FEATURE
A FINE TIME TO LEAVE ME LUCILLE 1 :
HOW HEALTH CARE IN RURAL AMERICA, AN ESSENTIAL PUBLIC SERVICE,
WAS ABANDONED FOR COMMERCIAL INTERESTS
AUTHORS Michael B. Flynn,MD, FACS and Dr. Eugene H. Shively, MD, FACS
Approximately
15-20% of
Americans
live in rural
America, depending
on
how rural is defined.
The federal government
has at least 15 definitions of rural. The Department of Agriculture
has 11 definitions. For the purpose of this paper we will
define rural as a county of less than 50,000 and not adjacent to an
urban area. 2,3
Bullitt and Shelby counties would not be classified as rural
because they are adjacent to Louisville (Jefferson County). Campbellsville
(Taylor County) has approximately 24,000 people and is
not adjacent to any urban area so it is considered rural. The health
outcomes in rural areas are much worse than urban areas. The factors
representing 81% of the causes include socioeconomic deprivation,
a high percent of uninsured people and a limited supply of primary
care physicians. 4
In 1946, Congress passed the Hill-Burton Act, a law that gave
hospitals, nursing homes and other health facilities grants and loans
for construction and modernization. 5,6 In return, they agreed to
provide a reasonable volume of services to people unable to pay and
make their services available to all people living in the area of these
facilities. It was a different time in this country. We had just won a
second long, draining world war and under the Marshall Plan were
in the process of reconstructing Europe. There was a sense that the
government has some responsibility for the welfare of all citizens.
This act of Congress increased the number of rural hospitals in the
US, especially in the South.
Rural hospitals have been closing since the 1980s, and the
Hill-Burton Act funding stopped in 1997. 6 Depending on the reference
source, somewhere between 21-25% of rural hospitals are
now at risk of closing. 7
Since 2010 and before the COVID-19 pandemic, 120 rural US
hospitals closed. It is estimated that 453 of the 1,844 rural US hospitals
are vulnerable. In Kentucky before COVID-19, 18 hospitals
(40%) were at risk of closing, 8 and 2019 was our worst year for rural
hospital closure. 8 Who knows what will happen in 2020, during,
22 LOUISVILLE MEDICINE