Economic importance of the health-care sector in a rural economy.

INTRODUCTION: Leaders in rural communities around the world are struggling to provide primary health-care services. Common reasons for this situation include low population density, low incomes in that population, and inadequate medical payment policies. Per capita incomes in many rural Oklahoma communities, like rural areas in most other US States, are lower than the State average due to higher unemployment, higher proportion of income derived from transfer payments (government subsidies) and fewer higher paying employment opportunities. OBJECTIVE: The primary objective of this paper is to measure the economic impact that the health sector has on a community's economy. METHODS: A model, which measures the direct and secondary employment and income impacts of the health sector, is presented using Atoka, a rural county located in south-eastern Oklahoma, USA, as case study. The model is applied to the county's five health-sector components (hospitals, doctors, nursing homes, pharmacies and others). Employment and payroll data are obtained for these sectors and the model measures the employment and payroll generated throughout the community as the health businesses and employees spend dollars in the community. RESULTS: The total employment impact of the health sector in Atoka County represents approximately 18.5% of the total non-farm employment. Secondary impacts of health-sector activity include the creation of jobs in other industries due to business and household spending. CONCLUSION: This study demonstrates the economic importance of the rural-health sector by quantifying its impacts on employment and payroll. The relationships among the existence of quality health care, industry attraction and quality of life for senior members of the rural community are suggested. By using a tool such as the IMPLAN model presented, rural community leaders are offered assistance to make important decisions about the provision of health-care services, particularly when the possible closure of the local hospital becomes an issue.

Managed health care: a concept not understood by rural Oklahomans.

OBJECTIVE: The purpose of the study was to find out what people in rural Oklahoma know and understand about managed care. METHODS: A fourteen-statement survey instrument was developed. A panel of managed care professionals were asked to participate to provide a "standard" to compare the responses of the general public. The survey was administered to the general public in five rural communities and to recipients of the Oklahoma AHEC Newsletter. RESULTS: Overall, the panel tended to agree and created an industry profile useful in comparison to the responses of the general public: (1) 55-65% of the respondents answered I Don't Know or Neither Agree nor Disagree to statements using the term "managed care" and only 15-20% of the public respondents answered I Don't Know to statements not including the term, "managed care." (2) 25-30% of the general public answered in accordance with the managed care panel. (3) Over 50% of the public respondents Agreed that changes are necessary in the health sector. CONCLUSIONS: The results of this survey suggest that rural Oklahomans are uninformed about the concept of managed care and need to become better informed.

Oklahoma's rural health providers and consumers prioritizing rural health issues.

The Clinton administration has been busy for many months devising a new health care plan to address national needs. Over the last three years, rural health providers and consumers in the State of Oklahoma have also been actively reviewing their state health issues and concerns and determining the priorities. The purpose of this paper is threefold: (1) to illustrate why it is vital to have a strong health care sector in rural Oklahoma; (2) to review the issues and concerns identified by rural Oklahomans; and, (3) to provide a philosophical basis for possible solutions to the barriers identified.

Establishing a family practice: a model to determine economic feasibility.

The availability of adequate health care is a major concern of urban and rural citizens. Community leaders and hospital administrators attempting to recruit family physicians and health care providers considering a specific community need a method by which they can evaluate a community's potential for supporting a first or additional primary care physician. To develop this method, a detailed survey of family practices geographically dispersed throughout Oklahoma was conducted in 1989. Data collected from family physicians and their administrative staff reflected the volume of ambulatory and hospital visits and the direct and indirect costs of the practice over the previous 12 months. Using the fixed and operating cost data, as well as number of patient visits and patient care revenue, we designed a model to project the economic feasibility of establishing a family practice in a specific community. This model can be used to project the number of visits a community can generate for a prospective family physician, as well as the direct and indirect costs, gross revenue, and net income of the practice.

Economic feasibility of a primary care practice.

To make informed career decisions, the new physician must acquire basic skills in medical management and health care economics and learn how to evaluate the potential survival and growth of a primary care practice. The authors have developed a model designed to aid physicians in determining the economic feasibility of establishing a practice in a specific community or joining an established practice.

A rural hospital's impact on a community's economic health.

This research illustrates the importance of a hospital to the economic health of a community. A simulation model of a rural community in Oklahoma is used to demonstrate how the implementation of the DRG reimbursement policy has impacted a rural community, and to project how the closing of the hospital would impact the economy of the community. The results indicate that rural hospitals play a vital role in the economics of their communities. The closing of a rural hospital has a devastating impact on the community, while the DRG reimbursement policy has had a significant impact on the community.

A model to determine the feasibility of a pediatric practice.

A major concern of urban and rural citizens of the United States is the availability of adequate pediatric health care in their community. Community leaders attempting to recruit health care providers and pediatricians considering locating their practice in a specific community need a method by which they can evaluate a community's potential for supporting a new primary care practice. A detailed survey was conducted in early 1988 of pediatric practices geographically dispersed throughout the state of Oklahoma. Data collected from the physicians and their administrative staff reflected the volume of office and hospital visits and practice costs over the prior 12 months. Using the capital costs and direct operating cost data with information obtained on the number of patient visits and revenue generated collected in this survey, we designed a model to project the economic feasibility of establishing a pediatric practice in a specific community. This model can be used to project the number of annual pediatric primary care visits a community can generate, the direct and indirect costs to establish and maintain a clinic, and the gross revenue and net income of the practice.

A model to evaluate whether a community can support a physician.

A major concern to the rural citizens of the United States is the availability of health care in their community. Community leaders and physicians considering locating in rural communities need a method by which they can evaluate a community's potential for supporting a physician. A detailed survey was conducted in 1986 of 25 physicians' practices in rural Oklahoma. Data were collected from the physicians on their number of patient visits and practice costs in 1985. Using this information, the authors designed a model to project the economic feasibility of establishing a physician practice in a specific community. This model can be used to project the number of physician visits a community can generate, the costs to establish and maintain a clinic, and the gross and net income of the practice.

Determination of settlement patterns in rapidly growing rural areas.

The primary factors affecting settlement patterns in rural areas of the United States are examined using factor analysis of survey responses from 1,156 households in Oklahoma. "Results indicate that quality of services, age of home and availability of services, rural atmosphere and job and family considerations impact most significantly. Analysis of variance indicates that differences exist in the relative weighting of factors by socio-economic, demographic and locational variables."