The list of rural health issues is a long one, according to Steve Barrow of the California State Rural Health Association. But it can be summed up by one statistic, he said.
“In the rural areas, we have 30% of the state’s Medi-Cal patients, and we have 10% of the state’s population,” Barrow said.
Barrow was one of the presenters at a recent bipartisan legislative hearing on rural health issues, presided over by Assembly members Alyson Huber (D-El Dorado Hills) and Linda Halderman (R-Fresno).
That high concentration of Medi-Cal patients, Barrow said, translates into a lack of primary care physicians, specialists and other providers for all rural residents, and he said that’s the driving concern in rural medicine. “It starts with access,” he said.
And access is, at its root, a financial problem, according to Albert Lowey-Ball of UC Berkeley.
“California is 48th in provider rates,” Lowey-Ball pointed out. “We’re at the tag end of Medi-Cal provider rates.” That is at odds with the state’s overall wealth, he said. “At the same time, California has one of the highest levels of the Consumer Price Index in the United States,” he said.
The state’s solution in the near term, he said, is a shift to a more integrated model of care. “Right now, about 48% are in managed care. And this percentage may rise to 63%,” he said, when you factor in the state’s planned conversion of dual-eligible patients — those eligible for both Medicare and Medi-Cal — to managed care.
“It’s also possible that Healthy Families will be merged into Medi-Cal
managed care, and up to 2 million commercial lives could be added under the exchange,” Lowey-Ball said. “And that could rise to 3 million by 2014, depending on the economy.”
All of that could mean a better outlook for lower income individuals, he said â” but at the same time could swamp rural areas with patient demand, because of a limited number of providers who can care for them.
That can only be fixed by solving a basic math problem, Lowey-Ball said.
“How can you bring in more physicians when reimbursement rates remain so low?” Lowey-Ball asked.
“We are actually looking at further Medi-Cal rate reductions,” Lowey-Ball said. “The [California Medical Association] told me the [reimbursement] reduction in a basic office visit will go from $18 to $11.20.” Then he said it again, for emphasis: “Eleven dollars and 20 cents,” he said.
That kind of reduction only leads one place, he said. “The implications of such physician fee cuts means reduced access, even more increase in the concentration of a smaller number of physicians, higher medical costs and increased ER use.”
In November, the CSRHA is hosting a rural health care summit in Sacramento, to mobilize support and discuss possible solutions.