Disparities between urban and rural healthcare need to be overcome

By Guest Columnist MATT CASEMAN, executive director of Georgia Rural Health Association, which is based in Sandersville

These are the facts:

* If you suffer a traumatic injury in rural Georgia as opposed to a metropolitan area, you are more likely to die.

* Seven counties in Georgia do not have a family physician; 65 counties do not have a pediatrician; 67 counties do not have a general surgeon; 68 counties do not have an OB/GYN; and 115 counties do not have a neurologist.

* Rural Georgians are more likely to be un-insured or underinsured and suffer from heart disease, diabetes, obesity and cancer.

Pretty telling, don’t you think?

Matt Caseman

There are many reasons contributing to the huge disparity. Younger populations are more centrally located in urban cities, whereas rural areas tend to be older and therefore have a greater need for critical healthcare services.

Furthermore, because of a lack of corporate jobs, many rural Georgians are self-employed, which means they pay more for health insurance resulting in fewer trips to the physician’s office.

Large numbers of rural Georgians are on Medicaid, the state/federal program for the poor. But low Medicaid reimbursement rates are causing doctors to rethink seeing those patients because in many cases it does not even cover overhead cost causing physicians to leave rural areas or practice in another state.

With these facts in mind, it is clear Georgia needs a dedicated revenue stream to upgrade and expand its trauma center network. Thirtythree states have found ways to permanently fund trauma care, but our state lags behind which is putting rural Georgians at a higher risk of death after a traumatic injury.

Here are some trauma care facts:

• Georgia has 150 acute-care hospitals, but it has only 15 designated trauma care centers.

• More than one million Georgians live at least 50 miles from a Level 1 trauma center — the kind that handles the most serious cases. That distance makes it virtually impossible to get them to such a facility within the “golden hour” — the period after a major trauma accident when emergency responders have the greatest chance to save a life. Many Georgians commute through areas that are similarly remote from lifesaving facilities.

• In metro Atlanta, there’s one fatality in every 339 accidents. In rural Georgia, it’s one fatality in every 74 accidents.
All this demonstrates how vital the rural health infrastructure is to Georgia’s small communities and their respective economies.

The hospital or the school system is usually the largest employer in rural counties. Not only are these small hospitals and Critical Access Hospitals saving lives and providing healthcare, but they also help put food on the table. There are 34 Critical Access Hospitals in the state that receive cost reimbursement from Medicare.

The National Rural Health Association, along with other non-profit organizations, is working tirelessly to protect the CAH network and other valuable rural health safety net programs before Congress.

In addition, Federally Qualified Health Centers serve large populations of the uninsured and are in 77 counties in Georgia at 135 clinical sites. FQHCs, also known as Community Health Centers, are a type of provider defined by the Medicare and Medicaid statutes.

They provide services to all persons regardless of their ability to pay, and charge for services on a community board approved sliding-fee scale that is based on patients’ family income and size.

In rural Georgia, Rural Health Clinics serve 55 counties. All RHCs are required to be located in a Health Professional Shortage Area to receive cost reimbursement.

This rural health infrastructure is essential for providing quality, affordable, accessible care to millions of our citizens. It is important that we not only support this network, but also that we find creative ways to expand and finance their long term growth.

There are positive signs however.

For example, Telehealth, the use of electronic information and telecommunications technologies to support long-distance clinical health care is expanding everyday. This innovative solution provides a means by which a patient without leaving their local doctor’s office is able to receive a diagnosis from a specialist located hundreds of miles away.

Our state is on the cutting edge of telemedicine because of the Georgia Partnership for Telehealth, one of the leading non-profits in the nation focused solely on these services.

Funding was also approved in this year’s state budget for new residency slots, FQHCs and Area Health Education Centers. These AHECs recruit, train and retain a health professions workforce committed to underserved populations.

The Georgia Rural Health Association’s 2012 R.U.R.A.L. Legislative Agenda included:

* Raising the Medicaid reimbursement rate;

* Upgrading and expanding the trauma care network;

* Reinvesting in primary care;

* Advocating for rural health safety net program;

* Lowering smoking rates by increasing the sales tax on cigarettes.

These will remain priorities next year for GRHA because they would all greatly benefit the state.

Georgia defines a rural county as having a population of 35,000 or less. Of the state’s 159 counties, 109 are considered rural with an approximate population of 1.7 million. Having to do more with less, the health providers in these communities are performing an outstanding job of administering care. They deserve our full support.

The Georgia Rural Health Association is committed to advocating relentlessly for the rural citizens of our state. Please visit the GRHA website at www.grhainfo.org for more information and learn how you can become an advocate, too.

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