Health Care, Access, Insurance
Maryland Mid-Shore Rural Health Assessment
(School of Public Health (UMD) Health Services Administration Doctoral Student)
Background: Senate Bill 707 Freestanding Medical Facilities- Certificate of Need, Rates and Definition (SB 707) established the Rural Health Care Workgroup to oversee a study of healthcare delivery in the Middle Shore region and develop recommendations to the legislature to meet the health care needs of the five counties – Caroline, Dorchester, Kent, Queen Anne’s and Talbot. Maryland Health Care Commission contracted with the University of Maryland School of Public Health and the NORC Walsh Center for Rural Health Analysis to conduct a study to develop rural health care delivery and payment options for the five counties. Objectives: To highlight our mixed methods approach and preliminary findings as we assess the capacities of the health system in the region; identify specific areas most in need of improvement; and propose options for enhancing health and health care delivery in the five counties. Approach: Assess and integrate findings/recommendations of health improvement plans, existing task force reports and analyses of public health/social services. Analyze existing Medicare, Medicaid and Maryland All Payers Claims data to determine health care utilization patterns of primary, specialty, and acute services by insurance coverage, geography, vulnerable groups and targeted analyses for behavioral health and chronic conditions. Conduct and analyze input from residents through focus groups, public hearings, and stakeholders interviews. Preliminary Findings: The 5 counties differ by socioeconomic status but share the challenges of rural counties, including transportation, workforce shortages, and economic development. Patients have to travel across counties for acute and specialty care, but transportation options are limited, especially for vulnerable groups such as the elderly and immigrants. Difficulties in recruiting physicians and mid-level providers should to be partly addressed by ‘growing our own’ with the support of local colleges. Conclusions: Option models for providing health care in the 5 rural counties models need to be informed by priorities, data and community input and be harmonized with Maryland’s Global Budget Progression Plan. Public Health Significance: Rural areas face significant challenges in providing high quality health care to residents close to where they live. Innovative solutions may include novel primary care models that meet the patients where they live.