[Congressional Record Volume 140, Number 45 (Thursday, April 21, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: April 21, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                 ACCESS TO RURAL HEALTH INFORMATION ACT

                                 ______


                           HON. KARAN ENGLISH

                               of arizona

                    in the house of representatives

                        Thursday, April 21, 1994

  Ms. ENGLISH of Arizona. Mr. Speaker, I rise today to introduce the 
Access to Rural Health Information Act. This legislation will help 
provide rural Americans with information they need to make sound 
decisions about their health.
  The Access to Rural Health Information Act would establish a toll-
free rural health care telephone hotline, through which rural residents 
can obtain information about medical services available in their area 
including physician referrals, emergency services, preventive and 
prenatal care, immunizations, and the availability of counseling for 
substance abuse, domestic violence, and sexual abuse. Information about 
location of health providers, and travel times and directions would 
also be available.
  Mr. Speaker, 25 percent of all Americans reside in rural areas like 
district 6 in Arizona. Rural residents are all too familiar with the 
frustration of trying to locate even basic information in areas of this 
country that have been traditionally underserved by the health care 
delivery system. Making sure that people can easily get this 
information is the first step toward improving access, quality, and 
cost containment in rural areas.
  There is also a personal side to this story. Some health problems may 
carry a social stigma in small towns. In urban areas, all it takes is 
opening the telephone book to find a detailed listing of physicians, 
clinics, support groups, and other critical information about health 
problems. In rural areas, where people may have grown up with the only 
doctor in town, confidentiality may be a problem. A toll-free hotline 
will help people easily find a professional, confidential source from 
which to learn about various medical problems.
  My bill would require the existing State offices of rural health to 
administer the rural health care hotline. The office of rural health 
has done a tremendous job serving as a clearinghouse for rural 
communities and health professionals who need to learn the newest 
medical technology or to recruit a primary care physician. My bill 
would build on this success and make information available directly to 
the consumer.
  Rural America faces a tough challenge in providing health care to its 
residents. Primarily, these problems can be attributed to the lack of 
primary care providers, physical and economic barriers, and the fragile 
nature of rural health care delivery systems dependent on a sparse 
population base. When a rural area loses its doctor, it often loses its 
health care.
  Rural areas find it difficult to attract and retain medical 
professionals for many reasons. These include lower incomes earned by 
rural physicians, higher operating costs, heavier patient case loads, 
and isolation from major medical facilities. In Holbrook, AZ, three 
primary care physicians serve 7,000 residents.
  Even when a person drives 2 hours to seek care from a doctor, he or 
she may spend all day waiting to get treated. The Winslow Indian Health 
Center, built in 1930, has a standard 3- to 4-hour wait just for a 
basic appointment. These and many other medical facilities face doctor 
shortages and other serious problems.
  The deteriorating physical infrastructure and fragile nature of rural 
health delivery systems threaten access to care. Hospitals in rural 
areas struggle to stay open, and community and migrant health centers 
continually face uphill financial battles to remain solvent. In Globe, 
AZ, the only hospital shut down recently leaving an entire city and its 
surrounding area without any needed medical facilities.
  Beyond the obvious problem of lack of medical facilities, rural 
Americans typically find themselves left out of the employment-based 
health insurance system. With a large percentage of rural Americans 
working in seasonal jobs, in small businesses, self-employed, or 
unemployed, many lack any health insurance at all. In fact, over 7 
million rural Americans are without basic health insurance, and are 
unable to pay high out-of-pocket costs for even routine, preventive 
treatment.
  Finally, one of the most critical health problems associated with 
rural communities centers around the problem of transportation. Sheer 
travel distance is a problem. Poor road conditions and bad weather can 
make traveling to seek medical treatment a hazard in and of itself. The 
lack of emergency medical services increases the risk of fatalities 
from car, farming, and other accidents. It is estimated that a well 
organized emergency medical service can cut injuries and deaths by as 
much as 15 to 20 percent.
  There are complex, and unique problems facing rural Americans as they 
seek access to medical care. These issues must be addressed in the 
context of the on-going health care reform debate. Many existing, 
innovative programs including the area health education centers, 
National Health Service Corps, and the development of 
telecommunications have already started to deal with access to care in 
rural areas. Building on these and other successful programs will help 
ensure quality, medical care to rural America.
  The development of integrated delivery systems will enable rural 
communities to have improved access to medical services. Federal, 
State, and local entities can create incentives for hospitals, 
physicians, and other providers to participate in community-based 
systems of care. By identifying and working to support a town's health 
facility, communities can solidify their sole source of emergency, 
acute, primary, and long-term care. Bringing together medical 
professionals and facilities to collaborate with one another will help 
address the health problems of underserved communities.

  Increased recruitment and retention of primary care physicians will 
reduce the shortage of medical providers. A restructuring of the 
incentives in training physicians to promote the education of primary 
care physicians will further reduce physician shortage areas. 
Physicians and health professionals are the cornerstone of a 
community's health care system. Without them, people lose their 
personal connection and sometimes only source of medical treatment. 
More equitable reimbursement for all providers as part of health care 
reform will enable more rural providers to better deal with the 
hardships of living in a rural community.
  Improvements and innovations in telecommunications will enable rural 
doctors and patients to have improved access to medical technology and 
health information. The rural health hotline will be one of the 
important links to bring physician referrals and health information to 
many people who don't know where to find the closest doctor, which may 
be an hour or two away.
  With the possibility of increasing numbers of primary care 
physicians, it will be critical for patients to be able to find new 
doctors in their surrounding communities. Another vital 
telecommunications link, telemedicine, has proven very successful in 
some of the pilot projects existing in rural States. With improved 
video technology, telemedicine can bring the knowledge and expertise 
from specialists located hundreds of miles away to the doctor's office 
of a rural practitioner. My bill says we should take telemedicine a 
step further. Let's use this technology to overcome some of the 
problems that limit access and impede efficient health services 
delivery in rural areas.
  Improving access to medical care for rural Americans is not an 
impossible task. Focusing limited resources on improving the number of 
providers and bolstering the existing health facilities will go a long 
way in bringing medical care to more rural residents. Creative ideas 
for dealing with few health professionals and long travel times to 
reach doctors will enable rural residents better access to health 
services.
  A rural health care telephone hotline will help ensure that rural 
residents will be better able to locate a doctor when they need one, it 
will help people find emergency medical treatment. It will help people 
take advantage of preventive health services, gain medical information 
on a confidential basis and learn where their health insurance is 
accepted.
  Mr. Speaker, I look forward to working with my colleagues to address 
the problems associated with rural health care access and delivery. I 
urge support for the concept of easily accessible, toll-free health 
services information telephone hotline.

                          ____________________