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Provider Perspectives
Rural Health Crisis: Traveling the Distance for Treatment
Melanie Koch is the chief clinical officer for Massac Memorial Hospital in Metropolis, a critical care hospital that serves seven southern Illinois counties. In this downstate locale, Melanie discusses obstacles confronting rural physicians operating under our broken health care system. Moreover, the depth of these problems have culminated into a shortage of doctors and specialists in rural or small town settings, which, needless to say, creates significant barriers to care for community residents.
Squashed between rising health care costs and problems with Medicaid reimbursement, many doctors declare that working in the countryside is a money-losing venture. Consequently, more and more graduating physicians, with college loans looming, are overwhelmingly choosing to work in urban environments where often times their hours are shorter and their costs lower.
To lessen the impact of this situation and open up access to primary care services, especially for those who are under- and uninsured, Massac Memorial Hospital launched a rural health clinic. Yet a larger problem still remains for those who need services beyond family practice. Providers like Melanie often spend hours trying to refer out patients for specialty care. There are simply no neurosurgeons in the area at all and only recently have orthopedics come. Other specialists in the region cannot afford to take on too many uninsured or underinsured patients. Koch ends up contacting Springfield specialists (which are four hours away!) for patients with Medicaid insurance and then must call a charitable group, such as the Ministerial Alliance, to arrange for transportation costs.
The St. Louis Children’s Hospital and other university-based hospitals in Kentucky, Missouri, and Tennessee all have been a huge help in taking on many Illinois patients. But Melanie is very mindful of the relationship the hospital has with these providers. Only complicated and life threatening cases are supposed to be referred to teaching hospitals yet this cannot always be the case because of the dire need for services. For example Melanie recently had a patient with a broken bone that needed to be set. She called three different providers in her region but none would take the patient’s Medicaid insurance. When this happens Melanie ends up shipping people by helicopter or ambulance to tertiary care centers like universities. That is an expensive three-hour trip for something minor.
Many areas in southern Illinois, or those cities south of Carbondale and Marion, are simply in this state of health care crisis. Melanie supports Illinois’ aim at expanding coverage with the stipulation that Medicaid reimbursements are provided more promptly and at a fair rate. Koch also adds, “To be effective the plan has to stay firm at providing incentives to providers in underserved areas such as tax breaks, loan payback, and special recruiting efforts to rural regions.” These roadblocks and stop points to care that our current health care system erects must be fixed. Illinois residents want change and deserve better.
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