Abstract
Rural residents have different health care needs compared to urban populations. There are economic, social and cultural as well as educational aspects that impacts the manner by which health care is delivered in rural areas. As a means to address the different health care needs of urban residents, legislators worked towards the development and implementation of policies that are perceived to improve the health and well being of the urban population. Included in these programs is the adoption of better payment plans, the promotion of wider and more affordable health insurance, and the alteration in the health care delivery system according to the Patient Protection and Affordable Care Act. These programs are intended to improve the delivery of health care services for residents in rural areas, who were generally disadvantaged in the past years due to inadequate plans to cater to their needs. However, while these programs have their apparent advantages, there are also some disadvantages associated with the adoption of new strategies.
Keywords: rural residents, health care, patient protection, affordable care act
Introduction
Rural health care caters to the health care delivery in rural areas, and this involves providing social, physical and mental health care for rural residents. The National Rural Health Association claimed that there are unique issues and combination of factors faced by Rural Americans, which create the disparity in terms of health care in urban areas (National, 2016). Some of these factors include economic factors, differences in culture and social norms, education, the recognition given by legislators and the accessibility of remote rural areas that tend to obstruct rural Americans to achieve a better and healthy living. Research revealed that rural residents have to face a multitude of barriers that hinder their ability to have a ready access to sufficient and effective health care. However, in recent years, policy makers introduced new health reform legislations that have an impact on rural health delivery. This paper aims to discuss the advantages and disadvantages of these recent changes in the rural health care and how it impacted the health and well being of rural residents.
There have been changes in the US health care system due to pressure from both the public and private sectors for the implementation of improved and innovative approaches in delivering health care services. In the past, many rural health care providers have difficulty in providing a more competent, coordinated and efficient health care services. Three of these major modifications in rural health care include a) changes in the payment strategies, b) ease of access to health insurance, c) and the recent changes in the delivery system under the Patient Protection and Affordable Care Act of 2010 (Alfero et al, 2014). The transition in the health care system in rural areas is geared towards making healthcare practitioners and organizations more accountable in delivering services to rural residents.
The Payment Policy Reform
With the goal of making better health care available to rural residents, government players, commercial insurers and self-insured organizations are working towards improving services “through payment alternatives to fee-for-service (FFS) and cost-based reimbursement” (Alfero et al, 2014). The new payment strategy is geared towards implementing bonuses and fines according to the quality of clinical services, per capita outlays for health care management, and share savings for better-quality services. This called for the formation of an accountable care organization (ACO) by health care providers and agree to “collectively take responsibility for the quality and total costs of care for a population of patients” (Abrams et al, 2015).
Some of the advantages of the payment policy reform are affordable and improved health care services. Further, it also encourages increased support for the type of care that improves the value and outcome of health care provided by practitioners, which includes the properly coordinated services and excellent primary care. The payment policy reform is geared towards transitioning to a “value-driven and population-based (capitated) payments for better outcomes supported by increasingly sophisticated performance metrics” (Alfero et al, 2014). It was supposed that the introduction of this reform in rural health care will result to better care, smarter spending, and healthier people when properly designed and implemented (Alfero et al, 2014).
On the other hand, the payment policy reform has also its drawbacks and this includes the risks associated with the limited experience of practitioners in terms of “managing care to a budget and limited capacity to coordinate care with other providers” (Abrams, 2015). There is also the tendency of health care providers to favor high-priced procedures over the inexpensive care management and cost-saving services resulting in more expensive health care services for patients (Abrams, 2015). It is to be noted that transitioning to a value-based and cost-effective health care delivery system involves integrated networks of providers among other important elements that require considerable constraint in time, finances and human capital aspects. This is even more difficult in rural areas due to “scarce resources, limited numbers of providers, small population centers, and the potential exposure to financial losses from poor risk management” (Alfero et al, 2014).
Greater Access to Health Care Insurance
Research revealed that people in rural areas are likely to be uninsured, compared to residents in urban areas. It was found that rural residents who are under 65 years of age are less likely than urban residents to be covered by private health insurance, and this can be attributed to the high proportion of small businesses and low wages in these areas (McBride and Kemper, 2009). Consequently, as a means to address the need of rural residents for more health insurance coverage, the affordable care act (ACA) was expanded by means of increased access to insurance marketplaces and Medicaid expansions (Alfero et al, 2014).
While the impact of a wider insurance coverage in rural areas was not yet fully established, it is believed that this reform can have a significant positive effect on the overall health and well being of rural residents. Some of the projected advantages include allowing the “health care providers to remain financially stable in areas with smaller populations” (Alfero et al, 2014). This is a critical factor in rural areas as these regions generally have a smaller market share, yet they have a larger proportion of people who are not insured. Proponents of the expanded insurance coverage claim that this can have an effect on increasing the number of people insured in the rural areas, which means that there will be a gradual elimination or reduction of economic factors that usually hinder rural residents to access health care services. The provision of the ACA that has already been implemented include the Medicare Shared Savings Program and the Bundled Payments for Care Improvement Initiative (Alfero et al, 2014).
Nevertheless, the expanded affordable care act can also have a negative implications. One of which is the possibility that only a few people will be interested to participate in accessing health insurance. The potential reason of low participation in the health insurance program includes a) low health literacy, b) the intricacies associated with exchange offerings, c) unaffordability and d) inadequate use of actuarial data to guide individual clients to the most suitable plan (Hoyler et al, 2013). In addition to the non-participation of the consumers, there is also the risk of the same sentiment on the part of insurers. There are instances when insurance companies may choose not to engage in risk-adjustment schemes, especially if they have to “maintain an number of consumers in grand fathered plans” (Hoyler et al, 2013). There is also the possible impact on health care costs, as insurance exchanges can only be controlled when certain conditions were met, such as when they are efficiently administered under a competitive market and there are preventive measures to counter adverse selections. Further, the ACA program for insurance expansion may result to the risk of increasing “moral hazard and over-consumption of health care services by a larger patient population” (Hoyler et al, 2013).
The Patient Protection and Affordable Care Act of 2010
The Patient Protection and Affordable Care Act were enacted in 2010, and was fully implemented in 2014. These enactments were geared towards the legal protection of patients from their birth to the period of their retirement. It was the goal of this program to reduce the number of uninsured Americans as well as increase the number of enrollments in Medicaid to about 15 million beneficiaries (Rosenbaum, 2011). On the part of employers, the ACA encourages them to carry out wellness activities in the workplace that stimulate and provide support for actual health outcomes. These wellness undertakings include the participation in wellness programs as well as incentives that are intended to actually achieve better health outcomes. (Rosenbaum, 2011).
The disadvantage of the Patient Protection and the ACA include the complexities involved in enrolling in these programs. For example, it was found that there was a difficulty on the part of would be members to enroll through the ACA website due to technical difficulties. Moreover, higher taxes are also attributed to the creation of the ACA, as it was theorized that the wealthy members of the society must help in paying for the insurance of the less privileged.
Conclusion
The rural health care system is intended to cater to the needs of rural area residents in terms of providing different forms of health care. There were unique health concerns of people in rural areas, and these issues can be attributed to the combinations of diverse elements which resulted to the disparity between the health care needs between rural and urban populations. Recently, some legislations were introduced by policy makers to transform the rural health care system. There are three key reforms in the rural health care system and these are the changes in the payment policies, wider access to health insurance, and the newly introduced modifications in the delivery system under the Patient Protection and Affordable Care Act of 2010.
References
Abrams, M., Nuzum, R., Zezza, M., Ryan, J., Kiszla, J., & Guterman, S. (2015). The afforcable care act's payment and delivery system reforms: A progress report at five years. The Commonwealth Fund.
Alfero, C., Coburn, A., Lundblad, J., MacKinney, C., McBride, T., Mueller, K., & Weigel, P. (2014). Advancing the transition to a high performance rural health system. Rural Policy Research Institute. Retrieved from http://www.rupri.org/wp-content/uploads/2014/11/Advancing-the-Transition-Health-Panel-Paper.pdf
Goodwin, K., & Tobler, L. (2013). Improving rural healthc: State policy options.National Conference of State Legislatures. Retrieved from http://www.ncsl.org/documents/health/RuralHealth_PolicyOptions_1113.pdf
Hoyler, M., Tracci, M., Jasak, R., Sutton, J., & Meara, J. (2013). Insurance exchanges under the affordable care act: How will they affect surgical care? Bulletin of the American Colleges of Surgeons. Retrieved from http://bulletin.facs.org/2013/05/insurance-exchanges/
McBride, T., & Kemper, L. (2009). A compodium of research and policy analysis studies of rural health research and policy analysis centers.Rural Health Research and Policy Centers. Retrieved from https://www.ruralhealthinfo.org/pdf/research_compendium.pdf
National Rural Health Association. (2016). What's different about rural health care? Retrieved from http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-about-rural-health-care
References
Rosenbaum, S. (2011). The patient protection and affordable care act: Implications for public health policy and practice. Public Health Reports, 126(1). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/
