organization of rural population medical care and prospect of its development
TRANSCRIPT
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Organization of rural population Organization of rural population medical care and prospect of its medical care and prospect of its
developmentdevelopment
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Economic Impact AnalysisJefferson County Hospitals
Direct Effects
Indirect Effects
Induced Effects
Total Effects
Employment Multiplier
15.12 2.84 5.12 23.12
Output Multiplier
1.00 0.21 0.36 1.57
Income
Multiplier
0.67 0.13 0.24 1.03
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Rural residents seeking health care are◦ Older than urban residents◦ in poorer health than urban residents◦ more likely to be disabled◦ more likely to be uninsured◦ more likely to face financial barriers in obtaining
healthcare◦ more likely to incur travel burdens while seeking care◦ much less likely to receive services than are their urban
counterparts if they suffer from serious mental illness.
Rural is different
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Why not let the market fix it?
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• Specific barriers to mental health access– Service fragmentation– Transportation– Lack of cultural and linguistic competency– Medicaid enrollment– Stigma– Immigration status.
Rural is different
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Southern Rural is Really Different
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Average age rural physicians 45Primary Care
◦ See more patients◦ Are more likely to be in shortage
Only 10% of practicing physicians practice in a rural area Less likely to have evening and weekend hours
◦ Perceived to be of poorer quality◦ Communication challenges due to lack of cell or radio
coverage in some areas make things more difficult◦ Preventive procedures are often sacrificed as patients
and providers attend to more pressing medical issues.
Rural providers
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Elevating care
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Defining Access
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• Conditions where timely early care would prevent hospitalization
• Patients with ambulatory sensitive conditions more likely to be hospitalized in rural America
Ambulatory sensitive conditions
JN Laditka, SB Laditka Health care access in rural areas: evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality Health & Place Volume 15, Issue 3, September 2009, Pages 761-770
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The phenomena of bypass
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So why don’t we just fix it?
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• Rural provider autonomy– Strict independence is no longer a success strategy
• Rural practice design– care management, team work, and interoperable
information technology require teams
• Low rural volumes– Need 5000 Medicare lives for an ACO, for example
• Historic rural efficiency– Cheap is not necessarily efficient
Barriers to system improvement
The March to Accountable Care Organizations—How Will Rural Fare? J Rural Health 2011
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How does Virginia do?
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Locating rural Virginia
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Physician distribution
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Mental health distribution
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Pediatric care
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Health care distribution
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Elevating care
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Defining Access
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• Conditions where timely early care would prevent hospitalization
• Patients with ambulatory sensitive conditions more likely to be hospitalized in rural America
Ambulatory sensitive conditions
JN Laditka, SB Laditka Health care access in rural areas: evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality Health & Place Volume 15, Issue 3, September 2009, Pages 761-770
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The phenomena of bypass
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Rural Access
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Thank you!