Rural vs urban?
The need to improve health transcends geography and party lines
July 21, 2016 | By: Andy Carter
According to politics, party affiliation—and the dictionary—rural and urban qualify as polar opposites. Here in Pennsylvania, country-city tensions can sometimes contribute to policy divides and an “us vs them” mentality.
Yet when it comes to health, vulnerable rural and urban communities have all too much in common. Both struggle with high rates of chronic disease and the poor health that goes hand in hand with low incomes.
Could the need to improve health upend conventional wisdom? Are the interests of country and city constituencies more aligned than we might think?
Rural or urban, similar obstacles to health
Public health experts say socioeconomic factors like income, education levels, and health literacy determine about 40 percent of our overall health. If we lag behind in these areas, so does our health.
Consider, for example, a Pennsylvania county that exceeds the commonwealth’s average rates for:
- Poverty (at least 38% higher) and unemployment (at least 9% higher)
- Heart disease (at least 16% higher) and diabetes (at least 15% higher)
- Difficulty getting access to primary care—for expectant moms, the rate of those without access to prenatal care is at least 30% higher
Are we in Clarion County (75% rural) or Philadelphia (100% urban)? Statistically, we could be in either.
Recent findings from the Joint State Government Commission also show that health problems cross county and party lines. Created in 1937 as the primary non-partisan, bicameral research and policy development agency for Pennsylvania’s General Assembly, the commission has identified medically needy communities in both rural Pennsylvania and inner-city Philadelphia.
Rural and urban—what Pennsylvania hospitals are doing
The hospital community experiences some of the same rural vs urban tensions that color other aspects of our state’s economic, social, and political life. As the state’s hospital association, we work with all our members to craft an agenda that helps them better serve their communities, especially those most in need, be they rural or urban.
Hospitals have found plenty of common ground to advance some big themes—and some practical steps we can take this legislative season—that will move us toward a healthier Pennsylvania. Here are three key health care innovations worth further conversation.
1. Moving care outside the hospital, into the community
From the hospital perspective, this theme captures much of what the ubiquitous “transformation of health care” is all about.
We’re moving care “upstream” to focus on routine and preventive care, especially for communities at risk for poorer health. For example, many hospitals are hiring community health workers to bring health education and coaching and basic health services to vulnerable Pennsylvanians. These efforts aim to keep people healthier, and out of the hospital.
When at risk patients do need hospital stays, we’re working to support better care “downstream.” During hospitalization and discharge, we’re doing our best to educate patients and their family caregivers, coordinate transportation and post-hospital care, and connect to social services like healthy, home-delivered meals.
We want patients to continue on the road to recovery at home and in outpatient settings—without return trips to the hospital.
2. Putting hospitals in charge of health care dollars (aka global payments)
As we move toward more outpatient care, hospitals are making investments in new services, staff, training, and technology—all designed to reduce the need for inpatient care. As a result, we’re seeing declines in the admissions and acute care payments that have financed hospital and health system operations in the past.
It’s the right thing to do, but financially it’s a double whammy.
Pennsylvania is investigating a new “global payment” approach that recognizes this disconnect. Instead of being paid for individual health care services, hospitals receive lump-sum payments to provide care for defined communities during defined periods of time.
In theory, this model would give hospitals the financial flexibility to invest in services that promote wellness, prevent disease, and improve health care access and coordination for vulnerable communities.
Maryland was one of the first states to implement global payments. Two years into its five-year project with Centers for Medicare & Medicaid Services, the state is on track to meet its goals of improved public health and reduced health care spending.
We’ve asked rural hospitals in Pennsylvania to consider participating in a global payment pilot.
3. “Beaming in” to your doctor’s appointment via telehealth
Telehealth harnesses technology (think two-way video and smart phones) to connect all manner of patients with all manner of doctors. Talk about spanning geographies!
How can a small, isolated rural community support the pediatric neurology practice needed to cure a child’s brain cancer? With telehealth, the local community hospital can connect this family to specialists at urban academic medical centers in Pennsylvania and, with the passage of the Interstate Medical Compact, other states.
Telehealth gives vulnerable rural communities access to a world of new health care options. At the same time, city specialists have the satisfaction of helping patients once far beyond their reach.
How lawmakers can help
We’re counting on lawmakers to maintain focus on the unique financial pressures that hospitals—especially those serving vulnerable communities with greater social needs—face right now.
We thank lawmakers for their support of full funding for hospital Medicaid payments and additional dollars for rural hospitals during this year’s budget negotiations. Now more than ever, hospitals must have stable, predictable payments in order to invest in new kinds of health care.
We urge lawmakers to pass legislation that removes barriers thwarting the development of telehealth. That’s an important step we can take this year to address the health needs of at risk rural communities.
Longer term, we’ll do all we can to foster a discussion about public policies to improve the poor health of vulnerable rural and urban communities. When those most in need have so much in common, surely we can prevail over entrenched differences that sometimes seem insurmountable.
A healthier Pennsylvania is well worth the effort.