New York State Medical Society The New York State Society's Committee on Rural Medicine is sponsoring a "cross-roads medical center" project, which involves establishing multiple "physicians" centers in rural areas in the State (11). As a result of a pilot study of three rural areas in need of medical services, it is estimated that each center would cover a geographical area of possibly four or five adjoining communities. Together these communities would have to have a population base-of approximately 10,000 to 30,000 residents--to support quality medical care. Until permanent physicians would be assigned to the centers, physicians practicing in nearby communities would staff the centers on a part-time basis. Hospitals and other medical facilities in nearby cities would cooperate with the centers in providing health care, and physicians from these cities would have staff appointments at the centers. Private Programs Monterey County Physicians In southern Monterey County, Calif., 10 private physicians and 80 supporting staff members have undertaken to provide comprehensive medical care to all eligible low-income residents, including migrant workers (4). Under this program--entitled the Rural Health Project--patients are cared for in the same facilities and by the same medical staff that serve other members of the community. Transportation--including a van equipped for wheelchair patients--serves the entire project area. The project, which is funded by an OEO grant to the Monterey County Medical Society, is an experiment concerned with developing a new way of organizing indigent care and at the same time providing a basis for comprehensive health planning at the local level. 17/ Illinois Physicians-on-Call In central and northern Illinois, the Nation's first corps of airborne doctors has been founded by a private physician (8). Called Physicians-on-Call, it consists of about 70 doctors, all of them young, who operate out of large office-type stores in a community not far from Chicago. Traveling exclusively by air, these doctors bring help and treatment to communities where on-the-scene medical personnel is either scarce or nonexistent. Working in small hospitals, clinics, and other local facilities for anywhere from half a day to a full week, they examine patients, provide treatment, perform operations, and offer other medical services which people in small towns and rural communities are finding increasingly difficult to obtain. Some 15 hospitals in the area are currently making use of the Physicianson-Call service. Coverage and assignments of the doctors are handled by a 17/ OEO funds were granted within the purposes of PL 89-749, Comprehensive Health Planning and Public Health Services Amendments of 1966. full-time scheduling secretary. In addition to benefiting patients in the area, Physicians-on-Call has brought help to many overworked physicians who have stayed in practice in remote areas despite heavy caseloads. Some medical authorities believe that this program will help keep physicians in their rural posts by offering them an opportunity to get away now and then to attend medical meetings in large cities, or simply by taking vacations they cannot enjoy now without abandoning their responsibilities. Sears-Roebuck Foundation The Sears-Roebuck Foundation has established a community medical assistance plan to supply educational guidance to towns that want to improve health care for their residents (11). For example, the plan provides information which will help a community decide whether it can support a physician. This information is gathered from physicians currently practicing in the trading areas, State, and county medical societies, and other informed individuals involved in health services. Information is also provided to assist the community raise funds and establish a medical facility on a sound financial basis. In cooperation with the American Medical Society, this program has helped 165 communities with populations of between 800 and 5,000 to acquire medical facilities for two or more physicians. Kentucky Dentists Physicians and dentists in Kentucky are taking to a form of reverse strategy to provide care to persons unable to reach medical centers (15). Mobile medical units--vans, trailers, trucks, or buses equipped with healthcare equipment--have provided a means to reach innercity patients as well as remote rural populations. Covington, Ky., for example, has been operating a mobile dental clinic since December 1970. Another such mobile unit has been put into use in West Virginia. Samaritan Health Services Good Samaritan Hospital, a major medical center in Phoenix, Ariz., is the sponsor of a 2-year old experiment to find new ways of providing medical care to both rural and urban residents of the State (7). The hospital has formed the Samaritan Health Services--a consortium of hospitals in outlying areas and Good Samaritan. Personnel in the outlying hospitals are given refresher courses at Good Samaritan and special health personnel from Good Samaritan are sent to the outlying hospitals when their services are needed. Resident physicians in the outlying hospitals can confer daily by telephone with experts at Good Samaritan. Patients with critical and complicated illnesses are flown to Good Samaritan for treatment. A good part of the consortium's job has been keeping the outlying hospitals supplied with doctors and nurses. The Samaritan Health Service has also kept two hospitals open in northern Arizona by being able to move doctors there and relieve them when necessary. The outlying hospitals' access to sophisticated medicine has also been improved. These hospitals can now offer medical tests that are impossible to perform in their small hospital laboratory. A car makes a circuit of each hospital daily and picks up samples to be tested in the Good Samaritan laboratory. The results are telephoned back to the individual hospital. Dieticians from Good Samaritan travel to the smaller hospitals and help them plan their meals. Other experts help set up better billing systems and community relations campaigns--services that small hospitals couldn't afford on their own. CONCLUSIONS The shortage of health personnel and facilities continues to be particularly acute in rural America. The number of rural counties without a doctor is increasing and will probably continue to increase as elderly physicians die, retire, or move away and are not replaced. It is not the number of doctors per rural county that is a major problem, however, but rather the physician-population ratio in rural areas and the fact that rural people must travel long distances to receive specialized medical care. In addition, rural hospitals are small, often inefficiently operated, and generally do not provide comprehensive health services. The federally funded programs discussed here--health manpower training and comprehensive health planning assistance, for example--may help to provide more adequate health services in rural areas. The proposals for new ways of financing health care--new types of insurance programs, for example--may help rural people to meet the rising cost of health care. Although rural and urban areas have many health care problems in common, the different types of populations and spatial variations in rural areas call for new and different health care delivery systems in rural areas. The special demonstration projects described in this report are excellent examples of efforts to meet the special needs of rural people. Most of these projects are still in the developmental stage, and it is difficult to predict which approach or combination of approaches would be widely applicable. It is hoped, however, that the experience gained from these and other such projects will help local health planners in developing guidelines for their own unique and specific needs. 1970. (2) 1965. Distribution of Dentists in the United States by State, Region, Survey of Needs for Dental Care, 1965. Bureau of Economic Research and Statistics. Chicago. (5) 1971. (6) 1971. American Medical News. Vol. 14, No. 14, Apr. Chicago. Distribution of Physicians in the United States. Dept. of Survey American Osteopathic Association 1972. The Rural Clinic Program. Chicago. (7) Auerbach, Stuart 1971. "City-County Hospital Confederation Aids Rural Care," The (8) Freese, Arthur S. July 20. 1971. "These Doctors Fly to Their Patients," Parade, The Washington (9) Gottlieb, Paul M. 1971. "The Migration and Distribution of Physicians" in Reference Data on the Profile of Medical Practice. American Medical Association. Chicago. (10) Johnston, H. L. 1972. Health and Health Care in Rural America: National Perspective. (11) Murphy, Betty (12) 1971. "Health Services Come to the Byways and Backwoods," Opportunity. U.S. Office of Economic Opportunity. Dec. 1971. "Neighborhood Health Centers--Bring More Care to Needy," (13) President's National Advisory Committee on Rural Poverty 1968. Rural Poverty in the United States. Washington, D.C. (14) (15) 1967. The People Left Behind. Washington, D.C. 1971. "Putting the Wheels on Medical Care," The American County. (16) Rimple, H. McDonald Nov. 1972. "The National Health Service Corps." Paper presented to the Rural Health Conference, American Medical Association, San Francisco, Calif. Mar. 17. (17) 1972. "SAMA's Health Projects Dedicate Summer to Change," Synergist. (18) U.S. Congress 1972. Congressional Record. Senate, S11593, Vol. 118, No. 115. July 24. (19) U.S. Department of Commerce (20) 1972. 1971. "Employment Profiles of Selected Low-Income Areas," in 1970 Census Consumer Income--Current Population Reports. Bureau of the Census. (21) U.S. Department of Health, Education, and Welfare Age Patterns in Medical Care, Illness, and Disability, United States, 1968-1969. National Center for Health Statistics, Series 10, No. 70. Health Interview Survey. National Center for Health Statistics. Health Services Reports. Health Services and Mental Health Administration. Vol. 87, No. 5. May. Hospital and Surgical Insurance Coverage, United States--1968. 1972. Time Lost From Work Among the Currently Employed Population, |