Downtown Oberlin, Kansas, where the United Methodist Health Ministry Fund held a community conversation on the future of rural health in early March. (Submitted)
The Kansas Reflector welcomes opinion pieces from writers who share our goal of widening the conversation about how public policies affect the day-to-day lives of people throughout our state. David Jordan is the president of the Hutchinson-based United Methodist Health Ministry Fund.
A strong health system is critical to thriving rural communities and the health of rural Kansans. Even before COVID-19 began surging in rural Kansas, it was becoming more difficult to sustain health care services in a changing Kansas, where the rural health system is starved of resources with limited opportunity to innovate.
Significant shifts in population make maintaining health care and other important services in rural communities more tenuous each year. The 2018 Kansas Health Foundation Report, “A Changing Kansas: Implications for Health and Communities,” outlined dramatic double digit declines in population in rural Kansas between 1960 and 2016. Similar depopulation is projected for the state’s rural counties through 2066. Additionally, our rural communities are aging, with 16.3% of the population of Kansas age 65 and over.
One positive trend is that Kansas, including its rural communities, is becoming increasingly diverse. The only population growth in Kansas this century came from a 52.5% increase in the minority population (any group other than non-Hispanic White). This trend makes it critically important that Kansas addresses longstanding racial and ethnic disparities in health, poverty rates and educational attainment.
The high rate of rural Kansans without health insurance is another challenge. Fewer people with health insurance means that hospitals are serving a greater proportion of patients who are unable to pay all or part of their bill. In addition, rural hospitals’ bottom lines have suffered as care shifts from the inpatient to the outpatient setting. Since 2010, five rural hospitals have closed and 73% of the hospitals in the state are operating at a loss.
Longstanding health care workforce shortages throughout rural Kansas also present a challenge to delivering care.
Kansas needs strong policy changes to address the challenges. We must think big, aim to be bold, and center equity in the work to improve the health of rural Kansans. Here are three things policymakers should consider:
Kansas must expand Medicaid. Expanding Medicaid will cut the number of uninsured adults in half, address disparities and improve health. This budget positive policy solution will bring hundreds of millions of our tax dollars back to Kansas annually and create a payment mechanism to protect rural providers’ bottom lines. Expansion will also create thousands of rural jobs and offer employment opportunities to some of the young people who now leave rural Kansas.
Kansas needs to reimagine the health care workforce. Recruiting providers — especially culturally competent ones who meet the social, cultural and linguistic needs of patients — to rural Kansas is difficult. Other rural states have addressed workforce shortages by changing licensing and credentialing policies to make better use of providers such as physician’s assistants and dental therapists as part of doctor led teams. Adding culturally competent providers such as community health workers to Kansas’ workforce can help patients navigate the health system. Such changes will allow Kansas to grow our own workforce. Changes to licensing and credentialing policies will be met with resistance but experience from other states shows that these changes work.
Kansas, and the federal government, needs to embrace innovation in care delivery and payment. Current payment models are stifling innovation. Fee-for-service payment requires providers to see high volumes of patients in person. The COVID-19 pandemic has led to a loosening of these rules and an expansion of telehealth. Sustaining these changes post-pandemic, particularly expanding telehealth, is one way to embrace innovation.
In rural communities, hospitals are tied to a financing model that limits opportunities to deliver care in ways that best meet the needs of each community. Loosening critical access hospital rules would benefit rural Kansas by allowing the Kansas Hospital Association to pilot the Primary Health Center Model they developed to offer a sustainable option to provide preventive and primary care, chronic disease management and emergency services.
We also know that health is more than health care. Other states are exploring using Medicaid dollars to address the social determinants of health — hunger, housing, transportation and early childhood education. Piloting this approach in rural Kansas can improve long-term health and reduce costs.
Having healthy residents and a sustainable health care system is critical to the vitality and viability of our rural communities.
Now, more than ever, we need to be working towards the future of health in our rural communities — a future that ensures all rural Kansans have access to care, uses rural residents as members of culturally competent health care teams, and innovates based on the needs of communities.
We cannot afford to lose time or another rural hospital. The future of rural Kansas is a stake.
Through its opinion section, the Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. For information, including how to submit your own commentary, click here.
Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our web site. Please see our republishing guidelines for use of photos and graphics.