General Rural Health
Health Care Affordability and Medical Debt: Differences by Rurality, Region, and Socio-Demographic CharacteristicsThe high cost of health care affects health at both the individual and population level, and rural residents experience inequities in health, access to care, and financial well-being. However, little research has examined how health care affordability differs by rural/urban residence, and how health care affordability varies along geographic and socio-demographic dimensions within rural areas. Brief 2024 NRHA Policy PapersOur policy papers present an in-depth assessment of an issue, with background information, status, impacts, proposed policy interventions, and recommendations for action relative to the position. Policy papers are used to discuss a longer-term vision for a rural health issue and NRHA’s role in advocacy. Policy papers are developed as a resource to draw from, serve as references, and use as background information on issues critical to rural health. Publication 2025 Trends in the Health Workforce Supply in the Rural U.S.This report describes trends in the supply and distribution of clinicians in primary care, behavioral health, and obstetrical care, as well as dentists, surgeons, community health workers, and home health aides, in the rural vs. urban U.S. workforce nationally and regionally. Researchers examined the availability of current and historical workforce data for professions important for rural communities. Report 2024 An Updated Model of Rural Hospital Financial DistressGiven the ongoing challenges and consequences of rural hospital unprofitability, there is a clear need for accurate assessments of financial distress risk. The financial distress model can be used by researchers, policymakers, and rural health advocates as a screening tool to identify at-risk rural hospitals for closer monitoring.
Inspiring Rural Youth to Consider Healthcare Careers Through an Interpersonal Healthcare Traveling RoadshowThere are well-documented shortages of healthcare providers in rural and remote communities worldwide, and these shortages correlate with inequitable health outcomes for rural peoples. This paper will share our experience from 15 years of running this initiative, for those hoping to implement similar programs in other areas of the world.
Recruitment of Residents to Rural Programs: Early Outcomes From Cohort 1 of the Rural Residency Planning and Development Grants ProgramThis study highlights the early recruitment outcomes of the 25 Cohort 1 RRPD grantees establishing rural residency programs, offering insight into recruitment strategies, application trends, and initial grantee successes. Understanding these emerging programs’ experiences is crucial for educators and leaders striving to enhance equity and access to health care in rural communities.
Health professional retention in underserved areas: findings from the National Health Service Corps Loan Repayment Program participants in the United States, 2019–2021Health care provider retention is important for mitigating workforce shortages in underserved areas. The National Health Service Corps (NHSC) provides loan repayment for a two or three-year service commitment from clinicians to work in underserved areas. We observed that technical assistance and job resources were more influential on clinicians’ intentions, compared to individual- or community-level characteristics. Organizations with efficient and supportive work environments may help retain clinicians in underserved areas.
Understanding the Rise of Ransomware Attacks on Rural HospitalsHospitals face a growing threat from ransomware attacks that are designed to disrupt care delivery and may consequently threaten patient outcomes and hospital finances. This policy brief presents findings from a novel database of hospital ransomware attacks, focusing on the frequency and characteristics of ransomware attacks on rural hospitals.
New Report Concludes that Achieving Value in Rural Areas May Require Increased Spending. The Physician-Focused Payment Model Technical Advisory Committee (PTAC), an independent federal advisory committee, has transmitted a Report to the Secretary of Health and Human Services. This report compiles information from previous payment model proposals PTAC reviewed, literature addressing the topic, and input received during a rural-focused meeting last year. They conclude that while value-based care often focuses on improving quality while reducing spending, achieving value in rural areas may require increasing spending.
RUPRI brief on rural pharmacy presenceThe RUPRI Center for Rural Health Policy Analysis released a new data brief continuing its series of reports exploring the availability of retail pharmacy services in rural America. Researchers at RUPRI found that between 2018 and 2023 the number of retail pharmacies across the U.S. declined by 3.9%. During that same period retail pharmacies in rural areas declined by almost 6%. The overall number of rural communities with retail pharmacies changed little during that 5-year period, but there was a substantial number of community-level changes. 184 communities lost all local retail pharmacy service while 195 other rural communities gained retail pharmacy service.
Support for Vulnerable Rural Hospitals: Lessons Learned
An overview of state and federal programs and models designed to support Critical Access Hospitals (CAHs) and other rural hospitals describes challenges – including chronic workforce shortages, high operating and staffing costs, inadequate reimbursement, operational and regulatory issues, and the diverse demographics of rural communities.
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The state of rural healthcare. Research report and outlook for 2023
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Strengthening the
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Few rural hospitals have signed up for Federal program for funding.
NPR reports on the rural hospitals that have converted to the new Rural Emergency Hospital (REH) model. Just 18 of the more than 1,700 eligible rural hospitals nationwide have applied for and received the new designation. Many hospitals are reluctant to give up inpatient services entirely, and some are concerned about how other payment streams could be affected. NRHA’s Chief Policy Officer, Carrie Cochran-McClain, discusses several legislative changes to the designation that could make it more appealing and feasible for some rural hospitals
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Explaining Health Inequities — The Enduring Legacy of Historical Biases
This article is part of an invited series by independent historians, focused on biases and injustice that the Journal has historically helped to perpetuate. We hope it will enable us to learn from our mistakes and prevent new ones.
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Chartis Study Reveals America’s Rural Hospitals Fall Deeper into the Red as ‘Care Deserts’ Grow Bigger.
Chartis, a comprehensive healthcare advisory firm, released new research indicating that 50% of the nation’s rural hospitals are operating at a loss and 418 are vulnerable to closure. Data and insights from “Unrelenting Pressure Pushes Rural Safety Net Crisis into Uncharted Territory” will be presented this week to members of Congress, rural healthcare advocates, and state offices of rural health during the National Rural Health Association’s (NRHA) 35th annual Rural Health Policy Institute Conference in Washington.
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Institutional Efforts to Address Legacies of Slavery—Implications for the Health Care System
Despite having ended more than 150 years ago, the legacies of slavery continue to impact almost every aspect of life in the US, contributing to persistent and large disparities across a broad range of sectors. These disparities largely exist because of structural racism that is baked into society in big ways (laws, rules, and practices) and in everyday ways (how teachers treat children, how physicians care for their patients).1
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The Nature of the Rural-Urban Mortality Gap
Using data from the Centers for Disease Control and Prevention, researchers at USDA’s Economic Research Service find that the age-adjusted natural-cause mortality rate for the prime working age population was 43 percent higher in rural areas than in urban areas.
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Critical Access Hospital-Local Health Department Partnerships to Address Rural Community Needs
The Flex Monitoring Team (FMT) has released a brief on the operation of Critical Access Hospital (CAH) and local health department (LDH) partnerships, an important area of activity to improve population health and address the needs of rural communities. The brief is based on data from the American Hospital Association’s Annual Survey of Hospitals and qualitative interviews with four pairs of CAH/LDH partners.
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Regulate Artificial Intelligence in Health Care by Prioritizing Patient Outcomes
Artificial intelligence (AI) holds great promise to enhance the quality of health care. Despite the aim of health care regulations to ensure high-quality care, there are few regulations governing the use of AI in health care. This dearth will soon change because a White House executive order instructed the Department of Health and Human Services to develop new AI-specific regulatory strategies addressing equity, safety, privacy, and quality for AI in health care before April 27, 2024.
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Leveraging Career Pathway Programs: State Strategies to Combat Health Care Workforce Shortages
The National Conference of State Legislatures provides an overview of programs states have implemented to address or mitigate workforce shortages. The report describes programs across various stages of education, including K-12, community college, and undergraduate programs.
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How History Has Shaped Racial and Ethnic Health Disparities
This timeline offers a historical view of significant U.S. federal policies and events spanning the early 1800s to today that have influenced present-day health disparities. It covers policies that directly impacted health coverage and access to care, relevant events in medicine, social and economic policies and developments that influence health, and efforts to tackle inequalities.
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2023 Health Workforce Research Symposium: Addressing Health Workforce Shortages Now & In the Future
On October 11th, HWTAC hosted the 2023 Health Workforce Research Symposium at the National Press Club in Washington, DC. The streaming component—which included Sessions 1 and 2—is now available to watch on demand.
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Access & Affordability The state of the U.S. health system in 2022 and the outlook for 2023
In this brief, Peterson-KFF Health System presents a dashboard showing health spending in the US that far exceeds what peer countries spend and growing out-of-pocket costs. Besides assessing the current state of the US health system, there is a discussion of 2023 in the context of the ending of the public health emergency, depletion of federal COVID funds, and strain on the healthcare workforce.
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Rural-Urban disparities in Medicare
A new report from CMS explores rural-urban disparities in health care in Medicare. The analysis relied upon data from the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys and the Healthcare Effectiveness Data and Information Set (HEDIS). Overall, the report states that people with Medicare living in rural areas had results that were below the national average for the Consumer Assessment of Healthcare Provider and Systems (CAHPS) survey scores for about 20 percent of all clinical care measures examined with rural residents. The analysis also explores variations in racial and ethnic differences in bot rural and urban areas.
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What rural health providers want from Washington
NRHA recently sent a letter outlining actions Congress can take to shore up rural health care, ranging from enhanced support for staff retention at the poorest facilities to carveouts from some controversial policies strongly opposed by the broader hospital industry.
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Lessons in Rural LeadershipProvides guidance on cultivating leadership among a rural behavioral health workforce. Highlights some challenges for building mental health workforce leadership curriculum and discusses local barriers faced by a rural behavioral health workforce, such as insurance coverage, transportation, and housing, among others.
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Iowa Healthcare Workforce Strategic Planning and Stakeholder Engagement InitiativeThe goal of this initiative is to use input from local communities and healthcare workforce
stakeholders to identify actionable solutions that would advance Iowa’s healthcare workforce. Through a variety of stakeholder events and meetings with healthcare providers, this initiative has gathered the insight necessary to assemble a Strategic Action Plan. |
Behavioral Risk Factor Surveillance System Survey Findings Brief
The BRFSS is an annual, state-based survey system that collects data on health-related risk behaviors, chronic health conditions, health care access, and use of preventive services from the adult (≥ 18 years) population in Iowa using telephone interviews.
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Understanding the impacts of rural hospital closures: A scoping review
Rural hospitals are closing at unprecedented rates, with hundreds more at risk of closure in the coming 2 years. Multiple federal policies are being developed and implemented without a salient understanding of the emerging literature evaluating rural hospital closures and its impacts.
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Experiences of Safety-Net Practice Clinicians Participating in the National Health Service Corps During the COVID-19 Pandemic
The impact of the COVID-19 pandemic has been particularly harsh for low-income and racial and ethnic minority communities. It is not known how the pandemic has affected clinicians who provide care to these communities through safety-net practices, including clinicians participating in the National Health Service Corps (NHSC)
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Interventions for health workforce retention in rural and remote areas: a systematic review
Attracting and retaining sufficient health workers to provide adequate services for residents of rural and remote areas has global significance. High income countries (HICs) face challenges in staffing rural areas, which are often perceived by health workers as less attractive workplaces. The objective of this review was to examine the quantifiable associations between interventions to retain health workers in rural and remote areas of HICs, and workforce retention.
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Taking Action Against Clinician Burnout
Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care.
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