Rural Health Policy
How do we ensure access to affordable, quality healthcare for our rural residents? How do we select Medicare and Medicaid reimbursement approaches that help rural healthcare facilities keep their doors open? How can we attract healthcare providers to rural communities? Rural health policy is the set of principles and plans of action our government uses to address these and other rural health issues.
Rural health policy takes place at the federal, state and local levels of government. Many people and organizations are involved in the formulation of rural health policy, including:
- Government agencies
- Membership organizations
- Rural health researchers
- Rural providers
- Rural patients
- Concerned citizens
These groups work to identify potential improvements to the provision and availability of healthcare services in rural communities through the implementation of health policy that addresses the specific needs and concerns facing rural areas.
Frequently Asked Questions
- What types of issues does rural health policy address?
- Who is involved in the rural health policy process?
- What is the process that takes an idea or issue and effects change to improve rural healthcare?
- Who are the key players in developing rural health policy?
- Which federal agencies address rural health policy issues?
- How do researchers support rural health policy?
- What role do membership organizations play in advocating for rural health issues?
- What resources are available to stay current on evolving rural health policy?
What types of issues does rural health policy address?
Rural health policy shares many concerns with the broader realm of health policy, such as the availability of and access to health services, healthcare quality, healthcare costs, and Medicare and Medicaid reimbursement. Rural health policy focuses more specifically on how rural populations are affected by policy. Health policy issues with particular interest for rural stakeholders include:
- Availability and financial stability of rural healthcare facilities, such as Critical Access Hospitals, Federally Qualified Health Centers, and Rural Health Clinics
- Healthcare workforce
- Health information technology
- Adequate Medicare and Medicaid reimbursement for rural areas
- Rural healthcare quality
- Rural public health
- Emergency medical services
Who is involved in the rural health policy process?
The formulation of health policy relies on input from various parties, each of whom contribute information and expertise needed to understand healthcare concerns of rural communities. At the federal level, the formal part of policymaking is conducted by the Executive, Legislative and Judiciary branches of the government, through the passage of legislation that impacts rural health.
The Executive Branch
The President plays a strong leadership role in policy formation. The White House Rural Council is a convening body comprised of federal agencies, in collaboration with the Executive Office of the President. The Council connects with and draws upon the expertise of rural residents to help inform and carry out its work focusing on job creation and economic development that includes access to quality healthcare.
The legislative branch is made up of elected officials in the U. S. Senate and the U. S. House of Representatives. Within these, the Senate Rural Health Caucus and House Rural Health Care Coalition, which are informally organized, bipartisan organizations, focus attention and act on behalf of rural healthcare concerns.
The role of the Judiciary is to determine the constitutionality of all legislation.
Federal agencies play several roles in the policy process. They collect information and inform policymakers about issues and needs related to rural healthcare. However, they do not simply act in an advisory capacity as they often are called upon to carry out legislative mandates through implementation of legislation, including issuing and enforcing regulations. Read more about which federal agencies address rural health policy.
Interest groups, such as membership organizations, advocate in the interest of their members, typically through their government affairs sections. Read more about the role membership organizations play in advocating for rural health.
What is the process that takes an idea or issue and effects change to improve rural healthcare?
An issue or idea related to rural health may come to light through research findings or concerns expressed by groups or individuals. Oftentimes, membership organizations bring issues identified by their membership to the attention of policymakers through policy briefs or by direct communication with the policymaker’s office.
At the federal level, once a problem and potential policy solution is identified, lawmakers in the U.S. Senate and House of Representatives may craft legislation intended to address the issue, with input from a variety of experts and interested parties. If the legislation is passed and becomes law, then federal agencies with jurisdiction over the related policy or program will be called upon to administer regulations and enforce the law.
In the same manner, state level policy is formed through the actions of many actors and enacted once voted through the state’s legislative branch and being signed by the governor. State level regulation and enforcement becomes the responsibility of state agencies in the same way it is delegated to federal level agencies, but due to a level of autonomy states hold as defined by the U. S. constitution, variation amongst states’ delegation of responsibilities exists.
At both the federal and state level, the process of identifying and addressing issues is iterative. Each time a change is made, lawmakers, researchers and interested parties examine the results, look for methods that might improve the situation, suggest possible legislation to modify the policy or program, and track the results.
Who are the key players in developing rural health policy?
As part of the Health Resources and Services Administration (HRSA) under the Department of Health and Human Services (HHS), the Federal Office of Rural Health Policy (FORHP) has a department-wide responsibility for analyzing the effects of policy on rural communities and helps shape rural health policy in a variety of ways. The Office advises the Secretary of Health and Human Services on major issues such as the effects of Medicare and Medicaid on rural citizens' access to healthcare. Since its inception, FORHP has worked with Centers for Medicare & Medicaid Services on the development and review of Medicare and Medicaid regulations. The Office also has established working relationships with other federal agencies in the development of policy and regulatory decisions.
The National Advisory Committee on Rural Health and Human Services (NACRHHS) is a 21-member citizens' panel of nationally recognized experts that provides recommendations on rural health and human services issues to the Secretary of the Department of Health and Human Services. The Committee produces annual reports that focus on key issues impacting rural health and human services. FORHP staff help coordinate the activities of the NACRHHS.
The Medicare Payment Advisory Commission (MedPAC) is an independent, 17-member group that advises the U.S. Congress on matters affecting the Medicare program. MedPAC has a broad statutory mandate to consider issues related to Medicare, including access to care, quality of care, and other issues. Medicare reimbursement in rural areas and how these payments influence rural Medicare beneficiary access to quality care is one area that MedPAC addresses.
Which federal agencies address rural health policy issues?
These are some of the federal agencies that, along with the Federal Office of Rural Health Policy (FORHP), work to address rural health policy:
Health Resources and Services Administration (HRSA)
Through FORHP and HRSA’s other bureaus and offices, including the Bureau of Primary Health Care (BPHC), which funds Community Health Centers (CHCs), and the Bureau of Health Workforce (BHW), which has multiple programs which address rural healthcare workforce matters
Veterans Health Administration (VHA) Office of Rural Health
Works to improve the access to quality healthcare for Veterans living in rural areas
Agency for Healthcare Research and Quality (AHRQ)
Works to improve the quality, safety, efficiency, and effectiveness of healthcare for all Americans, including those who live in rural areas
Centers for Medicare and Medicaid Services (CMS)
Implements Medicare and Medicaid regulations that impact rural beneficiary coverage and provider reimbursement
Centers for Disease Control and Prevention (CDC)
Work includes disease prevention and control, environmental health, and health education activities nationally and at the community level
Indian Health Service (IHS)
Focuses on the availability of healthcare services to American Indian and Alaska Native people, many of whom live in rural areas
U.S. Department of Agriculture (USDA)
Supports the rural healthcare infrastructure through the USDA Rural Development’s Community Facilities program
U.S. Department of Housing and Urban Development (HUD)
Supports rural hospitals through the HUD 242 capital financing program
How do researchers support rural health policy?
Rural health researchers focus their research on topics that highlight problems with the provision of healthcare in rural communities and identify recommendations that may influence public policy formulation. Findings from rural health research may help inform policymakers about disparities that should be addressed and methods that may be particularly effective. Researchers may also be tasked with evaluating programs that the government has put in place to address an issue or a problem. The federal government supports a number of rural research and policy analytic centers through the Federal Office of Rural Health Policy's Rural Health Research Centers and Analysis Initiatives program. For information about current rural health research projects, please see Rural Health Research Gateway.
What role do membership organizations play in advocating for rural health issues?
Membership organizations, such as the American Hospital Association's Section for Small or Rural Hospitals, the National Rural Health Association (NRHA) and state rural health associations, work with legislators to make them aware of the challenges specific to the rural health community. Organizations may produce publications to help inform policymakers about important rural health issues.
Membership organizations also keep their members informed about bills under consideration that may impact them and the implications of laws and regulations that have been passed. These organizations also help mobilize members by connecting them to their state and federal legislators so they can influence the outcome of any policies under consideration.
Membership organizations involved in rural health often join forces on issues where they can work effectively to address common goals. On issues where the needs of their constituents diverge, these same groups will choose to pursue their goals separately, coming together again on the next issue where collaboration will be effective.
Additional membership organizations with interests in rural health include:
National Organization of State Offices of Rural Health (NOSORH)
Works to enhance access to quality healthcare in rural areas
National Association of Rural Health Clinics (NARHC)
Focuses on the issues of Rural Health Clinics (RHCs)
National Association of Community Health Centers (NACHC)
Focuses on the concerns of Federally Qualified Health Centers (FQHCs), many of which serve rural communities
American Academy of Family Physicians (AAFP)
Represents the interests of family physicians, including those working in rural areas
American Public Health Association (APHA)
Works to influence policies and set priorities in public health
What resources are available to stay current on evolving rural health policy?
There are a variety of government agencies, member associations, research centers, and non-for-profit organizations on both the national and state level that serve as resources to stay current on rural health policy.
Federal Policy Resources
- National Rural Health Association (NRHA) – NRHA, and other membership organizations, closely follow rural health policy. The NRHA website has many important policy resources, such as government affairs links, official policy positions, and a blog that reports on legislation and regulations that impact rural health.
- Federal Office of Rural Health Policy (FORHP) – FORHP’s Policy and Research page identifies rural health policy issues and associated resources.
- National Advisory Committee on Rural Health and Human Services (NACRHHS) – The committee studies rural healthcare and provides its findings and recommendations to the Secretary of Health and Human Services.
- Rural Health Research Gateway – Provides access to publications and projects of the FORHP-funded Rural Health Research Centers.
- RHIhub Online Library – In our online library, we identify news stories and Federal Register Notices related to rural health policy. There are also organization listings which may help you identify other organizations interested in, or dealing with, rural health policy.
State Policy Resources
Note that there will be variation among states
- State Offices of Rural Health (SORHs) – These offices coordinate state-wide efforts to improve access to and quality of rural healthcare. This statewide exposure offers unique perspectives that inform future rural health policy.
- State Rural Health Associations (SRHAs) – These bodies advocate for policies to improve quality and access of rural healthcare.
- State Hospital Associations – These associations are not rural specific but their work affects rural healthcare policy, especially in predominantly rural states. Often provide key policy information at the state level.
- Primary Care Associations (PCAs) – Similar to the state hospital associations, these associations are not rural specific but hold implications for rural healthcare policy. Often provide key policy information at the state level.
- National Conference of State Legislatures (NCSL) – Although not rural specific, this organization works to support state legislatures and promote innovative policy at the state level, including rural health policy. Provides research, tools, and publications to inform and affect policy.