Abstract
This chapter discusses the key health challenges faced by rural families, the major national policies and programs for rural health, and the process and political context of policymaking for rural health. It first provides an overview of the health condition in rural areas and health disparities as well as their linkage to poverty in rural communities, followed by an overview of the existing government health policies and programs for rural areas and a critical analysis of the federalist system in health policymaking. Then it offers a brief overview of the American federalism and major decision-making models for health policy and discusses their application to health policy decision-making in the United States. The last part concludes by providing policy recommendations for addressing health challenges for rural families and children. It is hoped that this chapter will help professionals in social, health, and human services understand the complexity of addressing health challenges faced by many rural families and children through policy and program interventions.
TopBackground
Despite the remarkable progress achieved in recent decades in health care, including the passage of Affordable Care Act (ACA) and the expansion of Medicaid programs, access to health care remains a major challenge to many rural communities in the United States where about 46 million live, representing about 14% of the country’s population. It is apparent that there is a large gap in access to medical care between rural and urban areas (Rural Health Information Hub, 2018). Policymakers and researchers have made efforts to understand the causes of the gap and to find solutions to address this challenge. However, there is a unique set of challenges faced by different regions of the country in the provision and access of medical care.
Policy solutions to health challenges in rural areas must also take into consideration the unique incentive structure in health services. In healthcare systems, profit motives are pitted against system-wide efficiency and effectiveness. To illustrate, sources suggest that perverse incentives in the current health care payment system often put profit before patient care and health outcomes. The current pay-by-procedure structure in Alabama for obstetrician-gynecologist service motivated physicians and hospitals to overprescribe procedures and leads to poor birth outcomes (NPR, 2018). Other research suggests that increases in reimbursement rates are correlated with better health outcomes such as lower infant mortality (Currie & Gruber, 1994). The single-payer system and universal access to health care, however desirable, are politically infeasible in conservative states where they are most needed. Further research into the political process for reforming health policy at the state and even national levels will facilitate the reform process by discovering these types of systemic problems and bring positive changes to health care systems.
Key Terms in this Chapter
Access to Healthcare: Availability of health services, which can be in form of physical/geographic distance, or affordability.
Health Disparities: Differences in health condition such as disease, injury, violence, or opportunities to achieve optimal health among social populations.
Agenda Setting: A theory that describes how the topics of the public agenda are determined by news media or other actors.
Health Condition: State of physical, mental, and emotional well-being.
Social Determinants of Health: Factors that affect health, including socioeconomic status, education, employment, community environment, and social support network.
Policymaking Model: A theoretic framework that describes policy formulation.
Stream Theory: A theory that describes the process of policy change and hypothesizes that three streams—problems, politics, policy solutions—have to converge at right time for a change to happen. The theory is contributed by political scientist John Kingdon.
Rural Health: Health condition in rural residents. Sometimes this term refers to rural medicine, which assumes different needs of rural residents.
Federalism: A form of government that state and local governments share power with the federal (national) government. It generally contrasts to the other two forms of government: union and confederation.
Infant Mortality Rate: Infant deaths per 1000 live births, which is a key performance indicator for a health system.
Rural Poverty: An economic condition in rural area, which typically refers to annual household income below $24,000.
Affordable Care Act: A.K.A. “Obamacare,” refers to the comprehensive health reform enacted in 2010 during Obama administration, which provides subsidy for low-income households and mandates insurance for employers and individuals.