Sunday, August 09, 2009
In rural areas, lack of access is a crisis
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Beth O'Connor
O'Connor is executive director of the Virginia Rural Health Association in Blacksburg.
The July 27 Roanoke Times included a McClatchy-Tribune feature story about high-end hospital maternity wards in Minnesota ("Oh, baby"). The article detailed how birthing centers have developed into luxurious accommodations with spa-quality amenities.
I wish The Times would print an article about the maternity options available in the small, rural hospitals of Virginia. Unfortunately, the options are few.
There are seven hospitals in Virginia with the federal designation of Critical Access Hospital. CAH facilities have 25 beds or fewer and are at least 35 miles from any other hospital. Without these facilities, people in Bath, Dickenson, Giles, Page, Patrick, Rockbridge and Shenandoah counties would have to travel great distances for any medical service that required hospitalization.
Of those seven, only Carilion Stonewall Jackson in Lexington provides labor and delivery services. At any other facility, a woman who shows up in labor is put in an ambulance and driven to a hospital large enough to have a maternity ward.
Although emergency medical service personnel are trained to make emergency deliveries, this is not the best option for mother or child. To reduce the possibility of not reaching a hospital in time, women in rural Virginia are scheduling induced labor, which in turn contributes to other health issues.
Much of the national debate about health reform has focused on who is insured, who is not and how much health care will cost. Lack of obstetrical services in rural areas is something that affects women regardless of ability to pay. The richest woman in the world could show up at Carilion Giles Memorial Hospital in labor and she would still be transferred to a different facility.
The lack of obstetricians/gynecologists is just one example of how people in rural areas do not have adequate access to health care. There are many rural areas in the commonwealth with no practicing psychiatrists, psychologists, professional counselors or social workers.
None.
As a direct result, mental/behavioral health problems are not treated at an early stage, and those individuals who need emergency care likely will be transported out of their communities.
Rural Virginia is also lacking dentists and general practitioners. The stereotypical country doctor is fading away as Virginia's health care providers age. Data from the Virginia Board of Medicine suggests that more than half of Virginia's rural physicians will retire in fewer than 15 years. For more information on rural health issues in Virginia, I invite people to review Virginia's Rural Health Plan at www.va-srhp.org.
Change must come to rural America, too. For health reform to be a success, the health care crisis in rural America must first be resolved -- for it does not matter if you have health insurance coverage if you do not have access to a physician or other health provider. Legislation that finally addresses the long-standing inequities and disparities in rural America must be included as part of federal health care reform.
The rural health care safety net must be prevented from crumbling. A simple, yet multifaceted solution to the complex problem of delivering health care in rural America is needed. Three reforms are crucial:
1. The work force shortage crisis must be abated.
2. There must be equity in reimbursement.
3. Health disparities must be eliminated and vulnerable populations must be protected.
As Reps. Rick Boucher, Bob Goodlatte and Tom Perriello work with the rest of the House of Representatives on overhauling the nation's health care system, I ask them to remember that health insurance is not the same as health access.
