By Jean Wank Sartwell
Rural health care contradictions in North Carolina: Small, remote hospitals cannot afford to supply children and other important OB/GYN services, but their communities cannot afford to stop them.
If any hope exists to stop or overthrow this trend, rural hospitals and healthcare professionals will need strong accountability, privileges and help. A better regulatory and legislative framework that builds and maintains through the North Carolina legislature and its Department of Health and Human Services can help achieve it.
Although these changes will be dramatic to North Carolina, similar steps are already available or under consideration in many other states to deal with rural women’s health services.
“From the system’s point of view, we have had many opportunities for improvement,” said Dolly Prabid, a MACEC Health Education Center, or MACEC Department of Diseases and Feminist. “There are some structural ways that our health care systems are created that increase inequality and increase discrimination, whether it be geographical, socio -economic or ethnic.
“In an ideal situation, if we can serve and take care of women who need them in the communities where they live, and they do not need to travel and they have the support around them, … we have the severe rate of children’s mortality and maternity mortality rate.”
Care standards affecting rural women’s health
In North Carolina, the state enforces newborn level care, which means that hospitals are hired at the default standard of maintenance, which is expected to provide for newborn children.
If a hospital promises to treat children.
There is no matching system for maternity care in North Carolina. But 16 other states have maternity care standards provided by hospitals, including neighbors of North Carolina: Tennessee, Georgia and South Carolina. And more can be included.
Mississippi, a state in which a lot Poor The rate of maternity and newborns is developing a system of care standards for both maternity and newborns to solve a problem. According to Mississippi State Health Officer Dan Edney, it is to go directly later this year.
Edney told the CPP, “The state -run system will specifically target that the really weak window of labor and delivery, and immediate postpartum to both mothers and children.”
“Our goal is to provide high -risk attacks at the right level, so the mother has everything she needs, and the baby, especially the low birth weight, premature baby, will have immediate access to the right level of care. We are actively building this system.”
North Carolina policy makers are also considering implementing maternity care levels. But since further rules will eliminate the increasing costs of hospitals, it will require a measured approach.
“We can look like maternity care in North Carolina,” said Belinda Patford, the infant and community welfare section of the Public Health Division in DHHS.
“We are deeply interested in how it looks like if we update our newborn level care. We are still in the conversation, trying to find out what will be needed to advance this work.”
Collecting data and other forms of accountability
DHHS does not currently collect strict or standard data on maternity care in hospitals. Another strong data collection system can help the agency identify and address the issue. But lawmakers will have to pass the rules for this supervision.
State Representative Julie Van Hephine (De Relig) said collecting data in North Carolina hospitals could be the first step to resolve the issue.
“(DHHS) needs to have more data.” If we do not know what is happening, how can we guess how to resolve it? ” We will estimate where our efforts are to target our efforts. “
County health departments also do not have the ability to hold accountable. The departments are expected to work with local hospitals so that the community needs health diagnosis, but healthcare personnel have no way to force hospitals to meet these identified needs.
Giving more teeth and regulatory capabilities to these departments can prevent hospitals from eliminating or reducing rural women’s health services without any formal push.
Financial solutions to promote rural women’s services
Since maternity services usually work on financial loss, financing and payment reforms can encourage hospitals to maintain services. In rural areas, many patients have medicated, which makes maternal care less profitable for hospitals.
And the proposed deduction in Medicide can completely revoke the equation.
“The thing about maternity units is not a profit -maker,” said Amy Goldstine, a certified nurse at the UNC School of Medicine Department of Medicine. “So if you have a one -month birth, the hospital is still paying the staff to be available at this time.”
Low birth volumes increase the costs of patients, which makes services economically unstable in many rural areas.
An increase in medical compensation rate for rural hospitals and physicians can help solve this problem. State Representative Timethe Reader (R Greenwell), who is also a medical doctor, told the CPP that he was advocating for these better payments.
But at the national level, the future of Medicide is sure, as the Republicans in Congress have recommended a deduction in the program at $ 880 million.
Private insurance companies can also implement special payment models that cause more rural health care patients, but most do not do so. Some states need insurance companies to help the rural hospitals, but North Carolina has not done so far.
Solutions of manpower for hospitals
There is another immediate problem in the need for a rural health workplace solution.
According to Rebecca Begley, director of the Midwifery Education Program at the ECU, it is very important for experts to work in rural hospitals. He said that the college students and other members of the growing workforce were trained to practice in rural areas – which is different from urban practice.
The reader reader said, “It is better to take care of patients near their home.
“Therefore, it is important to provide assistance for rural hospitals and physicians. We will not have successful communities in rural areas without access to health care. Healthcare is very important for economic growth and growth.
“I have successfully advocated for a number of provisions to help and help in rural areas. We have provided funds for rural residences, loan payments for numerous health professions, financing for rural health facilities, and promoting health training through community colleges to train them in health training. Could go. “
Rap. Van Huffen is also in favor of concessions to bring back a health care manpower in the rural areas of North Carolina.
“When it comes to labor and delivery services, and generally Ob/Gyn services, we have to think outside the box, because we have such a serious problem for the workforce,” Van Hepen said. “This is especially true in rural communities.”
Van Hepin recommends a “own” style program that encourages newly trained nurses and doctors to return to their hometowns to practice. When I am deployed Academic Settings in North Carolina, this model encourages graduates with teaching programs to return to work in their school districts.
It also emphasized the importance of community colleges.
“More rural community colleges are trying to focus on the health workforce issue,” Van Hyphin said. “It is really important to invest in community college programs as they are taking people who live in these areas to enhance health care workforce.”
Increasing the capabilities of the current workforce is another strategy: give family doctors and EMTs an opportunity to expand their practice. And keep them trained.
State representatives Alan Bunsi (D Chapal Hill) prefers this strategy.
“Universities and hospitals can do a better job to ensure that ordinary physicians have been found in these rural areas (jinn),” Bunsi told the CPP (jinn) has continued training in the basics of pre -birth, delivery and post -birth care. “
Bunsi explained a “major role” for hospitals “to ensure that local doctors in the desert areas of these rural women’s health care areas are trained in the basics of OB/Gyncare. The state can give some money for it.”
North Carolina’s rural communities are at risk of losing women’s health care services.
Through regulatory and privileged shifts that are already under consideration, North Carolina’s rural community can prevent maternity services through financial reforms, development of goals workforce and more accountability, which will save the lives of women and children across the state.
The state may also see the recovery of rural women’s services programs, which hospitals have reduced or deducted in some areas if the regulatory and inspirational structure changes.
Rural health care deserts can be expanded, care can be expanded to create a new story for health care in rural North Carolina.
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