Rural policy brief最新文献

Key Findings. Twenty-five counties lost their sole community pharmacy between May 2006 and December 2010. Among these: (1) The average population density is 10.4 persons per square mile, compared to 87.4 for the United States. (2) The average population decreased by 1.6% between 2000 and 2010. Excluding the largest county, the average decrease was 2.4%. (3) The population age 65 years and older increased 5.4% between 2000 and 2010. Excluding the largest county, the 65-and-older population increased 2.1%. (4) The average change in the percentage of persons in poverty increased by 0.6 points between 2000 and 2010, from 15.5% to 16.1%, compared to a 4.0 point increase (11.3% to 15.3%) for the United States. (5) The average percentage of people younger than 65 years without health insurance was 24.6% in 2010, compared to 16.2% for the United States. (6) Nineteen of the 25 counties were designated "whole county" Health Professional Shortage Areas (HPSAs), meaning there was a shortage of primary medical care physicians across the entire county. (7) The average number of active doctors per 1,000 persons was 0.44, compared to 2.86 for the United States. Six of the 25 counties (24%) had no active MDs or DOs in 2010.

Key Data Findings. (1) From March 2012 to March 2013, rural enrollment in Medicare Advantage (MA) and other prepaid plans increased by over 200,000 enrollees, to more than 1.9 million. (2) Preferred provider organization (PPO) plan enrollment increased to nearly one million enrollees, accounting for more than 51% of the rural MA market (up from 48% in March 2012). (3) Health maintenance organization (HMO) enrollment continued to grow in 2013, with over 31% of the rural MA market, while private fee-for-service (PFFS) plan enrollment decreased to less than 10% of market share. (4) Despite recent changes to MA payment, rural MA enrollment continues to increase.

Key Findings. (1) The Frontier Extended Stay Clinic (FESC) demonstration project provided expanded emergency services and extended clinic stays to remote rural communities. (2) Although the FESC demonstration ended this year, the FESC model may be appropriate in rural communities other than the five original demonstration sites. (3) FESCs may also be alternatives to very low-volume rural hospitals.

Local rural pharmacies provide essential pharmacy and clinical services to their communities. Pharmacists play a critical role in the continuum of care for rural residents, and the loss of a local pharmacy may impact access to prescription drugs and clinical care. This policy brief identifies factors that contributed to the closing of six pharmacies and describes how the affected communities adapted to losing locally based services. Key Findings. (1) Five out of the six pharmacies studied closed due to retirement and/or difficulties in recruiting a successor. (2) In five of the six communities, residents now either drive to the nearest pharmacy or use mail-order to receive their prescriptions and, in some instances, receive their prescriptions through a courier service from a pharmacy in a nearby town. (3) Access to pharmacy services in these communities is of most concern for individuals with limited mobility and those who lack a support system that can pick up and deliver their prescriptions (e.g., the elderly and people with acute conditions).

Key Findings. (1) Medicare Accountable Care Organizations (ACOs) operate in non-metropolitan counties in every U.S. Census Region. (2) 79 Medicare ACOs operate in both metropolitan and non-metropolitan counties. (3) Medicare ACOs operate in 16.7% of non-metropolitan counties. (4) 9 ACOs operate exclusively in non-metropolitan counties, including at least 1 in every U.S. Census Region.

Key Findings. (1) A larger proportion of the rural population than the urban population is uninsured and low income (living at or below 138% of the federal poverty line [FPL]) (9.9% as compared to 8.5%) and a larger proportion of the rural population than the urban population will be eligible for subsidized Health Insurance Marketplace (HIM) coverage due to income levels and current lack of insurance (10.7% as compared to 9.6%). (2) Assuming full Medicaid expansion, a larger proportion of the rural uninsured than the urban uninsured would be eligible for Medicaid (43.5% as compared to 38.5%). (3) A smaller proportion of the rural uninsured than the urban uninsured has income above 400% FPL and thus will not qualify for either Medicaid or HIM subsidies (10% as compared to 14.1%). (4) The proportion of the uninsured population potentially eligible for Medicaid expansion is highest in the rural South (47.5%) and lowest in the urban Northeast (32.5%) and the rural Northeast (35.8%).

Key Findings. (1) Both the number and proportion of providers eligible to receive Primary Care Incentive Payments in 2011, 2012, and 2013 increased during the years used to determine eligibility (2009, 2010, and 2011). (2) For most practice types, rural providers were more likely to be eligible for Primary Care Incentive Payments. However, rates of eligibility varied between provider types. (3) Rural Family Practice physicians were less likely to be eligible for Primary Care Incentive Payments than their urban counterparts.

Key Data Findings. (1) Rural Medicare Advantage (MA) enrollment grew to over 1.7 million in June 2012 (17% of eligible beneficiaries), while total MA enrollment grew to nearly 13.4 million (27% of eligible beneficiaries). (2) Rural preferred provider organization (PPO) and health maintenance organization (HMO) enrollment grew to over 840 thousand (48% of the market) and 532 thousand (31% of the market), respectively, while private fee-for-service (PFFS) enrollment fell to 230 thousand in rural areas (13% of the market). (3) Rural MA enrollment varies across the country with concentrations of enrollment on the West Coast, the Great Lakes, and the Northeast regions of the United States. (4) The average monthly weighted premium for rural MA plans with prescription drugs fell in 2012 to $48 from $52 in 2011, but it remains significantly higher than the urban average which also fell during the same time from $38 to $34. (5) Zero premium plans are available to 73% of rural MA beneficiaries and to 95% of urban beneficiaries; however, only 48% of rural beneficiaries that have this option choose these plans compared to 63% of urban beneficiaries. The resulting average non-zero premium was $72 in rural areas in 2012, while the average non-zero premium in urban areas was $81. (6) Roughly a third (35%) of rural MA beneficiaries receive their MA coverage including prescription drugs without having to pay a premium, however this is significantly lower than 60% of urban beneficiaries that do not have to pay a premium.

Retail pharmacies provide essential services to residents of rural areas and serve many communities as the sole provider of pharmacist services. Losing the only retail pharmacy within a rural community (census designated city), and within a 10 mile radius based on driving distance ("sole community pharmacy"), may affect access to prescription and over-the-counter drugs and, in some cases, leave the community without proximate access to any clinical provider. This policy brief documents the closure of local retail pharmacies in which the pharmacist was the only clinical provider available in the community at the time the pharmacy closed. Characteristics of the community and the retail pharmacy are described. The findings may suggest future policy actions to minimize the risk or mitigate the negative consequences of pharmacy closures. Key Findings. (1) Between May 1, 2006, and October 31, 2010, 119 sole community pharmacies closed. (2) Of those 119 pharmacies, 31 were located in rural communities with no other health professionals or clinical providers. (3) In 16 states, at least 1 community lost a sole community retail pharmacy, and there was no other pharmacy within 10 miles (actual driving distance). (4) Of the 31 pharmacy closures in communities with no other providers, 17% were located in remote rural areas designated with a Rural-Urban Commuting Area (RUCA) score of 10 or higher. Such a score means that, on average, 60 minutes of travel time is required to reach an urbanized area, and 40 minutes is required to reach a large urban cluster of 20,000 population or more.

The closure of rural independently owned pharmacies, including pharmacies that are the sole source of access to local pharmacy services, from 2003 through 2011 coincides with the implementation of two major policies related to payment for prescription medications: (1) Medicare prescription drug discount cards were introduced on January 1, 2004; and (2) the Medicare prescription drug benefit (Part D) began on January 1, 2006. In this brief, we focus on rural pharmacy closure because of the potential threat such closures present to access to any local pharmacy services in a community. Services include providing medications from local stock without delay or travel, overseeing administration of medications to nursing homes and hospitals, and patient consultation.