Research & Publications -> On-going Research -> Improving Local Health Care Access: Innovative Approaches to Meeting Rural Health Demands

Improving Local Health Care Access: Innovative Approaches to Meeting Rural Health Demands

Heather McIlvaine-Newsad and Mary Jane Clark

Project Abstract

Residents of rural Illinois are faced with a "double jeopardy" situation when it comes to health care. First the health care needs of rural residents exceed those of their urban counterparts, and second the resources to address those needs are usually inadequate. The obstacles to obtaining affordable and accessible health care are complex and varied. They include geographic isolation, lack of transportation, language and cultural differences, economic disparity, and educational deficits that create challenges for rural health care consumers. Together, these variables represent formidable obstacles for improving the health of rural residents. One way to address these complex issues is to provide culturally and socially appropriate services to people where they live and work. This report highlights several innovative strategies rural communities in Illinois and Ohio have implemented to provide their residents with improved health care. They include school-based health centers; all volunteer rural EMS districts; community-based health care clinics for the uninsured; urgent care centers that serve patients with non-emergency needs "after hours" and; innovative group insurance policies for self-employed individuals; and new technologies in the form of mobile clinics and telemedicine, which are improving rural populations' access to health care services that were previously only available in urban areas.

Methodology

The data for this study was collected using qualitative methods. This research was exploratory in nature and serves to provide researchers, practioners, and policy makers with baseline data for future research. Further research utilizing a combination of quantitative and qualitative methods will provide a holistic perspective of the challenges and solutions for rural health care in Illinois.

1. Library research and Internet searches were utilized to determine local, statewide, national, and international approaches to innovative access to care.
2. A brief survey tool was mailed to nonmetropolitan municipalities, Critical Access Hospitals (CAH), and economic development organizations and agencies to ascertain information on innovative grass roots initiatives to provide additional services to the uninsured/underinsured or indigent populations in their respective communities. A total of 864 surveys were mailed and 110 were returned.
3. A follow-up telephone interview was conducted with community contacts to gather information about programs, strategies, or collaborative, creative approaches that were identified as meeting local community needs. A total of 53 in-depth phone interviews were conducted.
4. Key informants were identified through the survey tool and subsequent research was conducted to provide additional qualitative data for the final report.
5. A focus group consisting of a variety of rural health care professionals was conducted at the Illinois Rural Health Association Conference in April 2003 to provide input on which community-based strategies could be successfully implemented in Illinois.

Major Findings

Americans living in rural areas have a greater number of health problems than their urban peers, and have fewer health care services available to them. A major factor in this disparity between urban and rural health care is the longstanding shortage of health care providers in rural areas. Although 20 percent of the U.S. population lives in rural areas, only 9 percent of physicians practice there and only 3 percent of recent medical school graduates plan to do so.

Critical Access Hospitals, community leaders, and economic development organizations and agencies were surveyed to determine if community-based strategies currently exist in rural Illinois to assist in meeting the health care needs of the population. Survey results were supplemented with detailed information gathered from a round table discussion and through in-depth telephone interviews. The purpose of the research was to collect information about innovative health care strategies that were being successfully implemented in Illinois and surrounding areas. The goal of the research is to disseminate these findings to policy makers, community leaders, program planners, and clinicians who seek to improve the health care infrastructure in their local communities. The researchers hope that the models highlighted in this report may be successfully replicated in rural areas to improve the overall health care infrastructure in rural communities, as well as assist local providers in identifying successful strategies to help meet the local health care demands.

Findings indicate twenty of the twenty-seven counties in Illinois designated as having under-served populations are rural counties. Therefore, policy makers, providers and agencies should develop and support health care initiatives that benefit the rural population.

Research findings reveal that despite the dire state of health care services in rural Illinois, communities and agencies have been implementing creative strategies to help meet the needs of those individuals who are under-served. These approaches range from all volunteer rural EMS (emergency medical services) departments, to mobile mammography clinics, and in-school wellness centers. Regardless of the focus or scope of the project, three main variables were present in all of the projects surveyed. These include:

• Collaboration with a plethora of federal, state, and private agencies. A collaborative approach to problem solving, resource sharing, and funding is key to understanding the success of these projects;
• Community involvement and support. Those projects that were not sustainable often mentioned lack of community involvement and support as one of the key reasons why the project did not have the anticipated results; and
• Funding as the most significant barrier for attaining long-term success of a project. Agency directors, community leaders, and project managers spoke in depth about the difficulties in finding, attaining, and maintaining funding to support projects.

Implications

This study provides unique information regarding the ways in which rural communities, agencies, and providers are attempting to meet the needs of rural health care consumers. Several important implications can be noted from the round-table discussion, telephone interviews, and surveys. They are as follows:

• Additional follow-up work is needed to make this general information more useful and available for health care providers and others involved in meeting the health care needs of Illinois' rural population.
• Collaboration, networking, and sharing of resources are effective ways for those working on innovative health care projects to attain funding and develop effective community-based models. The collaboration should be multi-disciplinary, within the health care system, as well as across the community to include local government and other community entities. Collaboration on various levels should be encouraged and supported.
• Demographic, economic, and cultural barriers influence rural health care consumers' decisions about when and where to seek health care. Some of these barriers included lack of insurance, distance to a health care provider, distrust of those providing health care services, long working hours, lack of transportation, and inability to pay for a service. These factors must be considered when implementing new projects. Academics, key informants, and project contacts alike identified these areas as perceived barriers.
• Primary care providers - nurse practioners, nurses, pharmacists, physicians, etc. - should be encouraged to work in rural areas, or provide services on a routine basis to rural clients.
• Many successful and innovative projects are providing valuable services to rural health care consumers. More are needed however to begin to bridge the gaps between the health care status of rural and urban populations.

Conclusions

In summary, residents of rural Illinois are faced with a "double jeopardy" situation when in comes to health care. First the health care needs of rural residents exceed those of their urban counterparts, and second the resources to address those needs are usually inadequate.

To improve the health of rural residents it is necessary to break down barriers. However, these obstacles are complex and often not apparent to outsiders. Distance, lack of transportation, language and cultural differences, economic disparity, and lack of education create challenges for rural health care providers. Together, these variables represent formidable obstacles for improving the health of rural residents. One way to address these complex issues is to provide culturally and socially appropriate services to the people where they live and work.

Despite these challenges, there are signs of improvements in the rural health care system. There is growing attention to rural health care concerns at the state and federal levels. School-based health centers are providing services to more rural residents; rural EMS districts are providing valuable and sophisticated medical services to their rural clientele; communities are providing innovative health care for clients who do not have access to conventional medical services; and new technologies in the form of mobile clinics and telemedicine are improving rural populations' access to health care services that were previously only available in urban areas.

Based upon the research conducted for this study, the authors' suggest that four factors are integral for improving health care delivery in rural Illinois:

1. Health care and other related preventative services must be fully integrated into rural communities;
2. Communities must be involved from the inception of new health care projects in order to foster a sense of ownership and acceptance;
3. Communities will benefit from the use of local strategic planning that focuses on measurable outcomes that seek to ensure the continuous long term improvement to the overall health status of the entire community; and
4. The development of collaborative relationships between provider networks, rural health care consumers, local businesses, institutions of higher education, and policy makers are key to insuring the improvement of rural health.

Finally, improving the health of residents of rural Illinois is largely a matter of improving access to health care services. Such improvements will require policies that are based upon scientific and economic evidence demonstrating that preventative services are cost effective and beneficial to the economic, social, and cultural fabric of Illinois. These kinds of policy changes require, more than anything else, political will. As a state, we do not lack the knowledge or resources needed to improve the health care status of our rural residents. However, without the encouragement of policy makers it is unlikely that resources will be allocated to improve rural residents access to health care. Through innovative collaborative efforts like those outlined in this report, we can look forward to the gradual disappearance of the inequities in health care between rural and urban residents of Illinois.