RURAL HEALTH IN ALABAMA: Issues and Possible Solutions Dale E. Quinney, Executive Director Alabama Rural Health Association arha@arhaonline.org (334) 546-3502 ACCA ANNUAL CONVENTION AUGUST 23, 2017

RURAL AREAS ARE IMPORTANT TO EVERYONE!!!!!! Products produced in rural areas or produced from materials and resources that come from our rural areas are of critical importance to the survival of EVERYONE and produce economic impacts for everyone. ACCA ANNUAL CONVENTION AUGUST 23, 2017

ACCA ANNUAL CONVENTION RURAL ALABAMA COUNTIES Are Stifled By a Chronic Lack Of Healthy Population Growth Between 1910 and 2010, Alabama’s RURAL counties increased in population by only 35.3% while our URBAN counties increased by 291.2%. 24 of our 54 RURAL counties actually lost population between 1910 and 2010 with Bullock, Greene, Lowndes, Perry, and Wilcox Counties having approximately 1/3 of the population in 2010 that they had in 1910. Between 2010 and 2040, Alabama’s RURAL counties are projected to increase in population by only 1.1% while our URBAN counties should increase by 16.4%. 39 of our 54 RURAL counties and 2 of our 13 URBAN counties are projected to lose population between 2010 and 2040. ACCA ANNUAL CONVENTION AUGUST 23, 2017

Rural Residents Have An Unfavorable Health Status Life expectancy for rural residents is ½ year lower than Urban Alabama residents and 3 ½ years lower than that for the nation. Rural residents have an age-adjusted mortality rate that is 10% higher than that for urban residents and 33% higher than that for the nation. Rural residents have 4.1 primary care physicians per 10,000 population compared to 7.9 for urban residents. Rural residents have 2.7 dentists per 10,000 population compared to 5.5 for urban residents. 13 rural counties do not have a dialysis clinic. ACCA ANNUAL CONVENTION AUGUST 23, 2017

PART OF THE SOLUTION TO HAVING ADEQUATE RURAL HEALTH CARE: Change Scope of Practice to Better Utilize Nurse Practitioners and Physician Assistants ACCA ANNUAL CONVENTION AUGUST 23, 2017

PART OF THE SOLUTION TO HAVING ADEQUATE RURAL HEALTH CARE: Expand Telemedicine ACCA ANNUAL CONVENTION AUGUST 23, 2017

ACCA ANNUAL CONVENTION WHAT IS TELEMEDICINE? Major Types of Telemedicine: Store and Forward High Risk Patient Monitoring Distance Care Using Telemedicine Equipment Major Barriers to Telemedicine: Lack of Broadband Access Lack of Reimbursement for Telemedicine Services ACCA ANNUAL CONVENTION AUGUST 23, 2017

PART OF THE SOLUTION TO HAVING ADEQUATE RURAL HEALTH CARE: Encourage the development of small bed count hospitals in areas where these will work ACCA ANNUAL CONVENTION AUGUST 23, 2017

PART OF THE SOLUTION TO HAVING ADEQUATE RURAL HEALTH CARE: Encourage the development of county health coalitions, especially in rural counties ACCA ANNUAL CONVENTION AUGUST 23, 2017