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10 Strategies to Fix Ruralcare


Money, manpower, and medical records are killing rural hospitals. Throwing money at them won’t fix the problem, but these 10 ideas might.

Rural healthcare is in trouble and hospitals are closing at an alarming rate. I'm a city guy, but from what I can see, rural hospitals face many challenges and, in many instances, their closure threatens the very fabric of the communities they serve. Given the changes that have occurred in how we provide and pay for sick care, what are some possible solutions? Here are 10 ideas:

1. Address the manpower gap with intensified efforts to recruit doctors, nurses, and spouses with loan forgiveness programs, sabbaticals, rotations to more urban areas, and connectedness to colleagues. Rethink our "confused" immigration policies to make it easier for IMGs to practice in under-served areas.

2. Fortify already-existing rural health education programs in medical schools.

3. Provide health information technology subsidies to rural areas to relieve them of the financial burden of expensive EMRs and other data systems that threatens to bankrupt them. Think telecom subsidies and the taxes we all pay.

4. Reduce the demand for services by fixing the socioeconomic determinants of health disparities that are unique to rural communities

5. Install free high-speed broad band access.

6. Unbundle rural care. Consolidate emergency services and take advantage of existing cloud-based clinical care technologies like telemedicine and virtual clinics.

7. Roll up distressed rural hospitals and sell them to private equity to fix and flip. Possibly, securitize their assets without creating another Big Short.

8. Encourage the development of more rural-based innovation districts rather than concentrating them into major urban zones.

9. Make interoperability real.

10. Change the rules.

Rural sick care access and quality is not just a problem in Kansas. It is a global challenge and there are many lessons we can learn from underdeveloped countries.

Money, manpower, and medical records are killing rural hospitals. They need relief and just throwing more money at them won't fix the broken model. The last thing they need is some big city slicker like me telling them how to solve their problems.

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Victor J. Dzau, MD, gives expert advice
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