More than a third of rural Americans live in areas with a shortage of health professionals. Nearly 82 percent of rural counties are classified as “medically underserved.” Only 9 percent of American physicians practice in rural areas. Most rural areas also have a shortage of dentists, pharmacists, registered nurses, and ancillary medical personnel.

And that grim picture is not improving.

A report by the Center for Rural Affairs notes that only 3 percent of recent medical students plan to practice in small towns and rural areas, and the majority of medical professionals already practicing in rural America are 48 or older.

“Rural people and rural communities are faced with many of the same health care issues and challenges confronting the rest of the nation,” says John Bailey, director of rural research and analysis at the center.

“These include exploding health care costs, large numbers of uninsured and underinsured residents, and an overextended health care infrastructure.”

Chief among the numerous unique health care issues facing rural America, the report says, are a Top 10 which should be addressed as the debate over reform of the federal health care system takes place in Congress.

• A decline in manufacturing jobs has resulted in a rural economy largely based on self-employment and small businesses, resulting in more uninsured and underinsured.

The report says any health care reform legislation must provide options, including a public option, to small businesses and the self-employed that will provide “comprehensive, affordable, an continuous coverage in ways that are comparable to larger group coverage

• With a population that is older and has less employer-based health insurance coverage, a large segment of rural residents are dependent on public health care programs such as Medicaid, Medicare, etc. But many aren’t eligible for public programs.

“Viable health care reform legislation should strengthen public programs currently depended on by many rural people,” the report says.

Public insurance “has a history of health care cost controls,” it notes. Between 1997 and 2006, “Medicare spent about 60 percent less on health care per enrollee than private insurance.”

• The health care infrastructure in much of rural America “is a web of small hospitals, clinics, and nursing homes, often experiencing financial stress.”

Reform legislation should address the plant and technology needs of rural health care facilities and provide resources to expand such facilities as necessary for unserved or underserved areas, the report says.

• Reform legislation should also address the shortage of health care providers and work force by promoting rural medical practice, offering incentives to practice in rural areas, and recruitment and education for all types of rural health care professionals.

• With a rural population that is older than the nation as a whole, sicker, and more at risk, and an over-65 population expected to double by 2030, the report says reform legislation should provide health care services in community settings that allow rural seniors to remain in their communities. This should include enhancement of Medicare funding of telemedicine and other technology.

The report also calls for legislation that would address the need for preventive care, health and wellness resources, the lack of mental health services, the increasing dependence on technology, and more effective emergency medical services.

“These issues make it paramount that Congress and the White House get health care reform right for all Americans, urban and rural,” Bailey says.

The full report is available online at rural health care reform.

e-mail: hbrandon@farmpress.com