 |  |
| Medical Information: Urban Hospital Policies are Killing Rural Care |
| Nicholas V. Costrini, M.D. Medical Director Georgia Gastroenterology Group, PC |
| We all have laughed at the Jeff Foxworthy jokes about rednecks. In fact these jokes are so much a part of the American culture we have come to accept the fact that much of our country is still very much country. In more sober moments we all also acknowledge that there is some allure to the concept of rural life. Compared to the stereotypical jabs at the modern, urban condition, we find comfort in the notion that there are still some places in America where one knows and cares for neighbors, where one has time for breakfast (even if its before the chickens are up), and where you can walk down the street and see someone whom you first knew in grade school. I once asked a nurse at a rural hospital, What time do the cows come home? She replied easily, Usually before six. City folks are always in a hurry; country folks take time to enjoy family, friends, and a cool evening breeze. City kids go to prep schools and never do learn respect for parents, traditions, and nature. Children in small towns learn these values from grandparents who are equally respected. Perhaps all of these distinctions are less true as time, social evolution, and economic reality hammer away at much of what we all would like to think is preserved or has sanctuary. In reality, life in rural Georgia is hard. Rural counties and small towns in our state have higher poverty levels, higher unemployment, higher aging populations as young people move away in search of educational opportunity and financial security. Rural communities also have higher rates of chronic illness and poorer access to highest quality medical care. Thirty percent of Georgias counties are defined as rural, and are classified as economically lagging or declining by the Georgia Rural Development Council. This Council, in its Report, Rural Health In Georgia: A Framework for Success, linked the economic woes of these counties with important health statistics. Lagging or declining rural counties reported higher rates of heart disease, cancer, and diabetes than did more prosperous counties or the state as a whole. Because of the poor ability of such counties to even collect reliable health data, the exact numbers are probably not true but the general thrust of the data is likely true. Rural folks are smart and know when trouble is brewing. While they would rather receive their healthcare locally, they know that most rural hospitals are in financial trouble and at risk for closure. Seventy percent of the states hospitals that have gone belly-up in the past three years were located in rural Georgia communities. Factors contributing to the failure of many rural hospitals include a loss of Medicaid support as residents have been forced off this government program, loss of jobs in the region leading to higher proportions of uninsured and under-insured patients, and also to the travel of patients from local care facilities to urban hospitals for all kinds of care, even for those services which could be provided by local physicians and hospitals. In order to gain market share, urban hospitals have developed marketing strategies that are designed to draw patients from rural areas and rural hospital programs. Breast cancer screenings, hypertension clinics, well-baby care programs aimed at patients in Pembroke, Claxton, Reidsville, and Vidalia are marketed as being the best for improving the care of rural Georgians. In fact, the worst thing that ever happened to a rural Georgia hospital is oftentimes (with few exceptions) the hungry, deep-pocketed, urban medical center with a marketing department as big as McDonalds. Nearly all urban hospitals in Georgia have this same mindset. In luring patients to the city, they threaten and frequently destroy the financial infrastructure of the rural hospitals. Rural hospitals are cultural, social, and economic centers for small towns. The death of a rural hospital is not just a loss of a few hospital beds that can be absorbed by a competing hospital down the street; it is a tragedy of disastrous proportions. Big hospitals take a Darwinian approach survival of the fittest. Unless the state and Savannahs local hospitals reassess their programs and demonstrate a sincere interest in rural hospital financial health, the death toll will continue to rise in parallel with the expanding budgets and annual reports of our urban hospitals. Urban hospitals have their share of economic woes to be sure, but they morally cannot solve their own problems by putting the very existence of rural hospitals at risk. Rural hospitals also have the responsibility to be proactive; to select revenue-generating programs needed by the public and that also fall within the scope of their capabilities. Many rural hospitals apply this formula and are fiscally sound beacons of care for many Georgians. One of the most enlightening and enjoyable meetings one can attend is that of a rural hospital board. Some members wont wear a tie; some have just finished plowing the fields; but most of them know whats goin on. You see, their mommas didnt raise no fools.
|
|
|
|||||
|
|||||
