Challenges in healthcare delivery vary extensively by region. In the U.S., rural communities face a particularly unique set of obstacles. According to Health Affairs, “The lack of broadband in rural areas is one of the most striking inequalities in U.S. society. Due to the lack of broadband availability, tens of millions of rural Americans aren’t able to ‘see’ their doctor over the internet in the same way urban Americans can. Making matters worse, financially strapped rural hospitals are being shuttered by the dozens.”
Again and again, we see that public health is an interrelated web of contributing factors. It’s education, and it’s housing, and it’s family support, and it’s job security. In the 1930s public health could undoubtedly be tied to electricity. In modern times, the equivalent is access to high-speed internet. There are other compounding factors too. For example, on average, rural communities are older, sicker and less affluent with less healthcare coverage than their urban counterparts. For many hospitals, the services required by this population are low-margin or even net-loss activities, with much lower demand for higher-margin electives procedures to cover them. The impact, over-time, is a reduction in services offered, quality of patient experience, or even hospital closure. These hospitals also struggle with talent retention. With smaller budgets for recruitment and compensation, rural hospitals find they simply can’t attract and retain doctors, in some cases resorting to bringing in doctors on very short-term contracts or even on an as-needed basis.
You work for Representative Hilda Fortuna, a Democrat representing California’s 34th Congressional District. She has been approached by two other members of Congress — Republican Representative Sally Thompson who represents South Carolina’s First Congressional District and Kendra Mackie, a Republican representing Oklahoma’s 5th Congressional District. Representative Thompson and Representative Mackie want to discuss cosponsoring legislation with Representative Fortuna regarding expanding healthcare access in general, with a particular emphasis on addressing the needs of rural populations. Representative Fortuna is interested in working across the aisle and has agreed to meet to explore cosponsoring this legislation. You and Representative Fortuna will be meeting with the Representatives and their staffs to discuss the broad outlines of the legislation.
In preparation for this meeting, you are being asked to write a 6 to 8 page narrative memo addressing the key health challenges faced by rural populations and the primary issues undermining quality healthcare delivery there. You have been asked to include the closure of rural hospitals and health care facilities, the challenge of recruiting family and primary care physicians to rural areas, and the lack of broadband access for telemedicine. Representative Fortuna would like to understand how significant these problems are, if there are others that should be addressed in the legislation, and examples of rural communities where innovative approaches to serving their communities have been successful that should be more broadly replicated.
