Rural health care is in crisis and while many solutions have been offered to encourage specialist physicians to practice in small towns, the fact that rural health care is still in crisis suggests none have been successful.
Cardiologists are an especially critical need in Iowa, as rural residents are more apt to suffer from heart disease, hypertension, and stroke. Studies have shown that just a single annual visit with a cardiologist can have significant health impacts.
However, Iowa has fewer than 200 cardiologists, almost all of whom live in urban areas, and their numbers are expected to drop by 10% in the coming years as many retire and aren’t replaced.
To make up for that lack of rural presence, many Iowa physician group practices have developed a network of visiting consultant clinics where urban physicians in many specialties, including cardiology, make periodic visits to rural areas to see patients. The networks provide reasonable access and effective care to most people who live in communities too small to support a full-time cardiologist.
But the model has weaknesses. Physicians who participate are unable to see patients while they’re driving, and this “windshield time” also includes mileage and other vehicle expenses. The opportunity costs are significant enough that only about half of Iowa’s cardiologists participate in an outreach clinic.
One model for addressing this concern comes from Australia, which has an even greater rural health care crisis than the United States. There, the Australian government’s Rural Health Outreach Fund subsidizes qualifying specialists as an incentive to practice in rural areas. Our study found that if a payment program were adopted in Iowa to subsidize physicians for their windshield time, the payments would cost about $430,000 a year to maintain the current level of cardiology care in rural areas, even after the anticipated decline in numbers.
While our study looked only at cardiology, the findings suggest similar public subsidies would be an effective way to at least maintain health care coverage in rural areas in other specialties. While we’ve generally been reluctant to suggest the government pay providers to practice in certain locations, we may have few other feasible options to provide equitable access to necessary health care to some 60 million rural Americans.
Thomas Gruca is professor of marketing at the University of Iowa’s Tippie College of Business. He can be reached at Thomas-gruca@uiowa.edu.
