The Ethical Issues Surrounding Rural Health Care Delivery

Is it ethical for rural residents to be deprived of an adequate health care system?

One of the major challenges rural areas are facing is lack of physicians. Physicians are not attracted to practice in rural areas for several reasons. First, the demand for their service may not be to their satisfaction. Since the revenue of physicians is often dependent on the number of patients they see, their income will be directly affected by the lack of demand. For this reason, they much rather service areas where they are needed to maximize their value. Their goals are not to perform charity care or work in an area that will eliminate their opportunity to maximize their income. Their goal is also not to under utilize all of the skills and knowledge they acquired during the course of their training. Working in a rural area will not generate the opportunity to maximize their value and grow in their profession because the area is too scarce. It is even more challenging to have specialist and mental health providers because the demand is not evident. For this reason there is a massive shortage of specialist and mental health providers. A neurosurgeon will probably undergo at least 17 years of post secondary education. His annual salary is obviously dependent on the number of surgeries performed. In a rural area, it is vastly doubtful he will have many opportunities to utilize his skills.

A second major problem is generating funding to build a hospital. The federal government is not in the business of delivering health care. It is not economically logical to build a huge facility that will not demand a constant rotation of patients. In the past, it was difficult to attain 50% above occupancy rate in a 30-49 beds facility. There are not enough available funds to operate such a facility. A hospital cannot afford to employ doctors, nurses, technicians, nurse practitioners, physician assistant and administration staff on a daily basis if the beds are not occupied. Unlike the urban areas, there will not be enough volume of patients requiring services from doctors and nurses to compensate them. In order to operate a hospital financially, quality care and capital needs to be generated on a daily basis. It is crucial for a hospital to receive adequate amount of patients to be successful.

The United States have made some efforts to overcome some of these challenges. In 1948 they started the Hill Burton Act. This bill took federal money to build hospitals. Over 3,500 hospitals were built however many shut down due to lack of funding and problem noted above. Another method that was used is telemedicine. This was geared towards radiologist. Radiologist was able to diagnose patients using imaging studies. This method was effective because physicians were able to view these imaging away from their office. Although this method brought some resolution to the problem, it opened another drawback which was lack of physical contact with the patients. It is important that patients are physically examined and consulted by a clinician. This is just practice of good medicine. Two other ways the government made some efforts to alleviate some of these challenges were through paraprofessional and ambulatory care clinic. It was obvious patients needed to have physical contact with the physicians. These two methods were able to subsidize health care to rural area. Patients had a location to be treated and evaluated by a clinician.

The question states is it ethical for rural residents to be deprived of an adequate health care system? In my opinion, the elimination of the deficiencies is warranted. In order to eliminate the deficiencies, recruitment of more physicians who appreciate the challenge to work in rural areas is necessary. I understand the privilege that comes with being a doctor; however, the reward stills lies on providing quality care to patients in need. With the assistance from the government, special grants and scholarship can be offered to medical students, PA’s and NP’s with the commitment of servicing rural areas for a period of time upon completion of their studies. Loan repayment for licensed physicians who are willing to commit their services to a rural area is also an attractive incentive. Educational scholarships to current residents of the rural areas may generate committed providers because since they already live in these rural areas, they are more likely to stay there once they complete their education. As an alternative, I would recommend the establishment of mini care stations throughout the different communities of rural area. This has proved to be quite useful in many states because of its convenience and cost effectiveness. Care station offer basic primary care services at an affordable rate. They are usually employed by physicians and cost effective mid level clinicians and are available on a walk in and appointment basis for non emergent and semi-emergent cases. The facility is not as big and costly as a hospital but offers more than a private doctor’s office. Instead of having one big hospital, the idea of having a few mini care stations could bring better results. I would also campaign for more preventative medicine strategies. Until the shortage is resolved, the healthier the rural residents remain the less doctors, facilities and specialist will be needed. Physicians should not base their decision of where they will practice on the basis of the potential income they will generate; it should be based on the need and the difference their commitment will make in the lives of all human being. Urban or rural, rich or poor, black or white, female or male.