Rural healthcare access at risk

Health care remains an issue of debate across our country. However, when it comes to rural health care, the issue is complicated further by geography and a lack of providers, resulting in a loss of competition and ultimately costly burdens being placed on patients.

There are a number of medical issues that affect our rural communities at a greater rate than our urban counterparts. For example, diabetes incidence is about 17 percent higher in rural areas than urban ones, according to Texas A&M University researchers, which in turn leads to a greater rate of related complications.

Coronary heart disease death rates are highest in small rural counties, higher than both suburban and metro areas. The list goes on and all the while, new life saving treatments are left on the table by little known insurance policies - both public and private.

The majority of those living in rural regions receive their health care coverage through private payers or public programs like Medicaid, with many using a combination of both to bridge the gaps in care. Yet rural communities are now faced with a push by insurance companies to limit prescription drug coverage.

New treatment options continue to be developed, especially targeting those illnesses that affect rural regions the most, but efforts by insurers and others to restrict access to these needed medications are problematic. As a testament to the severity of this issue, patient advocacygroups and doctors are pushing back against these changes.

Rural regions often have limited competition, leaving patients with only one possible private insurer. This lack of options often leads insurance companies to raise prices while limiting coverage.

In the case of prescription drug coverage, anti-patient policies are on the rise. Prior authorization requires doctors to check with insurance companies before prescribing a drug, even if it’s the one they feel is best suited to treat the patient in question. Step therapy requires patients to try cheaper versions of treatments one by one. Both practices have been strongly criticized by doctors and patient groups.

A little known group out of Boston, the Institute for Clinical and Economic Review (ICER), was recently called out in the Billings Gazette for providing cover to insurers looking to employ these practices.

As the piece stated, “Essentially, insurance companies are now picking winners and losers in the healthcare arena. By deciding who does and does not get access to certain treatments and medications, insurers and the organizations advising them are taking the fate of many rural Americans into their own hands.”

ICER essentially measures the value of a patient’s life versus the sticker price of a medical treatment and in rural America’s case, life-saving drugs that treat both heart disease and diabetes have been deemed not worth the cost.

Between private providers and public programs, rural America faces no guarantee for quality of care. Despite this, rural communities continue to react with innovative approaches and solutions. This month, the Department of Health and Human Services (HHS) found that rural hospitals were outperforming urban ones on key quality measures.

While this information is promising, there is still work to be done and a number of obstacles to overcome. The efforts to push back against groups like ICER and the policies they support must be communicated across our rural regions. Quality care and equal access to prescription drugs and treatments must be secured for both the rural and urban regions of our country.

Jack Alexander hails from Bozeman, Montana and is the President & Chairman of the Rural and Agriculture Council of America (RACA). RACA is a consortium of rural leaders, small business owners, farmers and ranchers championing policies that advance the rural and agricultural goals and initiatives of America. 

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