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I don't think the trend has anything to do with the ACA - that is insurance based regulation.
I do think the trend will move to what we have here, a small clinic open three to four days a week and run by a PA (although could be a Nurse Practitioner too) affiliated with large regional hospitals in higher population centers with more patient use to cover the overhead of advances in medical machines and the costs associated with those advances. Your check-ups and run of the mil coughs, colds, flus, and infections will be handled locally, and more sever illness will require travel - but I doubt that is truly a new trend in rural health care, most "hospitals" in rural areas are really "clinics" capability wise, not a true hospital with trauma care and specialty treatment capabilities.
Generally speaking if you have a serious illness or terminal illness, you are going to specialty clinics/hospital anyway, and travel is usually involved. I am in NW MT and serious cancer treatments go to SLC UT for treatment with local follow-up at the regional health center/hospital.
It's the other way around. The ACA has stopped the trend, for a while. Before the ACA, hospitals weren't getting paid, so the low volume hospitals in rural areas were closing. Another trend was to close the ER. If a patient shows up at the ER, they have to be treated, and that was where all the uninsured patients went. It was eating the hospitals alive, and the solution was just not to have an ER. In small towns there is often no place to take an accident victim or a heart attack case, so they are in for a life flight.
The ACA put the brakes on the wave of hospital closings, but if we go back to large portions of the population with no insurance, you can expect small hospitals to start vanishing again.
Our hospital system here in our area is fantastic. Has won all kinds of awards.
The hospital system, owns the huge hospital complex in Billings, and keeps expanding with more buildings.
They also own hospitals/medical centers in smaller towns. Ours was replaced 2 years ago, and has hospital and the doctors services in the same building. Specialists are in the big hospital in the city, but some travel on a regular basis to the smaller medical clinics to service patients. The hospital has a special room with large screen telecommunication to connect to the large hospital specialists with test equipment and nurses trained to do the tests, which are read as conducted at Billings. This system is one of only 7 in the nation, that are affiliates with the Mayo Clinic, and they can hook up with the Mayo Clinic as needed.
This system covers Montana, Western half of the Dakotas, and northern half of Wyoming, Plus a section of southern Canada.
The system owns two medical helicopters, and 3 twin engine turbo prop medical aircraft, to bring in patients from all over the area they cover. My daughter had to be airlifted to Billings 3 years ago. They sent in a helicopter. The flight nurse was one of the best nurses I have ever seen. Former Military flight nurse. When she comes in the other nurses get out of her way. She fully evaluates her patient, and prepares they to fly. Her reputation is, she has never lost a patient getting them to the hospital. Her pilot and the copilot move the patient to the copter. The hospital nurses here, told me that is the best nurse in their whole system, and love to assist her in anyway they can as they learn by watching her. I have taken a couple of people to the emergency room one time each, and one in the daytime had a doctor within 5 minutes, and one in middle of the night, had one within 15 minutes.
Our system keeps building new hospitals, and clinics. They hire top quality doctors, and the doctors stay with them year after year. The two main doctors at our local clinic, started work after their internships, and have been here close to 30 years. Both have specialties. In addition my personal doctor has the reputation as the best diagnostician in the whole system. He is often called to Billings to look at a case needing his expertise.
We want small town life in our mid 80s, and this is one of the rare places in the country with the quality of medical service we can get.
You must have wonderful weather if helicopters can always fly. Where I live, you just have to hold it for a couple days in the winter until the storm passes. In the summer, the weather is pretty good, so all you have to do is schedule your medical emergencies for July and August.
Does Medicare pay for Medi-flight or is there a special rider that people in more rural areas get? If you need specialty care some five hours' drive away, are you on your own?
Medicare provides limited ambulance service, but doesn't pay for Life Flight. Around here there is an ambulance insurance called FireMed that costs about $50/year. It will pay for up to 3 ambulance trips a year.
When you go into southwest Virginia, many areas have no hospitals around for at least an hour. There are no freeways - most roads are two lane, curvy, and hilly, slowing travel down. More remote regions are unlikely to even have a medical clinic. Many medical needs are service by the Remote Area Medical biannual charity medical events, as most of the population is indigent.
In the remote areas in Buchanan and Tazewell counties near the WV/KY border, patients are often flown back here by helicopter to Kingsport or Bristol, which is 1.5-2 hours from most places by road from these counties. Our local health systems are good, but truly sophisticated treatments or complicated medical cases are often sent to Duke or Vanderbilt. We have no burn center in this area - those cases are sent to Knoxville, two hours away by interstate.
I prefer a physician. They are obviously better educated and we may safely assume that they're smarter. I use an internist who is a year younger than I. He has a private practice. When I visit, he is the one who takes my blood pressure. Most of his practice is Dermatology. I learned that he's considered an extraordinary diagnostician in this area. He often sends patients to Mayo in Rochester as he considers it to be the best. He apparently has a nose for melanomas.
This is a very pleasant place to live for physicians as well as laymen. I know of only two who left town, both of whom went to Alaska. I'm not sure what that says.
Does your physician take your blood pressure himself?
I know nurse practitioners who are much more in tune with their patients than many doctors. Nurses spend more time than doctors anyway. I don't feel like cattle when I see them.
And the program I worked in was a godsend to rural communities. Doctors wouldn't move there nor open clinics. There wasn't money in it.
The psych/mental health nurse practitioner program was incredibly important to the communities that went bust after the price of oil went down and people lost their jobs..... Doctors only made visits once a month - commuting 4 hours from Salt Lake to the Vernal, UT area. The nurses actually lived in the community and knew the people and their families and experiences.
Hands down - I'd take an NP over a doc anyday for primary care.
Some NPs may be alright but many of the ones that I have dealt with are timid to make decision. They tend to order tests that are unnecessary driving up the cost of my health care.
When I see an NP in the internal medicine practices, I have had to bump it up to the physician to avoid having to go through a battery of tests that he felt were unnecessary.
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Back to the topic at hand.
I live in a rural area about 30 miles from the nearest medical center. There is a local community hospital about five miles away that recently opened. I moved into the area before the small hospital opened. I am comfortable with having a major hospital 30 miles away. If I had to drive four hours, that would be different.
My contract with a private company gives me emergency air service for, as I said above, fifty dollars per year. I know that at least one hospital in Billings offers it as well.
I am astounded by the incredible low emergency air service annual cost of only $50.
Does the annual cost only give you access to the service but you have to pay for each usage or does it cover everything?
I find it's hard to believe that any commercial outfit could offer such a low fee. The fuel cost of the helicopter/plane alone would be way more than $50/hour let alone the manpower cost.
The article below shows the exorbitant cost of air ambulance in rural areas
The way the Thomsons read their insurance plan, they thought any emergency medical transportation was covered.
But it turns out, the air-ambulance company was out of their network, and they got a bill for $56,000.
....
Of all the complaints we have received in our office, not one person was uninsured,” said Jesse Laslovich, the legal counsel for Montana’s insurance commissioner. “They’re all insured. And they are frustrated as heck that they’re still getting $50,000 balance bills.”
...
The cost of an air-ambulance bill is split into two main parts, according to a study completed by the Montana legislature. First, a liftoff fee, which ranges from $8,500 to $15,200 in Montana, and then a per-mile charge for the flight, which ranges from $26 to $133 a mile.
Some air ambulance companies offer membership programs as protection from big bills. For an annual fee of about $60 to $100, patients face no cost beyond what their health insurance pays if they use that company’s services.
But Laslovich said that doesn’t always work, because a patient can’t always know who is going to pick them up.
...
He says some air-ambulance companies remain out of insurance networks because they can’t always reach in-network deals that allow them to stay profitable.
I hope that you don't mind giving more detail information about the services which you know.
But less take into consideration that living in or near Los Angeles is a death sentence for many people. Particularly older retired people. It is the deadliest place on the country for them to live. Dangerous due to the heavy smog in the area.
We left the Silicon Valley years ago, when the air was better than it is today, with the doctors telling me to take my wife and one son out of the air immediately out of the area, or to arrange their funerals as my son would not live over 90 days and my wife not over 6 months if we remained there. We left the area, and they got healthy immediately as the doctor told me they would. Later I developed problems that had occurred due to the earlier smog I lived in. I know a lot of people with the same story.
Older people that want to live, are often leaving the polluted cities, and going to clean air areas of the country to live, due to the problems such areas as Los Angeles have that will kill them if they live there.
I like living where the air is clean, skies are bright blue, clouds are white, and mountains 98 miles away are viable without smog hiding them from view shining bright and clear. The other option would be in the populated California areas with great operas, etc., and be buried in one of their final resting place, a cemetery along with my wife and living childen.
I was in my teens when my parents sold the house and moved out of the San Fernando Valley to the beach. It wasn't the house or the neighborhood, but the smog. I virtually lived on anthhistamines. Once they put a rule in that if the air was past a certain measure, no outside except for changing classes. As soon as we left, 90 percent of breathing problems vanished. I was told by a doctor that my ability to breath in deeply was damaged by all the smog.
And before I moved here, I lived in Riverside. During the winter you could look down the main streets, and see the mountains miles away. As soon as spring hit, the whole sky was grey. I lived on various anti hystamines. When I came here to visit a friend the very first thing I saw was blue sky. I'd already done some research about price and such. The way you could breath the air and it didn't smell like garbage sealed my decision to leave California.
That's why, should someone say they might consider the cheaper middle area of our land but for the weather, I will say yes, there are problems like tornados. But see how many can be expected in the spot you look. Some areas like where I live have not had a major one, as the storms turn around the area. But... when its not stormy, the sky is often nice and blue and the air is not contaminated. If you have any sort of breathing problems, it helps enormously. It won't make everything perfect, but it will make it a lot better.
I've heard the Sbd/Riverside area is doing 'better' but somehow I doubt its normal to see mountains and blue sky in July.
The other thing is that in a place like this, everything moves slower. Days tend to be like other days. The weather is changeable and helps keep things different. And it quiet.
Yes, there is stuff I miss, but then, going back I'd miss this even more.
And once you get used to being able to breath, it would be hard to justfy going back into the grey murk.
People who live in rural areas their whole lives are pretty self sufficient and are aware and accept that there won't always be someone ready to save them in case of an emergency. You have those city dwellers who dream of retiring to a rural area but are not completely aware of what entails. There is a great deal of "rocking the boat" with a rural lifestyle, especially as one ages. Those who can't deal with that should stay within the city limits.
I am astounded by the incredible low emergency air service annual cost of only $50.
Does the annual cost only give you access to the service but you have to pay for each usage or does it cover everything?
I find it's hard to believe that any commercial outfit could offer such a low fee. The fuel cost of the helicopter/plane alone would be way more than $50/hour let alone the manpower cost.
The article below shows the exorbitant cost of air ambulance in rural areas
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