[Congressional Record Volume 140, Number 71 (Thursday, June 9, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: June 9, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
          RURAL HEALTH DELIVERY SYSTEM DEVELOPMENT ACT OF 1994

                                 ______


                            HON. PAT ROBERTS

                               of kansas

                    in the house of representatives

                         Thursday, June 9, 1994

  Mr. ROBERTS. Mr. Speaker, it is obvious we need to improve our health 
care delivery system. Many farm and rural associations certainly know 
this. Health plans sponsored by commodity associations operate in 21 
States, insure more than 45,000 people, and have benefited farmers for 
over 20 years. Rural communities have been forced to develop solutions 
to their unique problems. However, they need the proper tools. I don't 
believe vast sums of money or regulatory schemes are the tools they are 
looking for. I do believe in ensuring that the limited Federal health 
care pie is sliced fairly, and that rural priorities are given fair 
consideration.
  Compromise is a way of life for rural Americans. Rural residents have 
fewer choices of physicians or hospitals. There is generally little 
choice if the patient wishes to be treated near home. Rural physicians 
must settle for fewer medical colleagues to rely on for consultation 
and support. Rural facilities utilize less-sophisticated hospital 
equipment.
  It is obvious that the rural health care delivery system deserves 
special attention. The important components of a rural health system 
must be clearly defined and understood by every Member of this 
Congress. Giving rural communities the tools they need must be the 
cornerstone of any bill that is passed. For this reason, Mr. Stenholm 
and I are introducing today a package of sensible rural health 
provisions that must be included in health care reform. The Rural 
Health Delivery System Development Act of 1994 includes provisions that 
the Coalition has previously endorsed, as well as additional programs 
to encourage voluntary network development in rural and underserved 
areas.
  Today, I would specifically like to point out some of the incentives 
and assistance we have included for rural health providers and 
facilities.


                 National Health Service Corps Program

  The shortage of health care professionals in rural areas continues to 
be the main barrier to the access of health care services in rural 
areas. For example, while the United States averages 2.4 physicians per 
1,000 residents, 82 of Kansas' 105 counties have less than 1.0 
physicians per 1,000 residents.
  Many programs aimed at improving access to health care and attracting 
physicians to rural areas are tied to the National Health Service 
Corps. In determining assignments for National Health Service Corps 
personnel, areas that have been designated as Health Professional 
Shortage Areas [HPSAs] are given priority. In many areas, this 
designation is the most important criteria for determining whether 
rural physicians are eligible for additional incentives in rural areas.
  Unfortunately, recent studies have indicated that the HPSA 
designation is deficient in its ability to adequately define 
underserved populations. This legislation would:
  Amend the HPSA definition to take into account the high 
concentrations of Medicare, Medicaid and uninsured patients found in 
rural areas as additional criteria to indicate underserved populations.
  Extend bonus payments for 3 years to physicians in rural health 
shortage areas that lose their designation.
  Increase funding for the National Health Service Corps.


                        Primary Care Incentives

  The Nation's supply of doctors grew nearly 3.5 times as fast as the 
general population during the past decade. Yet the percentage of 
physicians trained in primary care has been falling steadily, reaching 
as low as 32 percent in the last few years. This shortage of primary 
care doctors constitutes one more barrier to access to health care in 
rural areas. This legislation includes the following additional 
incentives to encourage physicians and other health care professionals 
to enter primary care:
  Defer student loans for interns and resident doctors in primary care 
training programs.
  Adjust the geographical indices to correct for lower reimbursement of 
rural physicians' services.
  Expand the training of mental health professionals and nurses in 
rural areas.
  Redirect Medicare-supported Graduate Medical Education [GME] funds to 
support state demonstration projects to encourage primary care and 
rural-based educational experiences.


                 Assistance for Rural Health Facilities

  Hospitals and health clinics face special problems in meeting the 
needs of rural areas. This legislation would assist rural facilities 
by:
  Expanding options for hospitals to provide emergency care in rural 
areas.
  Establishing a Federal Office of Emergency Medical Services to 
develop regional emergency care networks.
  Enhancing systems for the air transport of rural victims of medical 
emergencies.
  Adding flexibility to the current Essential Access Community Hospital 
[EACH/RPCH] regulations.
  Increasing funding for Community and Migrant Health Center programs.


                              Telemedicine

  Telemedicine is particularly important to rural health delivery 
systems. It assures less professional isolation for rural physicians, a 
critical component needed to recruit more health providers to rural 
areas. This bill expands telecommunications options for rural medical 
facilities, allowing them to establish links with larger, more 
technologically advanced facilities.
  Mr. Speaker, not all rural areas are alike. Rural Kansas is different 
from rural New York and each community must have the flexibility to 
structure health delivery systems that take into account special 
circumstances. This legislation will help to ensure that all rural 
areas are given the opportunity to expand services and develop networks 
utilizing the facilities and providers that exist in each particular 
community.
  This legislation is not intended to restructure the current health 
care delivery system or create new bureaucracies. It is crafted to 
support ongoing efforts, including establishing tax fairness for all 
the self-employed, to make health care more accessible and affordable 
for rural areas. Congress cannot afford to pass a national health care 
reform plan that does not take into account the special needs of the 
rural health delivery system. Rural folks deserve access to the same 
quality health care as those living in urban areas.
  Again, thanks for letting me share this information with the 
committee. I appreciate your interest in rural health and look forward 
to working with you to improve our Nation's health care system.

                          ____________________