Local Commentaries
11:21 am
Wed March 10, 2010

Bill Knight - March 11

Macomb, IL – The economy and health care are so closely linked in rural areas that both individuals and communities are profoundly affected, according to independent studies. Struggling local economies often result in fewer people protected against injury or illness.

Rural Illinoisans in particular are far less likely to have health insurance than others, according to Illinois Research Teaching Outreach, which notes rural residents are therefore at increased risk for financial devastation, poor health care, or both.

Just 25% of rural hospital patients were covered by private health insurance, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ). Of rural residents who are employed, about one-third work for small businesses, but fewer than half of that number have health insurance from their employers. So, they pay individual premiums, medical expenses, go bankrupt or pray they'll never get ill or injured.

University of Illinois Cooperative Extension specialist Paul McNamera said, "In my interviews with health-care workers, rural residents, and social workers around Illinois, I have heard repeated stories about the difficulties that low-income people in rural Illinois face in affording health insurance and in obtaining appropriate health care when they do not have health insurance."

Medicare patients account for 45% of all stays at rural hospitals, the AHRQ reported last month. Urban hospitals report just 35% Medicare patients.

Meanwhile, over the last 25 years, 470 clinics and hospitals have closed in the rural United States for lack of funds, and more than 2,100 areas suffer from acute physician shortages.

The National Center for Rural Health Works shows that one primary-care physician working in a rural area generates $1.2 million in annual revenue and creates 23 jobs. One hospital typically accounts for as much as 20% of a local economy. A loss of providers, by contrast, results in devastating hardship: Even the departure of the equivalent of one-half of one full-time doctor translates into a decline of more than $500,000 in community income and the loss of 14 jobs.

The loss also can inflate costs for patients who must go to the remaining regional health providers, which charge substantially higher rates and must pass along higher costs for transporting patients from outlying areas.

Val Schott, director of the Oklahoma Office of Rural Health at Oklahoma State University, said, "Health care is the No. 1 provider of jobs good jobs in rural areas. On the reverse side, as we see health care fail we see whole communities dry up and virtually disappear. Health care is critically important to payroll and jobs but also to any kind of economic development, because no one is going to move where there is not good care."

The five most common illnesses among the two-thirds of rural residents hospitalized in rural facilities were pneumonia; congestive heart failure, chronic obstructive lung disease, chest pain, and fluid and electrolyte disorders.

Cynthia Moothart, policy director with the League of Rural Voters, said, "Opponents of health reform argue that we should allow the free market to do its thing, that somehow corporations which have put decades of profits over people will turn things around. As a native Iowan working on behalf of rural communities, this blinkered thinking sadly suggests Harold Hill arriving back in River City with the promise of new trombones."

The AHRQ News and Numbers is based on data in "Inpatient Stays in Rural Hospitals, 2007." The new report uses statistics from the 2007 Nationwide Inpatient Sample, a database of hospital inpatient stays that's nationally representative of inpatient stays in all short-term, non-federal hospitals. The data are drawn from hospitals that make up 90 percent of all discharges in the United States and include all patients, regardless of insurance type, plus the uninsured.