It’s time to rethink rural health in Iowa

Today, The Gazette's news team begins a series of articles examining health care issues in rural Iowa. It is a worthy topic.

When it comes to accessing care, Iowa's rural residents face challenges that would surprise their more urban neighbors.

Rural health care is a patchwork of small hospitals and rural clinics. Specialized care often involves significant travel and expense. Psychologists, cardiologists, gynecologists and even dentists can be scarce. Some patients must travel to another county for even basic hospital care.

Rural health care providers face challenges of their own.

Iowa is home to 82 Critical Access Hospitals - a certification specific to smaller, shorter-stay facilities - more than nearly any other state (the state also is served by 142 Rural Health Clinics). And despite some special considerations that come with the certification, many face newer challenges, such as meeting health care reform mandates while continuing to balance budgets.

Nearly all rural hospitals are highly dependent on Medicare and Medicaid. Compared with urban facilities, a much smaller percentage of their patients are covered by private insurance.

Many doctors serving rural areas are aging, and incentives to bring in younger replacements have not been completely successful.

Many rural hospital buildings are older, too, having been constructed with help from funding from 1946 legislation to upgrade rural medical facilities, and now are grappling with a need to renovate or rebuild.

While larger cities can rely on several significant employers, rural communities often are driven economically by the presence of a school district and a hospital, often in that order.

Yet, despite the challenges facing rural health care, there are opportunities emerging that are yet to be discovered.

Larger, urban-based systems are bringing regional facilities under their umbrella - either by outright purchase or through network affiliations. Patients receive quality care at their local clinic or hospital and can receive highly specialized care through the urban owner or partner.

These regional health care systems also are establishing rural ambulatory centers, which offer limited short-stay capacity and helipad service to a larger facility.

While all may not agree this move to regionalized health care is good, it has provided a more sustainable and flexible footprint for general health care in communities that otherwise might go completely unserved or be significantly underserved.

Many rural hospitals are specifically positioned to offer community-based care, especially to patients with chronic conditions. This preserves local capacity to allow patients to age in place while still providing support for chronic care.

Continued advancements in telemedicine also may result in additional avenues of generalized patient and critical care services.

Bringing younger or specialized physicians to an area may be possible through mentorship programs or specialized medical school tracks for rural deployment.

Loosening of rules regarding allowed duties by physician assistants and nurses also may help fill in the gaps.

There certainly are other ways to combine services and resources that would help rural health facilities, and rural residents, continue to thrive.

Finding sustainable ways to provide high-quality, accessible health care to our shrinking rural populations will require flexibility in vision and tactics, keeping at the forefront the specific needs of the communities and people they serve. But it's necessary for our residents, our medical professionals and our critical rural areas.

Iowa's rural population may be shrinking, but the need for rural health and wellness services is as strong as it's ever been.

Our commitment to finding 21st century solutions to current problems in Eastern Iowa should be equally strong.

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