ERIC ED225759: An Agenda For the Future. Proceedings from the Conference on Health Planning and Rural Development (Corvallis, Oregon, July 21-22, 1980). Summary.

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‘DOCUMENT RESUME e

ED 225 759 ee RC 013 804
; TITLE An Agenda’ For the Future. Proceedings from the .
_ Conference on Health Planning and Rural Development
(Corvallis, Oregon, July 21-22, 1980). Summary.
. INSTITUTION | Department of Agriculture, Washington, D.C.; Farm
7 Foundation, Chicago, I111.; Western Rural’ Development
; Center, Corvallis, Oreg. :
REPORT NO WRDC-Paper-12 ; .
PUB DATE Jul 81 : a) .
NOTE 9p, ae a
PUB TYPE - Collected Works - Conference Proceedings (021)

g

. _.EDRS PRICE ~ MFO1/PCO1 Plus Postage.» ~-
DESCRIPTORS Coordination; *Health Education; *Health Personnel:
' *Health Services; *Hospitals; *Older Adults; Policy
Formation; *Rural Areas; Rural Population ‘
IDENTIFIERS *United States (West) .

4,

. ABSTRACT
Investigating ways to improve the delivery of health
Care services to rural residents through health planning and rural
+ -development activities was the purpose of the 1980 conference. Four
topics addressed by the participants were chosen because of their
importance to the rural health systems of western communities and
because coordination of efforts in these areas would be beneficial.

Topics included: the role of the rural hospital; health personnel in

rural areas; rural health education; and special impacts affecting
Care. Research or position papers were presented on each topic,
followed by group discussion and descriptions of instances where.
health planners and rural development specialists have been working ,
together. Participants then formulated recommendations whic@ wére
categorized according to policy development, coordination, ahd
research activities. Thesé proceedings present a brief summary of.
each of the four topic sessions and the recommendations developed at
ae conference, Appended is a list of conference participants.”.

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US. DEPARTM

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EDUCATIONAL RESOURCES INFORM

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"PERMISSION TO REPRODUCE THIS: . .
MATERIAL HAS BEEN GRANTED BY’ «

JUIN 1982

oe . / 3 RECEIVED I -
INFORMATION CENTERIERI) - Xe, ERIC. CRESS
Proceedings from the
.

“Conferencé on.
_ Health Planning and - |
* Rural Developtront .

An Agenda for the Future

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Western Rural Developiment mre
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Western Center for Health Planning’.
TE He: “cooperating:
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A regional center for applied Social science and community development can
s i cooperating with Land Grant Universities in
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idaho, Montana, :
5 Western Rural Development Center Alaska Arizona California Colorado Guam Hawa Mon t,
} Oregon State University Nevada, New Mexico, Oregon, iets Washington, Wyoming ne
Meo, G Corvallis, OR 97331 : Joo? o
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Acknowledgements

- a
Tre US Depattment of Agriculture and
ine Heaith Resources Administration in
corjuncicn with the Western Rural
Develcoment Center (WRDC) and the ae

Western Center tor Health Planning,

organized and sponsored the Conference
on Health Planning and Rural Develop. *
ment An Agenda for the Future Ihe
conference was hosted by WROCin
Corvallis Oregon on July 21-22, 1980 In
addition the Farm Foundation, Chicago
Ninos provided special financial
assistance :

it should be noted that the recommenda
tions reflect the Consensus of the confer
ence participants, and do not necessarily
reflect the views of the Department of
Health and Human Services. the US
Department of Agriculture, the Farm
Foundation, Western Rural Development

.
f

Center nor the Western Center for Healt
Planning ‘

Copies of the following informal papers,
which were presented at the conferencé
are available from the Western Rural,
Development Center, Extension Hall 307,
Oregon State University, Corvallis, OR
97331 Inival single copies are tree of

charge

© Useful Health Models for Rapidly
Changing Areas Gerald A Doeksen
WROC Y, July 198!

* The Integrity of Rural Health Care
Systems The R&e of the Rural Hospital
Roger A Rosenblatt WRDC 10. July
1981 .

Economic Issu®vin the Reduction of
Rural Hospital Capacity A Research
Summary JonB Christianson WROC *
11 July 1981 F

*

-

J

es

investigating ways to mprove the
del'very of heaitn care services to fuga!
residents through health planning ana
rural development activites was the *
purpose of the conference, wnich was red
Or yu'y 21 22 1985 in Corvaliis Oregon
Expe”ence has dempnstrated that ac-
kMOvseagemnent and reinforcement of the
compementary goa's of healtn planning’
acdsura ae opment fan vea gore!
erdeavea .

Tre sonleienee crought together heath
cianrers Extens.on personnel research
fers th nterests n healthcare ang |

"ecera’ DOI CyMakers '0 give.them tne

Opre”™tuniy to pecome more famil af with
eacr ctrers pou.ces and oregrams ang to
excrange ‘deas regarding coordinator of

TRE SU ISD TS addressed by 're
comererce pat rants were chaser
because ch Ire mporiance te tne cura

of waster commur tes
cecause coordination of efforts in
ingse areas wOu'd be vereficra! These
tOO'CS Werte
© Roe othe rura-hosp.tai, 4
* Heath DEersorne n rural arez 5"
® Rua: hea tr education and
* Specia: mpacts affecting rusa! health
care, >
ReSeaicn oF DOSIt‘ON papers were
presert edon each topic followed by group

e
.

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4 $C455.0n arid descriptions of instanées 7
vinere health giannerS’and rural develop '

MEN! specialists Nave been working
toge*ner Cor‘erence participants then
‘ormuated recommendations which were
categorized according to policy develop
ment ccordination and résearch activities
Treseproceedings will present 4 brief
summary of each of the four topic sessions
andibe recommendations developed at

the conference
c

Role of the rural hospital

Recent efforts togeal with the problems
of rurai Nealth care delivery have over-
JooKed the role of the rural hospital
Physicians very often expect access to”
hospitals for professional and economic
reasons Infact there is evidence to
support the proposition that physician
recruitment and retention are closely
related to availability of hospital services
Recognizing the hospital as a critical link in
the tural health care system, the confer-
ence participants Hae the current
economic obstacles faced by hospitals

“

future activites ce

Aretent nd:cation of tnis type of :
cooperat-on's the agreement signed
between tre USDA ard tre Departmentot
Heath Eaucation and We:'are (Currently
tha Department of Hea.th and Human
Se ces) to coordinate the funding for
corstructior and operation of sural health
certers “Wore recently ata conference of
heaith qeanners and rural development
spec a.sis n Washington. OC twas
cong used tha! coordination of activities at
ireregora eve! would be most effective
Tre Covvafes conference emphasized the
de'very of reatn care Services inthe rural
West "re maonty of conference partici-
Carts were "om the Inirteen western
States

arg tre rasicctureg ‘rat would ensure
frecy at ty :

Rural "os ta's are in economic trouble
‘ora varety of reasons As the medica!
profess on Decomes moore and more
technica! rural hospitals with their smajler
Patient loads nave not been able to afford
expensive and sophisticated equipment
sor id devetop tHe technical expertise
required to operate the equipment In
mahy instances this has led to a decrease
in the demand for hospital care at the
sm@iler rural hospitals in favot of care at
the larger hospitals in more populated

“areas Thisttendency towards decreased

demand has been accelerated by im-
proved transportation systerns to urban
areas Atthe same time that rural hospitals
are experiencing a decrease in demand,
they aré facing rising costs. ancluding
costs due to compliance with federal and
State regulations ;

Consequently, many rural hospitals
have closed in recent years, and many
more are near closure There is Concern
aes ae to close hospitals have not
b Sed on a complete accounting of
Costs. such as increased travel Costs, ,
increased medicakrisks, and effects on
local economies Although overbedding
may be a problem in some areas, I! ts likely
that a restructuring of the functions of the
rural hospitai would be More appropriate ~
than clostre in dealing with the current
economic forges :

This restructuring process would in-
clude estimating the number of persons
served by the hospital and the type of
inpatient services required by that popula-
tion over time It could then be determined
for each inpatient service if the local
hospital could provide that service

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hor ac4ar Tega part o*practice

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Ce ved broed “nancial support A major
"eases ‘ort 5+, tne lack of ducumentation
or Mew card of health edur ation

CIOgrams 7 F eereration hip between benay
Sta Changes and decreases in morbidity
aod marta ty +s difficult to quantify
Corsequenty broad furtding wilnotukely
De Avadable unt! there is evidence that
Peath education ss cost effective in 7
IMprOvIPZ health status Perhaps the best
aporuach '¢ te addres. those health
educdalion programs which are most easily
defended such 4s those relating to
smoking hypertension and obesity -

Special population impacts
affecting rural health care

The woridwide energy crisis has led to
an increased dependence on domesuc
PMEIGy 4 Ninety seven percent of
{he avaiable national energy 16 1p Cgal and
rl shale and federal Region VIN has 50

earn 6

ined the’st trains on rifral health care
Totem, in parts of fhe West due to this
ne fed led dependence: jon domestic ener

Gy LOG es ¢

Many rural COMMUNES wilt EXPENenc
iq r&fpldpopulation influxes, to develop
energy feoources Theshealih systems of +

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Recommendations §- -

Policy development

“re Cdol "ud MEAIN DO Es’ 4,0
Ceet dhe crea aime maf qtegratun
WET IT! ah LS Joven oment agence
“rs Leturee aporcach dom cote
Lert y ot ize —. eee: ‘NC Udi" G

we tc Ing ar rsonner Curranty,
rere sasteat Bi a or heb attempts to
"eCOG" Z2'TED QhtOl dil ‘uraiareas andia
oromcie inte'3s ,ersmental appraache; to
3 i

viems This strategy 5
“te House Smail Communi
yvooment Policy state

r December 197% tr

or Seoigmber 24 198G the Rura:
Beye opmes TActiP L 96-355) was signed
Saw es sded in this legislation the.

ita) 33
amare Wet bro
ri

ces ong

‘or Sma. Comm unity and Rural Develop

mert on USDA ‘or ‘facilitating the imple

mentaron of the Rural Development Act of

1972 angestabichment of a Working

Group for Rural Development to assist the

secretary of Agr culture in designing

coordinating and implementing'federal
rural development efforts in cooperation
wr rural development programs of state
and iocal governments*

Policy recornmendations de. veloped al
ine Conference on Heaith Planning ard
Rural Ge velopment
° Continue to < support legislative effort,

which seek to maintain active rural

‘development activities and centers in:

"USDA and HHS ;

* An important factor in developing policy
ivtocal leadership Itis essential to seek
the knowledge, ideas, and suggestiens
of these leaders if policymakers Wish to

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a GGs:"gn Of Under Secretary ;

r planners, educators

FP oPeG hat ine e"orts of this
3S we as Otrers will Relp establish a-
7 "he sharing of technica:
ce ‘pap d growth communities

uae ae

cee rar

cv o™sde for pianning ‘or
ies dé very Pas Deen devel

"
seu Eten, ae
aDy Extens

ODS POs C7 agents in Oklahoma in
Vat s'aie Excers.on agents and HSA
CeO Te 4.8 WOrmed Cooperatively to
OneCas" "72 "2a IP Crofessorais aNd
? aia ce reeded in Oklanoma
var perod This type of

wOse Sg afrangement coulda
cre? ocaiitres and could be
"ett yen pianning ‘or the ‘
> o fated grewtP areas inthe

vo.

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is
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4
:
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Thess dressing i sues nrura,
a’@4a5 0 or etfoctive manner The

de 2 oomect fipcalreadersnipis «
~portact or rural areas to be able to

take Ine «1 ative and responsibility for
'6C-4 Neath problems

e Eroyurage tra exchange of information

nottahona! flexipnity and cooperation

among ‘edera! State regional andlocal
programs © formulating health care
pol'cy wh cn rreets rural needs Federal
and state programs must be evaluated
ore perspective of local resources
befdre they are implemented’

* Modification of reimbursement policies
and regulations which have an adverse
effect on the viability of hospitals and
CHIC, IN tural areas
Regulations regarding personnel licen
Sure Shouid be reviewed and wpBre
necessary Modified to allow for differ
ent mixes of health professionals to
deliver care in underserved rural areas

Coordination

Cooperation and interaction among
federal state regional and local health
and researchergis
imperative to maximize output from linfited
resources and avoid duplication of effort
The Land Grant universities through the.
Cooperayve Extensidn Service the Depart
ment of Health and Human’Services
through its Health Systems Agencies

we

(HSAsy'and regional offices, and the US

Department of Agriculture through its,
various divisions have begun to share
information and experiences More of this
int eragency coordination 1s warranted to
deal atfettively with rural health concerns

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Recommendations developed in the rural nosp:tats, The objective is to aid
. ‘area of coordination hea'th planners in determining the levele
", ® Increase the cooperative efforts be and scope of services that can be
ic tween the Department of Health and offered appropriately and satgiy atthe
. : Human Services andthe US Départ 10Ca' evei
: mentor Agriculture to share research « Derer~™.re the immediate and long-term
: ard technical ass:stance to rural areas ™Mpacis Of fura: hospital Closure onthe
especially at the federal and regionai overaii economy of a community
7 feveis - Likew Se determine the effectofanew -
, * Maintain the unkages between AHECs facvisty Or expansion of an old facility on
. and teaching research institutions and potent.ai economic growth +
estabdlisn nnkages among AHECs Hedith * Determ.ne the ievel of economic
Systems Agencies ahd the Extension ncen' ,@ that is necessary to retaina’
Serv ce.1 order to coordinate heaitn Provider 'r an area andthe possible *
education e'torts and develop a channel IMpact Of providing that incentive
’ 3° communication tpough public and private expenditures
° Proy.de ‘or state level linkages with updet various financing arrangements \
*2dera and state agencies Lang Grant * Determine the extent to which econom
esttutons ardiocalHealthSystems ‘ic CoMpertion exists between provid:
Agerc es for dissemination of researo> ers Ths research should examine the
a7 3 °23Cu'ce data related to hneaith ; etrects of distance and population on
pet TS3 OE wey Nruralareas crov ders ard tne types ovheaith care
© Corte ce the predass of devempine » 'esOu’ces available ateachsite The ,
COTS Co Chetface Delweer Pegiih 3 results o'th 3 type of research could
Cares researcrers Extension per Nee determine the influence of one
s057e and community develoomen: Drow der on the viability of another
, crogras State ruratdeveiopmen: orovider in he same or Nearby
, TOUTS SSMOUIG 7c 'ude representation commun ty
"Tom Dea th p'anre’s and Land Grant * Develop methodologies and systems of
4 VErSitles to provide a mechanism ‘or forewarn.ng communities aad HSAs of
€9 taborat.on on rura! concerns within rapid Dopuigtion growth or decline and
the otructure of State government While- potential impact on anarea shealth +
. Mere 5 2 desire tor some type of formal care system ;
+ 4 relat onsnip bet ween.nealih system * Develop antnropological and‘sociologi-
gences and Land Grant universities it cal methods for educating health
$no' necessary to wait for this . personnel to the realities of rural areas
a ; organizations venicle to initiate ex Similariy develop means to help rural ‘
+ change Fo’ example several Extension residents gain realistic expectations of .
( professionals currently attendiocal - .” “medical personnel and the delivery
HSA meetings and include HSA Staff as system
01” authors in various projects This , * Assess the characteristics of the’
'/De of Cooperation should be eter Oppulation and thei health priorities to
developed . evelop an effective health education
* As tne proad range of technical program ~ ‘< e
r Pie tah nek Saas nee ae * Evaluate and redefine standards for |
tetas oe health education in the school system
institution regiohal fural development Teal ic at tank
: centers and regionathealth planning € final act of the parteipants o pe
_ , centers stould be supported as the foci Conference on Health Planning and Rurat
“ . x ,. ‘OF Coordination and dissemination of Development was formation of a Working
“ lechnical assistance on community Committee on Rural Health with the, =
: development'and rural health commitment to carry forward these .
- 5 fa recommendations The Health Resources
, Drobiems— and solutions : 3
7 Administration and the U S Cfepartment of
Research Activities . Agriculture have taken thé witiative to *
iz ; Collaborate on rural health issues and
oe There are crucial gaps in scientific along with the Western Rural Development
: ‘ Loan ob uratngalih Care problems __ Cantar and the WestemCenter far Health ,
‘ eievant baseline information should be Planning to torr the organizational
developed for evaluation of proposed and jehicle for disseminatidn of the results of
bh * ~ ongoing projects and demonstrations this conference \
‘ Research RCP OEREA aH AMS . _ !tis the hope of the sponsors of the
* Giventimited concentrations of relevant conference that better integration of rural
faculty the regional research approach —_heaith programs and activities will result
needs to be developed toinitiateandto — Eurther. it 15 our hope that in this era of
Suppport work in the area of health constrained resources we will rnore y
oe . a *° ASSess the quality.pf care and the -effectively use those resources ayailable

e economics of procedures perfo?med in to us

¢

' Conference on Health Planning and :*
Rural Development: An Agenda for the Future

+ ten

es -_« ss % é Corvallis, Oregon —
Participants ae | July 21 22 1980
ws . "Mary Afearn " Nancy Dooran
oe eo , EDD ESCS USDA é Planner Nortrwest Oregon Health «
: Depa er| of Agncurture and Resource Systems Agency
: ' cOonom.ics , 5201S W Westgate Drive
"4 O: egor State un'vers:ty . \ Portiand Oregon 9722)
D Corva''s Oregor 37331 ; 5Q3'297 8241
vetfrey Bae Harty Fergusor r
t oY UMWers ty O° bo orago FreHA Deparment of Agriculture .
dea tr Screrces Carver S Ag’ cy ture Bulding,
: S050 East gin Avenue * Roor 685" .
soos Cecye Ce.orade sl26. : Wash ngtos DC 29250
2 20% 996 7877 492 677 evguae (LS
: ? Steorer Borrey « Morte ee ‘arg. ,
i Executive Dracte * Cooperat..e Extension Service
ra ‘ © Weestere Apzora dea tr Systgms agency Montana State | oe ‘
CenturyPlaza Nt. . Bozemar Montana 59715
"28" West2Zdin Steet SS 406°994-3561 ;
: : Roc™ 439 ros
Yama Anzona 86368 , Raioh Giidroy4
. txecutwe Director 2
; Bruce-Brggs * Montana Heaith Systems Agency
/ one : ‘ Executve Director . . Chairman Forewarning Device For,
Mie * Mon-Dak dea'th Systems"Agency - Energy Development ;
F . 1727 South University Drva 324 FuljerAvenue . .* . .
. ‘Fargo North Dakota 58103 * Helena Montana 59601 ' ‘
; 791 2800002 ° 406/443 5965
von Christianson 7 “Bernal Green ”
Bepartment of Pubs Policy Planning Leader Health and Education Program
, ang Agministration and Department of Area
Ecoromics “Economic Development Division:
7 . Ur vers sity of Anzona ~ USDAYESCS/EDD Room 492
a > Tucs07 Anzona 8572! _— S0012thStreet SW. - ot,
BOZ E26 198% > . , Washirigton DC 20250* : aot
a o 2
; bas , Sion Cotsen? 202/447-8673 .
. & . ' Department of Agricultural Econormcs steve Jasperson ns
ar Unversity of Cai.fornia Executive Director ’
v f Davis Carfornia 95616 ‘ Eastern Oregon Health Systems Agency
, are ; Q167752-1519 PO Box 520 1
ie - BanesGesiesi Redmond. Oregon 97756
ee “ Depastment of AgneulturatEconomics soo eerotee a
t , : University of California, Davis Marsha Kilgore
- , Dav's California 95616 Office of Rural Health,
, Km Ne "State Health Planning and Meee
. rn Wittam Culwell . . Agency “a eS
«* " Sdctology Graduate Student 3886 Beverly Street Nw. 2
. Medical/Rurdl Suite 19
' University of Idaho 7 : Salem, Oregon 97303
. Moscow, Idaho 83843 : 503/378-4684
: Gerald Doeksen Susan Klein 7
Department of Agricultural Economics Health Resdurces Program Director
- : : Oklahoma State University PO Drawer P
; ae 4 _ StiiWater, Oklahoma 74047 . Bouider Colorado 80302
“Indidates conference organizers aeSI 24: 6081 , od 303/497-0216, eo °
oe, a? 6 7
oo

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ry e .
2 4. . 7 © i
Jopnr xusrman : Borre SajenS - if
Departmen of Agricultural Economics Aaministranve Assstant
Urn, abe ofCa forma Easte:r Cregcr Healtn Systems Agency :
PO Box 52°
Redrorga One 307 37786

7. “ok * =
Veestere Centerto: sea tm Planning MereSarger! “F
"U2 Mamet Su te S54 F Rura ONO OGy Re esearcn Associate
Sar Frare sto Ca Foes gata? sbacrert co Agncu tural &conomics
255 S40 760 * i
S '9a6 55525
Tega Mantras. Sees. oe oe
Pl cy Mat ager ac’ 34d Coorgrator OS ae
. Faery mae AIT stator “La a"o. ; - :
Depatmert Ar oltre AS poten "of Program
pS Ag clue BL ans = (OF “3G. idennes OPEL
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COT NES Crago Meath Syctenm Ages, : ation
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