University Studies Rural Health Care

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University Studies Rural Health Care

By Jeff Arnold

Fort Smith Times Record, July 15, 2003

Researchers at Texas A&M University hope to find more efficient and cost-effective ways of delivering disease management services in rural areas by examining select rural health systems.

A common characteristic identified among rural populations in southern states — which rank as some of the least healthy in the nation — is less access to health-care services than their urban counterparts.

Nearly half of rural residents in the United States suffer from at least one major chronic illness. But rural residents average fewer physician contacts per year than urban residents, according to the Agency for Healthcare Research and Quality.

Dr. Jane Bolin, assistant professor at the A&M School of Public Health, said preliminary data in the school’s research project, “Disease Management in Rural Areas,” suggest even with fewer physician visits, the taxpayer burden of caring for rural residents with chronic diseases can be reduced through nurses’ monitoring patients while providing the patients with better care.

Because more rural residents live at or below the poverty level, work for smaller employers that don’t offer health insurance or have less comprehensive plans in general, they rely more on Medicare and Medicaid, Bolin said.

Although many rural health system administrators are concerned that providing home health nurses in rural areas for disease management will increase costs, preliminary data suggests overall costs are reduced in the long run.

“The thing about (chronic diseases like) diabetes and congestive heart failure is if they are not adequately managed and controlled, they worsen and the cost per patient is significant for health plans,” Bolin said.

A central Texas rural health system — which is among seven systems being monitored by the researchers — estimated patients in its diabetes-management program have 80 fewer hospital admissions per 1,000 patients per year than the patients who do not participate in a such program, since they began program in 2000, according to preliminary data.

The data provided by the central Texas system also showed patients in the diabetes-management program also required fewer days in the hospital than those not in the program and had lower prescription costs.

Although researchers hope to identify several successful strategies for providing disease-management programs in rural areas, Bolin said preliminary results indicate the systems that have strong plans have strong nursing care programs.

Bolin said Medicare and Medicaid are now looking at requiring health plans that contract with them to provide disease management programs.

But how to implement disease management programs under Medicare and Medicaid is still an obstacle according to testimony given in September by Dan Crippen, then director of the Congressional Budget Office, to the U.S. Senate Special Committee on Aging.

Crippen said lawmakers need to develop a system to determine how to identify and enroll beneficiaries, how to pay for disease management services and how to ensure that the interventions are cost-effective.