department provided the space for the first community health center and a state public health service grant supplied the operating funds.
Since that first clinic opened its doors with one doctor and a nurse, the Southern Illinois Healthcare Foundation has been developed and has built another 14 clinics that provide a wide variety of primary medical services, including well-baby checks and physicals. Doctors, nurses and other traditional health care providers work at the centers, but so do nutritionists and social workers, who help people become and remain healthy.
"As an elderly woman, it's very important for me to have a doctor close to my home," says Mary Wilkerson. "The foundation has clinics all over the area so that people like me don't have to travel long distances." She has been a patient of the Centerville clinic for more than three years, and is "very pleased" with the health care she receives. The clinics also provide transportation for elderly patients who can't get around by themselves and young mothers who need extra help.
Today, the foundation employs 39 doctors and nurses and 550 people from area communities. The centers directly and indirectly support 679 full-time jobs, and those employees handled 81,000 patient visits in 1997.
THE MONEY STAYS HOME
Every health care dollar spent in a rural area recycles through that community at least one and a half times. One rural physician generates more than five full-time jobs and $233,000 in local economic activity, according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. the Federal Office of Rural Health Policy. Statistics show that the health care industry provides up to 20 percent of the payroll and employs up to 15 percent of the people in rural communities.
Through their activities, the Southern Illinois Healthcare Foundation centers generated $53 million in local revenue in 1997. The indirect effect of that economic activity on household incomes was almost $27 million.
"Community health centers make dramatic contributions to the health and well being of their communities and to the economic output of the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. while operating under a very small budget," says Dan Hawkins Dan Hawkins may refer to either of the following people:
Yolanda Smoot, a registered medical technician at the Quick Care Clinic in Centerville agrees. "My job at the foundation has not only been a way for me to bring home a paycheck and take care of my 3-year-old daughter, it has allowed me to be a part of the community and to give something back."
A PLACE TO WORK
The entry-level jobs An entry-level job is a job that generally requires little skill and knowledge, and is generally of a low pay. These jobs may require physical strength or some on-site training. Many entry-level jobs are part-time, and do not include employee benefits. created by expanding a health care system can piggyback piggyback
1. A broker trading in his or her personal account after trading in the same security for a customer. The broker may believe the customer has access to privileged information that will cause the transaction to be profitable.
2. nicely with states' welfare-to-work efforts. Most community and rural health centers are willing to hire and train low income residents. Yolanda accepted the job at the clinic so that she could be closer to home. "Having my job in the area makes it easier for me to go back and forth to get my daughter from day care," she says.
The Southern Illinois Healthcare Foundation has been a successful partner in the welfare-to-work movement. Over 70 percent of the clinic's employees are single mothers. A majority are former welfare recipients. "The biggest health problem in southern Illinois is unemployment," says Robert Klutts, executive director of the foundation.
"Unemployed people Noun 1. unemployed people - people who are involuntarily out of work (considered as a group); "the long-term unemployed need assistance"
plural, plural form - the form of a word that is used to denote more than one are less healthy and usually have no access to transportation or health insurance," he continues. The foundation not only provides health care to the community, it also offers job training for a variety of health-related vocations like medical assistants and medical receptionists, along with benefits including reimbursement Reimbursement
Payment made to someone for out-of-pocket expenses has incurred. for tuition. A former welfare mother can find a receptionist job with sufficient pay and benefits to keep her off welfare while contributing to the local economy by spending her paychecks there. Yolanda worked at a grocery store while she was training to be a medical technician, but she didn't receive benefits like health insurance for herself or her daughter. It wasn't until she began working at the clinic that she was able to provide regular medical care for her family.
RURAL AREAS AND HEALTH
According to the National Rural Health Association of Kansas City Kansas City, two adjacent cities of the same name, one (1990 pop. 149,767), seat of Wyandotte co., NE Kansas (inc. 1859), the other (1990 pop. 435,146), Clay, Jackson, and Platte counties, NW Mo. (inc. 1850). , Mo., a quarter of the U.S. population lives in rural areas, and they are often poor, lack insurance and, on average, are older than city dwellers. Their health is often worse than that of people in urban areas. They make inappropriate and expensive emergency room visits more frequently because they have no health insurance. Residents of these remote areas feel that the care they do receive is of lower quality. A recent study found that 48 percent of rural residents believe that urban health care is better.
Even though health care spending represents 14 percent of the nation's economic activity, most occurs in cities. Few doctors are willing to live and practice in remote areas, especially for extended periods of time.
Compounding the problem in many parts of the country is the movement to managed care. Many rural hospitals have been forced to close - more than 400 since 1980. A large number of the surviving hospitals have been purchased by large, urban-based managed care networks, resulting in even more money flowing out of town. Even if residents have insurance and make their premium and cost-sharing payments, the money does not stay in the rural community if clients travel to cities for health care.
"If an HMO HMO health maintenance organization.
A corporation that is financed by insurance premiums and has member physicians and professional staff who provide curative and preventive medicine within certain financial, has enrolled all the patients in an area, and the doctors that live and work in the area don't have a contract with the HMO, the patients can't use the existing health care services in their town," says Texas Senator David Sibley David Sibley may refer to :
tr.v. in·tim·i·dat·ed, in·tim·i·dat·ing, in·tim·i·dates
1. To make timid; fill with fear.
2. To coerce or inhibit by or as if by threats. into signing a contract with the managed care organization," says Sibley. Overall, 32 rural organizations in 13 states are developing their own insurance programs in order to participate in the managed care environment.
"Economic expansion, coupled with improved access to health care, makes investments in community health centers one of the most productive uses of capital," says Steve Tribuzzi of the Illinois Primary Health Care Association.
State lawmakers have been encouraging the development of health systems in rural areas in a variety of ways:
* A law in Minnesota requires the commissioner of health to provide technical assistance to rural communities to coordinate local health care services and recruit new providers.
* An Arkansas law provides grants for medical clinics through a Rural Medical Clinic Revolving Loan Fund A Revolving Loan Fund (RLF) is a source of money from which loans are made for small business development projects. A loan is made to one person or business at a time and, as repayments are made, funds become available for new loans to other businesses. . Washington state is looking at legislation this session that would set up a similar fund.
* Oregon gives physicians, nurse practitioners nurse practitioner
n. Abbr. NP
A registered nurse with special training for providing primary health care, including many tasks customarily performed by a physician. , dentists and podiatrists who practice in rural health areas tax credits of up to $5,000 a year for 10 years.
* State-funded repayment programs in Idaho and numerous other states help doctors and other health care providers pay off their medical school loans in exchange for working in small towns.
* Nebraska's health professional loan repayment program is funded through a community match program that combines state and local resources.
* Virginia and Tennessee recruit elementary, middle and high school students to health care professions in rural areas. A physician shortage program at Jefferson Medical College in Pennsylvania selectively recruits young people from rural areas who are committed to returning to their hometowns to practice medicine.
* Florida's Rural Development Council provides training and employment for rural residents in health-related fields and coordinates welfare, food stamps food stamp
A stamp or coupon, issued by the government to persons with low incomes, that can be redeemed for food at stores.
Noun 1. and Medicaid services.
* Arizona encourages managed care plans to contract with existing rural health centers through a successful expansion of its Medicaid managed care program to rural areas.
* Oklahoma's SoonerCare program offers incentives for urban managed care plans to work with rural providers and health centers.
* Legislatures in North Dakota North Dakota, state in the N central United States. It is bordered by Minnesota, across the Red River of the North (E), South Dakota (S), Montana (W), and the Canadian provinces of Saskatchewan and Manitoba (N). and Utah have called for studies to look at possible effects of managed health care on rural health.
Other ideas states are exploring:
* Helping communities identify potential local, state and federal funding sources and obtaining matching funds Noun 1. matching funds - funds that will be supplied in an amount matching the funds available from other sources
cash in hand, finances, funds, monetary resource, pecuniary resource - assets in the form of money to establish clinics.
* Encouraging collaboration between public and private groups by changing laws and regulations so that small communities can be creative in their plans.
* Promoting pilot and demonstration programs.
* Offering financial incentives to help stimulate local employment and improve the economy.
* Granting tax exemptions tax exemption, immunity from the requirement of paying taxes. Federal, state, and usually local law provide exemption from taxation for a wide variety of organizations, usually not-for-profit, such as churches, colleges, universities, health care providers, various and abatements to organizations that invest in the construction or improvement of health care sites.
* Exempting rural health systems from existing certificate of need laws.
* Creating state enterprise zones that provide financial incentives to businesses, like health systems, that move into communities with depressed economies.
There are other good programs around the country. For example, South Carolina South Carolina, state of the SE United States. It is bordered by North Carolina (N), the Atlantic Ocean (SE), and Georgia (SW). Facts and Figures
Area, 31,055 sq mi (80,432 sq km). Pop. (2000) 4,012,012, a 15. , Massachusetts and Mississippi have developed profitable community health centers that provide employment and bring not only health care but economic relief to smaller towns and cities.
"Community health centers are proven investments. They pay dividends. They provide employment and improve the community's health, which brings business in," says Lathran Woodard of South Carolina's Primary Health Care Association.
"You've all heard of the Little Engine That Could. Well, I like to think of community health centers as the' Little Engine That Did.' They are the success story in the health industry of the last 20 years," says Jim Hunt
James Baxter Hunt Jr. (born May 16, 1937 in Wilson, NC) was a four-term Democratic governor of the U.S. , director of the Massachusetts League of Community Health Centers.
SPECIAL LOANS FOR RURAL BUSINESSES
Rural entrepreneurs do not pay higher interest rates than urban borrowers, according to a recent United States Department of Agriculture United States Department of Agriculture (USDA),
n.pr established in 1862, USDA is responsible for the safety of meat, poultry, and egg products. It conducts ongoing research in areas from human nutrition to new crop technologies and also helps ensure open (USDA USDA,
n.pr See United States Department of Agriculture. ) study, but obtaining capital is more difficult.
Due to regional disparities in education and wealth, rural borrowers are often considered less credit worthy than their urban counterparts. This fact combined with the small number of commercial banks serving rural communities, commonly two or fewer, creates a lack of capital for rural entrepreneurs.
So states are developing new finance programs that specifically target rural businesses. In the forefront are California, Florida, Kentucky, Minnesota, North Carolina North Carolina, state in the SE United States. It is bordered by the Atlantic Ocean (E), South Carolina and Georgia (S), Tennessee (W), and Virginia (N). Facts and Figures
Area, 52,586 sq mi (136,198 sq km). Pop. , North Dakota, New Mexico New Mexico, state in the SW United States. At its northwestern corner are the so-called Four Corners, where Colorado, New Mexico, Arizona, and Utah meet at right angles; New Mexico is also bordered by Oklahoma (NE), Texas (E, S), and Mexico (S). and Wisconsin.
Some of the key approaches are to:
* Target private entrepreneurs in towns with populations ranging from 6,000 to 50,000.
* Offer low-interest loans to both new and expanding businesses.
* Tie loans to the potential to create or retain jobs for low income people.
* Offer funds for developing essential infrastructure in rural areas.
North Carolina has an interesting program funded by the USDA and the North Carolina Technological Development Authority. It provides loans to emerging companies and incubator incubator, apparatus for the maintenance of controlled conditions in which eggs can be hatched artificially. Incubator houses with double walls of mud, a fireroom, and several compartments each holding about 6,000 hens' eggs were developed in ancient times; the projects. Loans range from $25,000 to $187,000, and interest rates vary according to the risk. Incubator loans go to businesses in communities with less than 25,000 people or unincorporated Adj. 1. unincorporated - not organized and maintained as a legal corporation
unorganised, unorganized - not having or belonging to a structured whole; "unorganized territories lack a formal government" parts of an urban county. Applicants are evaluated on their ability to create new, permanent jobs. The Emerging Company Loan is designed to serve as a source of working capital or for the purchase of machinery or equipment.
Kentucky has a well-known job creation program (adopted in 1988) that offers state income tax credits as a way to attract new manufacturing businesses to rural areas. The Kentucky Rural Economic Development Act targets counties that have had unemployment rates above the state average in each of the five preceding years. In addition to the tax credit, the business may also claim a job assessment fee of 4 percent of the gross wages of each new employee hired. Since 1989, the 400 businesses applying for the credits have provided some 45,000 new jobs. The program works equally well for large corporations and small more and pop businesses, says Steve Jones Steve or Steven Jones is the name of:
- Kim Shilling SHILLING, Eng. law. The name of an English coin, of the value of one twentieth part of a pound. In the United States, while they were colonies, there were coins of this denomination, but they greatly varied in their value. , NCSL NCSL National Conference of State Legislatures
NCSL National College for School Leadership
NCSL National Conference of Standards Laboratories
NCSL National Council of State Legislators
NCSL National Computer Systems Laboratory (NIST)
FEDERAL INCENTIVES FOR RURAL HEALTH
There's federal help available for communities that want to expand health care services in rural areas. The Medicare Rural Hospital Flexibility Program in the federal balanced budget Balanced budget
A budget in which the income equals expenditure. See: budget.
A budget in which the expenditures incurred during a given period are matched by revenues. act of 1997 was modeled after a successful demonstration project in Montana that allowed hospitals in rural areas to offer fewer services and still qualify for the higher cost-based Medicare reimbursement rate. Previously, rural hospitals that received Medicare reimbursements had to provide a wide variety of acute care services in order to receive the higher reimbursement payments.
The federal program allows struggling rural facilities to reduce their scope of services and tailor the remaining services, including emergency and primary health care, to the population they serve. For example, a critical access hospital can provide emergency and outpatient services outpatient services Hospital-based services Managed care Medical and other services provided, to a nonadmitted Pt, by a hospital or other qualified facility–eg, mental health clinic, rural health clinic, mobile X-ray unit, free-standing dialysis unit Examples , such as treating an asthma attack, but is not required to treat patients in the hospital for longer than three or four days in order to receive higher Medicare rates. Patients needing to stay in a hospital longer are stabilized sta·bi·lize
v. sta·bi·lized, sta·bi·liz·ing, sta·bi·liz·es
1. To make stable or steadfast.
2. at the critical access hospital and then transferred to a larger one.
In 1998, 43 states expressed interest in developing a critical access hospital program and could qualify for some $25 million in grants.
Gretchen Flanders tracks rural health issues for NCSL. For details on community health centers involved in economic development activities contact Colleen col·leen
An Irish girl.
[Irish Gaelic cailín, diminutive of caile, girl, from Old Irish. Meiman at the Bureau of Primary Health Care The Bureau of Primary Health Care is a sub program of the United States Department of Health and Human Services. Key areas of responsibility