FROM THE COVER
addition , having adequate health care locally available also attracts nonhealth related businesses to the area . Other major indicators of Alabama ’ s rural health crisis include the following :
• Alabama has the 4th highest death rate among all 50 states , with the rate in our rural counties being 11 percent higher than that for our urban counties .
• Alabama ’ s life expectancy at birth is three years less than that for the nation and three-and-a-half years less for our rural residents .
• Only two rural counties ( Coffee and Pike ) are recognized by the federal government as having enough primary care physician service available to meet the minimal ( not optimal ) needs of the population . No rural counties have enough dental service for the Medicaid population to meet the minimal needs . No rural counties have enough mental health care to meet the minimal needs .
• According to iVantage Health Analytics , 32 of 46 rural Alabama hospitals are operating in the red . It is common for hospitals with chronic financial difficulty to eliminate services that are a financial drain . Obstetrics is such a service at most smaller hospitals . In 1980 , 45 of Alabama ’ s 54 rural counties had hospital obstetrical service available . Today , only 16 of the 54 rural counties have this basic service available .
While the lack of health care access and poor population health status are complex issues with many needs to correct the entire problem , the following are possibilities for improvement :
• Expand the scope of practice for nurse practitioners . Alabama is one of the most restrictive states in utilizing these highly-trained health care practitioners .
Nurse practitioners are working with rural physicians to expand clinical hours to provide health care access during non-typical rural clinical hours , and clinical days are being expanded to include weekends . More adequate use of nurse practitioners is increasing access to health care in our rural areas and can do much more if restrictive rules are relaxed .
• With the health care access issues that we have in Alabama , we should be a leader in the expansion of telemedicine . This very promising technology is expanding in Alabama , but we lag behind most states in promoting this expansion . Georgia , Mississippi , and Tennessee have passed legislation requiring private insurance reimbursement for telemedicine services . Blue Cross / Blue Shield of Alabama is to be applauded for voluntarily providing reimbursement for several major types of telemedicine services . To fully take advantage of this technology , Alabama needs to enhance reimbursement and expand broadband access .
• Alabama needs to authorize a type of rural hospital with only a few beds where these can financially survive without threatening existing rural hospitals . Currently , hospitals with fewer than 15 beds cannot be licensed in Alabama . Such facilities exist in many rural areas in other states , including Mississippi and Tennessee . The national trend is moving to small bed count rural hospitals that utilize telemedicine access and have patient transfer agreements with more comprehensive medical centers . Alabama ’ s health care
stakeholders also need to assist our rural hospitals in developing new streams of revenue .
• Rural county residents and officials can become more involved in local health care by establishing a county health coalition , similar to the Coalition for a Healthier Escambia County . These coalitions can have members from hospitals , physicians , dentists , mental health , public health , EMS , dialysis , education , law enforcement , domestic counseling , county and city government , the religious community , local businesses , etc . Together , local health issues and needs are identified and this coalition works together with a loud voice to secure what is needed . It is possible that such a coalition could expand its interests and activity beyond health care to include other areas of local need .
The Alabama Rural Health Association works for the preservation and enhancement of health to rural citizens of Alabama . For additional information , contact ARHA at 334- 546-3502 or arha @ arhaonline . org . n
GET IN THE GAME
Wednesday , Aug . 23 “ RURAL HEALTHCARE NEEDS IN ALABAMA ”
Dale Quinney & Farrell Turner , Alabama Rural Health Association
Afternoon General Session
22 | COUNTY COMMISSION