Respond?to?two?of your colleagues by either supporting or respectfully challenging their explanation on whether there is an evidence base to support the proposed health policy the

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Peer 1

Betty Hyunjung Kim

Discussion

Policy Description ( US Congress, n.d.)

The bill, known as the Rural Health Innovation Act of 2023 and introduced in the Senate on 03/23/2023, establishes two grant programs aimed at improving access to emergency care in rural areas. These programs are managed by the Federal Office of Rural Health Policy within the Health Resources and Services Administration.

Firstly, the office is required to provide grants to federally qualified health centers and rural health clinics with the goal of enhancing walk-in urgent care, triage, and other emergency services in rural areas. Secondly, grants are also provided to health departments in rural areas for a range of emergency services including triage and transport to emergency departments as well as primary care services similar to those provided by emergency departments. Recipients of these grants may allocate funds towards staffing, equipment, or other necessary expenses related to providing these essential services.

These departments face challenges such as a shortage of medical staff, insufficient medical equipment, limited access to emergency services, and difficulty providing comprehensive primary care services. By allocating federal funds to enhance the capability of rural health departments, the policy seeks to alleviate these challenges and improve health outcomes for rural populations.

Policy Background

In many rural areas across the nation, there exists a stark disparity in healthcare access and quality when compared to urban centers. This divide is driven by factors such as geographical isolation, economic constraints, and a chronic shortage of medical professionals willing to practice in these less densely populated areas. The ramifications of this divide are profound, as rural residents are more likely to experience health problems associated with aging, chronic diseases, and occupational hazards specific to agriculture and manual labor predominant in these regions.

Traveling long distances for medical treatment is not uncommon for rural populations, leading to delayed care, less frequent engagement with preventative services, and a higher likelihood of hospitalizations for conditions that could be managed through regular primary care. The infrastructure limitations, compounded by economic challenges, mean that rural health departments are often underfunded and underequipped, struggling to provide even the most basic health services.

Social Determinant

The social determinant most affected by this policy is "Access to Health Services." The policy directly targets the improvement of healthcare infrastructure in rural areas, which encompasses the availability of primary care services, emergency services, and other critical health resources. By enhancing rural health departments, the policy is aiming to increase the accessibility of medical services for rural populations, who currently face significant challenges in obtaining adequate healthcare due to distance, resource scarcity, and workforce shortages. This increase in accessibility is likely to have a positive impact on health outcomes for these communities.

Moreover, the scarcity of healthcare resources in rural areas is not merely an inconvenience—it represents a significant public health concern. The outcomes for patients in these areas are measurably worse when compared to those in urban settings, with higher rates of mortality and morbidity.

Evidence-based research

The implementation of policies similar to the Rural Health Department Enhancement Program is supported by various research studies that highlight the challenges of healthcare delivery in rural areas. It stressed the importance of health policies that address rural healthcare issues by taking into account all dimensions and their interactions. This approach is essential for effectively meeting the unique needs and challenges faced by these communities (Dassah et al., 2018).

It also examined the factors that affect students' satisfaction and their intention to enter rural practice, emphasizing the significance of placements at University Departments of Rural Health (UDRHs) and the collaborative efforts of academic institutions, healthcare organizations, and government agencies in attracting students to rural practice and addressing workforce shortages in these areas (Smith et al., 2017).

Furthermore, White (2013) emphasized the importance of evidence-based policies and strategies to improve rural health. The focus was on government and community policies related to rural health determinants. It also highlighted the positive impact of supporting research on rural health workforce and promoting rural research. There was an emphasis on the need for enhanced capacity building initiatives for the rural workforce and research efforts (Shee et al., 2022). It is clear that addressing the challenges of healthcare delivery in rural areas requires a comprehensive approach that includes targeted policies, collaboration between academic institutions and healthcare organizations, and investment in research and workforce development.

In conclusion, research studies have consistently emphasized the importance of addressing healthcare delivery challenges in rural areas through comprehensive and evidence-based policies.

References 

Dassah, E., Aldersey, H., McColl, M., & Davison, C. (2018). Factors affecting access to primary health care services for persons with disabilities in rural areas: A "best-fit" framework synthesis.  Global Health Research and Policy,  3(1). https://doi.org/10.1186/s41256-018-0091-x 

Rawal, L. B., Joarder, T., Islam, S., Uddin, A., & Ahmed, S. (2015). Developing effective policy strategies to retain health workers in rural bangladesh: A policy analysis.  Human Resources for Health,  13(1). https://doi.org/10.1186/s12960-015-0030-6 

Smith, T., Sutton, K., Pit, S., Muyambi, K., Terry, D., Farthing, A., Courtney, C., & Cross, M. (2017). Health professional students' rural placement satisfaction and rural practice intentions: A national cross‐sectional survey.  Australian Journal of Rural Health,  26(1), 26–32. https://doi.org/10.1111/ajr.12375 

US Congress. (n.d.).  S.953 – Rural Health Innovation Act of 2023. Retrieved January 6, 2024, from https://www.congress.gov/bill/118th-congress/senate-bill/953?q=%7B%22search%22%3A%22S953%22%7D&s=2&r=1 

Wong Shee, A., Quilliam, C., Corboy, D., Glenister, K., McKinstry, C., Beauchamp, A., Alston, L., Maybery, D., Aras, D., & Mc Namara, K. (2022). What shapes research and research capacity building in rural health services? context matters.  Australian Journal of Rural Health,  30(3), 410–421. https://doi.org/10.1111/ajr.12852 

Peer 2

Sandy L Sullivan

     The policy I have chosen to discuss is H.R. 4473, which is to amend title XVIII of the Social Security Act to provide for

site-neutral payment for cancer care services under part B of the Medicare program.      It was found in a report from MedPAC in June 2022 that a major shift in where therapy occurred from the physician's

office to hospital outpatient increases costs for patients but does not improve the quality of care.      This legislation would shift the reimbursement to equal no matter where the treatment occurred. In other words,

Medicare reimbursement rates for cancer treatment would be site-neutral. The payment clause of this bill states,

“payment for cancer care services shall be made in the same manner and to the same extent as payment is made pursuant

to paragraph (21)(C) under the applicable payment system described in such paragraph with respect to applicable items

and services furnished by an off-campus outpatient department of a provider that are described in paragraph (1)(B)(v).”

(Medicare Patient Access to Cancer Treatment Act. 2023. H.R. 4473)      I believe providing this across the board for Medicare patients would give better access to those in outlying areas who

may not have access to treatments except in a physician’s office. Evidence shows the statistics for outpatient treatment

fees grew from 9.6 percent in 2012 to 13.1 percent in 2019. COVID-19 had some impact on these numbers. According to

the bill, evidence also shows that if payment rates had been set, Medicare spending in 2019 would have declined by 6.6

billion dollars. (Medicare Patient Access to Cancer Treatment Act. 2023. H.R. 4473)      The social determinants affected by this policy would be healthcare access and quality. Medicare is detrimental to

many of our aging population as the only insurance coverage they have. When it doesn’t cover things like cancer

treatments or the costs far outweigh the benefits, citizens might choose to forego treatment. By making Medicare B

cancer reimbursement a non-site specific rate to providers, it won’t matter whether the patient goes to the hospital or a

clinic. The cost of therapy in a hospital setting is more expensive, requiring the utilization of staff and supplies not

necessarily needed in a smaller physician's office. Access to healthcare and cancer screening services is important to

overall health.  Increasing access to treatment will allow better outcomes.      In conclusion, Medicare does cover some cancer treatments. Part A hospitalization covers testing and treatment during

a hospital stay; however, there is a deductible to be met first. Part B covers screenings, which, using smaller outlying

clinics and physicians, can cut the costs associated with travel for those visits. Part B also only covers 80%.      This law will help with some of the costs being absorbed by making the reimbursement non-site specific, thus keeping

control of the funds being used by Medicare.

References

Baum, J. (2022, October 2). Does Medicare Cover Cancer Treatments? EHealth.                                                                                   https://www.ehealthinsurance.com/medicare/coverage/does-medicare-cover-cancer-treatment/

Health Care Access and Quality (nd) Healthy People 2030. Office of Disease Prevention and Health Promotion.                              https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality

Hopkins, K. (2022, February 1). Medicare Coverage for Cancer Treatments. MEDICAREFAQ.                                                               https://www.medicarefaq.com/faqs/medicare-coverage-for-cancer/

H.R. 4473, Medicare Patient Access to Cancer Treatment Act, 118th Congress, 2023-2024. Session 1.                                               https://www.congress.gov/bill/118th-congress/house-bill/4473/text?                                                                                         s=5&r=1&q=%7B%22search%22%3A%22Cancer+treatments%22%7D

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