One of the biggest problems facing rural America today is lack of access to healthcare in the area. While not every rural area is experiencing a shortage in doctors and nurses, shortages are much more pronounced in rural areas than urban ones. According to federal data, only 14% of Americans live in a rural area, but rural areas experienced two-thirds of the shortages in primary healthcare professionals.
Recently, the Center for American Progress (CAP), an independent, nonprofit policy institute, produced a hefty report on ideas that might alleviate these shortages. We recommend reading the entire report, but we’ll highlight some of the issues in this blog post.
The CAP’s general conclusion is that we need to stop making it hard to practice profitably in rural areas. To do that, we need to reduce the relative cost of practicing, both in terms of education and malpractice insurance. We also need to ensure that alternative healthcare delivery systems, such as telemedicine and mobile treatment clinics, are covered by insurance and reimbursed at the same rate as traditional ways of doing things.
Offering more low-interest loan programs and student loan forgiveness
One way we could reduce the cost of doing business for rural doctors is to make sure they can afford the cost of their education. According to the Association of American Medical Colleges, the average doctor leaves medical school with $203,000 in student debt.
Unfortunately, the existing federal loan forgiveness program that rural doctors can be eligible for only forgives a total of $50,000. Iowa could supplement this program and offer additional loan forgiveness to medical professionals who practice in rural areas for a given period of time.
Another need is simply a way for lower-income people to access medical school at all. The Kaiser Family Foundation estimates that rural healthcare settings will need an additional 14,858 providers to eliminate current shortages.
Iowa could choose to subsidize these loan programs further because they don’t currently cover the full cost of tuition. For example, a first-year medical student at an in-state, public school can expect to pay $36,365 in tuition. But the maximum loan available through these programs is for $12,500 a year.
Lowering medical malpractice costs
There is no doubt that medical malpractice insurance is costly. According to a 2004 study of rural physicians in Florida in the Journal or the American Medical Association, those rural doctors who planned to leave the community within the following two years cited the cost and availability of medical malpractice insurance as an important factor in their decision.
One way to reduce the cost might be to protect doctors from frivolous claims. A medical malpractice claim requires proof that the healthcare provider failed to provide the generally accepted standard of care. If doctors could document that they were adhering to evidence-based standards and following all appropriate guidelines in diagnosis and treatment, they could potentially be immune from suit.
This might also reduce wasteful “defensive medicine” – performing unnecessary procedures or consultations to stave off accusations of negligence.
Allowing innovation in the provision of care
Finally, the CAP notes that insurance may not cover telemedicine and its associated costs at the same rate as in-person care. For example, many insurance companies don’t pay when providers store and forward records, which is necessary to provide effective telemedicine. Iowa could mandate the coverage.
Similarly, mobile clinics might be a great opportunity for expanding healthcare in rural “healthcare deserts.” Research has shown they provide good health outcomes at low cost. However, they are currently mostly run for uninsured patients. This could be expanded.
A lot needs to be done to ensure that people in rural areas have the access they need to quality healthcare. What do you think of these ideas?