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