Rural policy brief最新文献

In this policy brief, we estimate and document rural hospital charges due to ambulatory care sensitive conditions (ACSCs) in the United States, by insurance type, from 2000 to 2004. ACSCs are specific adverse health conditions that can be managed in an ambulatory setting and should not require hospitalization. Hospital charges due to ACSCs are reported by region and payment source (private insurance, Medicare, Medicaid, uninsured). Community hospitals are important safety-net providers, and ACSC-related hospital expenditures in those hospitals could reflect the consequences of uninsurance and underinsurance (inhibiting access to ambulatory services). Research about the trends of ACSC-related hospitalizations can contribute to the assessment of the access to and quality of primary health care systems across US regions over time. Our study used nationwide hospital inpatient discharge data to examine the trends and regional variations of rural hospital charges due to ACSCs.

The purpose of this policy brief is to provide policy makers, researchers, and stakeholders with information about the closure of rural independently owned pharmacies, including pharmacies that are the sole source of access to local pharmacy services, from 2003 through 2010. This period 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 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. Those services include providing medications as needed (not waiting for mail order), overseeing administration of medications to nursing homes and hospitals, and patient consultation.

Primary care is the foundation of the rural U.S. health care system. Thus, the willingness of rural primary care physicians to accept new Medicare patients is critically important to the Medicare program and to rural America's elderly. But universally consistent access to primary care physicians for Medicare beneficiaries may be in jeopardy. The American Academy of Family Physicians (AAFP) reports that the percentage of family physicians accepting new Medicare patients declined from 84% in 2000 to 73% in 2008. Urban family physicians accepted new Medicare patients at a lower rate (70%) than did rural family physicians (83%). In this policy brief, we use results from a large national physician survey to assess U.S. primary care physician and general surgeon willingness to accept Medicare patients. We also assess physician-reported reasons for not accepting Medicare patients.

The Patient Protection and Affordable Care Act (ACA) authorizes several changes to the Resource-Based Relative Value Scale (RBRVS) system that are designed to increase primary care physician personal income and reduce geographic variation in primary care payment. In this brief, the ACA-authorized primary care payment adjustments are modeled in a prototypical rural primary care practice to assess both the potential impact on physician personal income and the likelihood that the changes will achieve the desired policy outcome. Key Findings. (1) The Patient Protection and Affordable Care Act (ACA) increases physician personal income in a prototypical primary care practice an average of $3,537 (1.9%) in 2010 compared to baseline income as if the ACA were not enacted. In 2011, physician personal income in a prototypical primary care practice increases by an average of $12,013 (9.3%) compared to baseline. (2) Due to Geographic Practice Cost Index (GPCI) changes legislated by the ACA, physician personal income increases are greater in entire-state Medicare payment localities than in states with multiple Medicare payment localities. (3) The requirement that at least 60% of a practice's furnished services must be specific "primary care services" to receive the ACA primary care bonus may eliminate eligibility for rural primary care practices that tend to offer more procedures (thus proportionally fewer primary care services) than urban/suburban practices. (4) The ACA primary care payment increases may be too small to have a significant impact on primary care and rural physician shortages. Targeted and significant primary care payment bonuses may be a more effective policy to reduce specific physician shortages.