Health Care Accessibility for Chronic Illness Management and End-of-Life Care: A View from Rural America

Author:

Artnak Kathryn E.,McGraw Richard M.,Stanley Vayden F.

Abstract

The Institute of Medicine (IOM) reporting on the quality of health care in America recommends six aims for achieving the health care system we could have. Together with the Institute for Healthcare Improvement (IHI) Triple Aim initiative, a framework has emerged to challenge providers, educators, and policymakers to remake the health care system according to specific objectives: to provide care that is safe, effective, patient-centered, timely, efficient, and equitable to more people at a price we can afford. Complicating this mission of better prevention and better care at a lower cost is a daunting demographic: January of 2011 marked the month and year that the first of the baby boomers turned 65. The U.S. Census Bureau in May 2010 projected the number of Americans of this age and over to reach 88 million by 2050, more than double the current figure of 40.2 million. Parekh and Barton forecast in stark detail what it will be like to address these burgeoning numbers of older Americans with comorbidities, including the fact that over 20% of the population currently experiences at least two chronic medical conditions.

Publisher

Cambridge University Press (CUP)

Subject

Health Policy,General Medicine,Issues, ethics and legal aspects

Reference100 articles.

1. 31. Grantmakers in Health, Rural Health Care: Innovations in Policy and Practice, Issue Brief no. 34, 2009, available at (last visited October 12, 2010).

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4. 50. See Jacobsen, et al., supra note 48.

5. 75. A Critical Access Hospital (CAH) is a hospital that is certified to receive cost-based reimbursement from Medicare. The reimbursement that CAH's receive is intended to improve their financial performance and thereby reduce hospital closures. Each hospital must review its own situation to determine if CAH status would be advantageous. CAH's are certified under a different set of Medicare conditions of participation (CoP) that are more flexible that an acute care hospitals CoP. A map marking the location of CAH's can be accessed at (last visited March 3, 2011). As of September, 2010, there were 1, 320 certified Critical Access Hospitals located throughout the U.S. CAH's must be located in a rural area and meet one of the following criteria: (1) located 35 miles or more from another hospital or 15 miles from another hospital in mountainous terrain or areas with only secondary roads. More detailed information can be accessed in a letter sent from CMS to State Survey Agency Directors September 7, 2007, available at (last visited March 3, 2011).

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