The Safety Net Role of Independent Rural Health Clinics
Rural Health Clinics (RHCs) have become an important part of the rural health care infrastructure. As of March 31, 2006, 3,673 RHCs were providing a wide range of primary care services to the rural residents of 46 states. Of this number, 2,000 are independent RHCs. The patient populations served by these RHCs include a high proportion of rural elderly and poor through the Medicare and Medicaid programs (Gale and Coburn, 2003). In addition, RHCs are increasingly looked upon as belonging to a class of providers that comprise the health care safety net (Gaston, 1997, Buto, 1997, Gage, 2000, Hartley and Gale, 2003), based on the requirement that they be located in rural areas that are designated as underserved. As defined by the Institute of Medicine (IOM), safety net providers “organize and deliver a significant level of health care and other health-related services to uninsured, Medicaid, and other vulnerable populations” (Lewin and Altman,2000). The IOM further identified a subset of the safety net known as “core safety net providers” that have a legal mandate or explicit mission to offer services to patients regardless of their ability to pay and whose patient mix includes a substantial proportion of uninsured, Medicaid, and other vulnerable individuals. The authors did not include RHCs in their list of core safety net providers. This project will explore the ways in which independent RHCs serve as part of the safety net. Through analysis of RHC cost reports and a national telephone survey, the safety net functions of independent RHCs will be identified and assessed. Findings will be disseminated to federal, state and local rural health officials and stakeholders.
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