Finally an Edge for Rural Patients?

Rural residents are poorer, older, tend to live more years with impairment, and often face more barriers to obtaining medical care than their urban counterparts. It seems only natural to assume that when physical functioning declines or cancer strikes rural residents, more time will pass before a referral is made for treatment than for people in cities. In fact, two studies report that the opposite seems to be true. A regional Medicare Demonstration found that primary care physicians referred their patients to a new program featuring a prevention home visiting nurse at an earlier stage of ADL impairment than their urban counterparts. In a national study of disease stage of cancer at initial referral, urban residents were referred at a later stage than rural residents for colorectal and lung cancer treatment. For both types of cancer urban residents were more likely to seek treatment for the first time when they were in the later stages of the disease. In the regional Medicare Demonstration rural patients were able to maintain their ADL functioning over a 22 month follow-up period while urban patients experienced ADL decline. What are the policy implications of this early referral pattern for rural residents? Is there an approach for service organization in rural America that might overcome the inherent barriers to access while maintaining cost equity between rural and urban America? Joan Van Nostrand, DPA, Director of Research, ORHP/HRSA/HHS will be the Respondent.