A NATIONAL AGENDA FOR RURAL MINORITY HEALTH SERIES:

THE NEED FOR RESPONSIVE RURAL HEALTH DELIVERY SYSTEMS





An Issue Paper Prepared by the National Rural Health Association— July 2001




BACKGROUND


The changing and interlinking dynamics of any community affect that community’s health status. For example, it is commonly understood that socioeconomic determinants such as income, educational level and age all affect one’s access to health care services, which in turn affects one’s health status. A number of studies have shown that minorities have poorer health and elevated mortality levels for many of the leading causes of death. Researchers report that between 1980 and 1990, every health indicator for which data were collected indicated an increasing gap between black and white populations (Amey et al. 1997; Greene et al. 1999; Mueller et al. 1997).
Perhaps not surprisingly, studies also indicate disparities in access to health care services for rural minorities. Health care access is worse for rural minority populations, even in comparison to urban minority populations. (Mueller et al, 1999). Other studies have pointed to the difficulties which minorities experience in obtaining needed medical care (McAuley 1998; Shi et al. 2001; Strickland and Strickland 1996). In many cases, minorities were provided less intensive treatment for their health conditions compared to whites.
In addition to access barriers such as uninsurance and lack of adequate transportation, minorities also often experience cultural and language barriers that can impede their access to appropriate health care. According to the 1990 census, 25.1 percent of Asian Americans, 23.8 percent of Hispanics, 4.5 percent of Pacific Islanders, 4 percent of American Indians/Alaska Natives and 0.9 percent of Blacks were linguistically isolated. And the number of people with limited or no proficiency in English is growing.



In the case of rural minorities and migrant farm workers, health care access problems are further exacerbated through the lack of participation in the development and implementation of community-based health care initiatives. Recruitment, retention, training, and promotion of racial and ethnic minorities within the nation’s health professions workforce will not only help eliminate disparities in the health care received by minorities, it will improve the health of all Americans. Racial and ethnic minority physicians are, in general, more willing to provide care to poor patients who find themselves with no insurance or public insurance such as Medicaid. Also, minority physicians can bridge linguistic, cultural, and historical barriers that hamper access to care (Pathman and Konrad, 1996).
The goals of Healthy People 2000 articulated the need to address health disparities for all Americans and there is specific mention of the major disparities between minorities and majority populations. The goals of Healthy People 2010 addresses issues relating to health care delivery systems for rural residents.

Health Delivery Systems Defined


The U.S. health delivery system is large and complicated enough to defy definition. For purposes of this paper, the health delivery system is understood to include a broad range of health-related activities and organizations, including but not limited to: preventive care, public health, primary, ambulatory and in-patient care, emergency and specialty care, dental care, mental health care, long term care. The fractious nature of the U.S. health care system – it isn’t one system at all, but a conglomeration of activities and organizations – contributes to its inadequacy with respect to health care for rural minority populations.

STRATEGIES/ACTION STEPS



A. Increase the Recruitment and Retention of Rural Minority Providers
1. Develop programs to enhance the identification and recruitment of rural minority providers.
2. Provide incentives to increase the number of high school students who choose health careers with enhancement programs.
3. Implement Centers of Excellence for Rural Minority Providers to increase the number of providers who practice in rural minority communities,
4. Implement an assessment of the number of rural minority professionals by disciplines.
5. Encourage health profession’s schools to include rural minority rotations in their curriculum.

B. Revise Financial and Payment Mechanisms to Ensure Reimbursements for Rural
Health Care Providers

1. Expand insurance coverage for the poor and near poor. The Children’s
Health Insurance Program (CHIP) represents a large step in the right
direction and is benefiting minorities. It seems appropriate that in this
time of great national prosperity, further reducing the ranks of the
uninsured would be a top national policy priority. The passage of
universal coverage legislation would solve the problem of the lack of
health insurance for low-income people.
2. Recommend programmatic changes for reimbursement for rural providers to increase access to health care services for rural minorities.
3. Increase funding for community and migrant health centers.

C. Facilitate linkages with Rural Minority Populations in the Health Care Delivery System
1. Implementation of data collection systems that document the number of rural minorities in Census Data Collection.
2. Ensure that programs are developed which require participation of rural minorities in health delivery systems.
3. Implement requirements that needs assessments are conducted in rural minority communities to document their health care needs.
4. Implement demonstration projects that facilitate minority participation in rural health care delivery systems.

D. Develop Programs and Initiatives to Improve the Health Status of Rural Minority Residents.
1. Implement programs to address the "Best Practices" of rural minorities to participate in health delivery services.
2. Develop programs and initiatives to increase the number of rural minorities in preventative services.
3. Develop programs that address the cultural and linguistic needs of rural minorities.
4. Ensure that managed care organizations develop sensitivity to rural
minority populations.


POLICY RECOMMENDATIONS


The authors make the following recommendations to Federal and State Governments:
1. Promotion of a culturally sensitive delivery system to establish and strengthen primary health care and safety net providers in rural minority communities.

2. Promotion to increase access and awareness to culturally and linguistically appropriate minority health care training for providers.

3. Promotion of building bridges between existing health care delivery services and other rural formal and informal community support systems.

4. Promotion and empowerment of rural minority persons, health groups and local leaders to become involved in their communities to decrease physical, financial, institutional and psychological barriers to health care.


REFERENCES


Amey CH, Miller MK, and SL Albrecht (1997). The Role of Race and Residence in Determining Stage at Diagnosis of Breast Cancer. Journal of Rural Health. Spring; 13(2): 99-108.

Greene PG, Smith DE, Hullett S, Kratt PP, and P Kennard (1999). Cancer Prevention in Rural Primary Care: An Academic-Practice Partnership. American Journal of Preventive Medicine. Apr;16(3 Suppl): 58-42.

Mueller KJ, Ortega ST, Parker K, Patil K, and A Askenazi (1999). Health Status and Access to Care among Rural Minorities. Journal of Health Care Poor and Underserved. May;10(2): 230-49.

Mueller KJ, Patil K, and F. Ulrich (1997). Lengthening spells of uninsurance and their consequences.
Journal of Rural Health 13(4): 29-37.

McAuley WJ (1998) Historical and contextual correlates of parallel services for elderly African American communities. Gerontologist. Aug; 38(4): 445-55.

Pathman DE and TR Konrad (1996). Minority physicians serving in rural National Health Service Corp Sites. Medical Care. May;34(5): 439-54.

Shi L, Politzer RM, Regan J, Lewis-Idema D, and M Falik (2001). The Impact of Managed Care on the Mix of Vulnerable Population served by Community Health Centers. Ambulatory Care Management. Jan;24(1): 51-66.

Strickland J and DL Strickland (1996). Barriers to Preventive Health Services for Minority Households in the Rural South. Journal of Rural Health. Summer;12(3): 206-17.

AUTHORS


Jeffrey J. Guidry, Ph.D., Associate Professor, Texas A&M University, Health and Kinesiology and School of Rural Public Health; 159 Read Bldg/MS4243, College Station, Texas 77843-4243, [email protected] (979) 862-1182.

Estelle Brouwer, Director, Office of Rural Health and Primary Care, Minnesota Department of Health, 121 East 7th Place, St. Paul, MN 55101, [email protected]
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