Let's reimagine rural health in our state

 By Ann Schlueter
    As the chief operating officer of a small rural hospital in Fairfax, Mo., I see the difficulty rural Missourians have in accessing health care daily. Our hospital, Community Hospital—Fairfax, is fortunate to have strong local support and a solid financial foundation. Despite the challenges rural hospitals experience, our hospital has been able to make the investments needed to remain an essential community asset in Fairfax, an important health care resource for communities throughout far-northwest Missouri. Increasingly, stories like ours are the exception and not the rule.

    Rural health care faces significantly different economic and demographic challenges than urban and suburban Missouri. Building a strong and sustainable rural health care system requires different policies, investments and partnerships. At the same time, maintaining and improving the physical and economic health of rural Missouri calls for a different vision—it calls for us to reimagine rural health.
    The economic challenges are real. Nearly 40 percent of Missourians live in the state’s rural counties. Six rural hospitals have closed in Missouri throughout the past four years, and 47.1 percent of rural hospitals in the state operated in the red in 2016.
    Rural Missourians are statistically less affluent, older and more likely to have chronic health conditions than their metro counterparts. They also are less likely to have health insurance. As a result—although they are more likely to benefit from primary care or need specialty care—they are less likely to be able to pay for the care they need. And, with higher rates of Medicare, Medicaid and self-pay patients, providers often receive less than cost in reimbursement for care.
    Rural demographics challenge the health system as well. By 2030, more than 25 percent of Missourians will be over age 65. However, 46 percent of Medicare beneficiaries—generally those 65 and older—are located in rural areas of the state. Research indicates that 90 percent of seniors want to age in place. With a strong correlation between age and the need for health care services, keeping seniors in their homes and in their communities will require a robust rural health care system. Unfortunately, six rural Missouri counties currently lack a primary care physician.
    These challenges are not insurmountable. However, they demand concerted effort to overcome.
    For example, rural Missouri has an acute health care workforce shortage. The jobs are plentiful, but candidates with the appropriate training are insufficient. Gov. Mike Parson indicated training Missourians for the jobs of the future will be a priority of his administration. Missouri’s demographics point to health care jobs as jobs of the future.
    Accessing behavioral health services—especially close to home—is challenging statewide and profoundly difficult in rural Missouri. Nearly all of Missouri’s rural counties are classified as Behavioral Health Professional Shortage Areas. This problem is compounded by the state’s opioid and substance abuse crisis, which has strained the behavioral health system. To make progress, Missourians will need to reimagine how we serve behavioral health patients, expand partnerships between behavioral health and primary care, and leverage state and federal resources. Parson’s budget recommendations include several important components of this effort.
    Finally, Parson asked for significant new infrastructure funds to upgrade bridges in rural Missouri. Better rural infrastructure will help reduce the travel time to emergency care. However, there’s another rural bridge worth investing in—efforts to bridge the digital divide. Telemedicine holds great promise as a tool for keeping health care local. Broadband expansion can help Missouri reimagine rural health just as rural communities will use better access to improve their economic health.
    As the state works to reinvigorate Missouri’s rural communities through better infrastructure, education and training, and targeted economic development, small and well-directed investments also can improve rural health and health care.
    We can move rural and all Missouri forward. A core strategy is to reimagine rural health.
    EDITOR’S NOTE: Ann Schlueter is the chief operating officer of Community Hospital-Fairfax, in Fairfax, Mo.

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