Small, independently owned pharmacies play a broad role in health care delivery in rural areas and provide essential clinical services such as blood pressure monitoring, immunizations, and diabetes counseling. Unfortunately, many of these pharmacies are at risk of closure due to the adverse effects of Medicare Part D negotiated networks on their financial viability.
Researchers from the UI College of Public Health’s Center for Rural Policy Analysis (RUPRI) recently analyzed the rural populations served by these pharmacies, as they are most at-risk to lose access to some of these essential clinical services. Understanding the characteristics of this vulnerable population may be useful for proposing policy changes.
According to the research team, in 2014 more than 2.7 million people lived in 663 rural communities served by a sole independently owned pharmacy, and more than one-quarter of these residents (27.9 percent) were living below 150 percent of the federal poverty level. More than 19 percent of them were above age 65, while more than 35 percent of residents were dependent on public insurance or were uninsured.
For a majority of these rural communities, the next nearest pharmacy is more than 10 miles away, which creates access problems for these populations since they are also those most likely to experience barriers to travel (i.e., low-income, publicly insured, and aged 65 years and older). Consequently, loss of a sole, independent pharmacy may deprive many of these rural community members of access to essential clinical and pharmacy services, even if they can continue receiving medications through other means such as mail order or delivery from another location.
Read the full RUPRI policy brief.
A high performance rural health care system, incorporating principles of affordability, accessibility, community focus, high quality, and patient centeredness, could be built upon existing rural primary care services, according to new policy paper from the Rural Policy Research Institute (RUPRI) Health Panel.
“There are growing concerns about the current and future state of rural health care,” says Keith Mueller, Ph.D., chair of the health panel and head of the Department of Health Management and Policy in the University of Iowa College of Public Health. “Health care systems in rural America face disadvantages that their larger, urban counterparts do not, namely disproportionally ill and disabled citizens, under-financed primary care, and geographically isolated providers.
“We believe that a high performance rural health care system, informed by the needs of each unique rural community, will lead to greater community health and well-being,” Mueller says.
In the paper and accompanying brief, “Advancing the Transition to a High Performance Rural Health System,” the RUPRI Health Panel recommends a range of alternative approaches to achieve a high performance health care system, and builds on the panel’s earlier work that conceptually defined the core elements of such a model.
“We previously described where we ought to be in terms of rural health care,” continues Mueller. “We must now take it a step further and explain how we get there – offering strategies and options for creating a pathway to a transformed, high performing rural health system.”
The panel categorizes approaches to achieve its goal of an improved health system into four basic groupings: community-appropriate health system development and workforce design; governance and integration approaches; flexibility in facility or program designation to care for patients in new ways; and financing models that promote investment in delivery system reform.
In addition, each of the four approaches includes a brief discussion of policy considerations and comments about demonstration ideas that can further these approaches.
The RUPRI Health Panel was established in 1993 to provide unbiased analysis and information on the challenges, needs, and opportunities facing rural America. RUPRI’s aim is to spur public dialogue and help policymakers understand the rural impacts of public policies and programs. RUPRI’s reach is national and international and it is one of the world’s preeminent sources of expertise and perspective on policies impacting rural places and people.
Funding for this project was provided by The Leona M. and Harry B. Helmsley Charitable Trust.