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Provider Perspectives
Sheldon Keyser
Illinois is known for its diverse communities in both industrial urban centers and rural landscapes. While all of the state's communities contribute equally to the character of Illinois, there is an unjust disparity between urban and rural areas in terms of health care. The rural south in particular suffers from a shortage of providers, understaffed facilities and inadequate health care delivery. As a result of this injustice, communities in Southern Illinois are experiencing a decline in overall health. In response to this inequity, the Illinois Rural Health Association (IRHA), a coalition member of CBHC, has been active in trying to improve access to health care in rural areas through advocacy, education, networking and leadership. Sheldon Keyser, President of IRHA, recently spent some time with CBHC to explain some of these problems in rural health care and give a briefing of the ongoing efforts to combat them.
The most significant of these problems is without a doubt the lack of doctors, dentists, psychiatrists and other specialists that communities rely on to monitor health. While economic disincentives are a root cause for this decline in providers, the shortage is more complicated than a simple lack of funding. Looking back two or three generations, current health care deficiencies appear to have roots in the slow local economy, the high incidence of malpractice suits, and the dwindling numbers of Medicaid-accepting providers. In the resulting vacuum, the quality of existing resources has suffered as well. With more doctors leaving the area, the remaining providers tend to lack the necessary experience to address the full range of community health issues. Unfortunately, this exacerbates the problem of malpractice. The combination of an error prone system and dissatisfied patients can lead to higher malpractice insurance. This acts as a disincentive for doctors to practice in the area and so they are more likely to move elsewhere. A lingering effect of this problem is the atmosphere of distrust in the doctor-patient relationship and with fewer people willing to seek care, it has lead to an overall decline in the health of the community.
Another enduring knot in local health care is the delay providers experience in receiving reimbursement for their Medicaid and Medicare claims. Hospitals and clinics are forced to operate with a deficit and can only do so for so long. The dwindling numbers of providers accepting Medicaid and Medicare is especially problematic as Southern Illinois has a much higher percentage of elderly citizens than the rest of the state. The delay in making these payments is a statewide problem according to most reports, but it is magnified in areas like the south where Medicaid and Medicare are major parts of service payments.
With health care suffering at the hands of several interrelated factors, Mr. Keyser and the IRHA try to highlight one issue at a time to give supporters some focus and not have them lost in the full load of rural health problems. Currently, Mr. Keyser and the IRHA are looking to improve access to mental health care in Southern Illinois. Psychiatrists are among the many specialists that are few and far between in the region. This shortage is especially glaring given the high rates of drug abuse in Southern Illinois. With crystal meth and crack cocaine use on the rise in southern counties, the rate of birth defects and child behaviorial problems is increasing as well. In addition to bringing more mental health specialists to the area, the IRHA hopes to clear some of the stigma surrounding mental illnesses through ongoing publicity and education campaigns. Greater acceptance of these illnesses invariably increases the willingness of people to visit doctors and inquire about treatment.
In both recognizing the hard work of local doctors and documenting the trends of local provider shortage, the IRHA ultimately hopes their reports encourage state legislators to increase spending for health care in Southern Illinois. With more resources allocated, the chances of unraveling the area’s health care problems will definitely improve.
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