Rural Health Care
Wallawa County Hospital emergency room
Introduction
Country Doctors
Country Patients
Oregon's Health Care System
Oregon's Health Care System
Like the health care system nationally, Oregon's health care network is a complicated, multi-layered bureaucracy designed to ensure quality health care to everyone in the state. It doesn't always work that way. Rural communities often find that the system of allocating resources and reimbursing health care providers is based more on urban realities than rural conditions and tend to exacerbate the problems and crises facing rural areas. This section provides a basic sketch of the variety of channels through which Oregonians receive health care and the related problems faced in rural communities.
There have been and always will be people who have private insurance or pay cash for medical services. The remainder either secure government assistance (Medicare or Medicaid), rely on other government programs, or go without. Since 1994, Oregon has offered a special option for low-income residents: The Oregon Health Plan (OHP). It operates under a waiver from the federal government that enables the state to provide basic health care services to a greater number of low-income people than if each applied for Medicaid individually. The OHP functions with a system that prioritizes, or rations, health care. Some treatments, including experimental interventions for diseases like cancer, are not covered.
In this system, rural health care providers often face a "double-whammy" when it comes to seeking reimbursement for their services. Rural doctors and hospitals work in areas with small populations and tend to see far fewer patients than their urban counterparts. As a result, their overhead and expenses are higher per patient even though Medicare and most managed plans reimburse at the same, or in many cases, lower rates than for urban patients.
On top of this, because of poor rural economies and an aging population, a much greater percentage of rural patients rely on Medicare/Medicaid than have private insurance, generating less reimbursement income for the doctor. To stay profitable, urban doctors and hospitals carefully manage the ratio of Medicare/Medicaid-to-privately insured patients that they see. Rural health providers often do not have the option of turning down patients based on their ability to pay.