The dramatically rising number of AIDS cases in rural areas could cripple smaller hospitals' budgets for indigent care.
President Clinton's AIDS czar Kristine Gebbie and rural healthcare analysts sounded that alarm at National Rural Health Association National Conference on Rural Health held last month in San Francisco.
"This epidemic hits on a rural healthcare system that's already weak to begin with," Ms. Gebbie, national AIDS policy coordinator, told MODERN HEALTHCARE in an interview at the NRHA conference. "If they don't get into a system that provides universal coverage, all people with AIDS can do is show up in an emergency room and pray."
Rural hospitals with 50 beds or fewer may have about $50,000 in their budget for indigent care, and that would be exhausted if the hospital has one or two uninsured AIDS inpatients in one year, said David Berry, chairman of the University of Nevada Las Vegas Department of Health Care Administration. Mr. Berry is the author of several books on rural healthcare.
"AIDS is a really serious concern in rural areas where cases are growing faster than more urban areas," Mr. Berry said of the estimated 14,000 AIDS cases in rural areas with populations of less than 50,000.
While those AIDS cases account for just 6% of all AIDS cases nationally, the rate of increase in AIDS cases in rural areas is growing three times faster than in urban areas, according to the Atlanta-based Centers for Disease Control and Prevention.
Mr. Berry's analysis of CDC data shows there was a 9.3% increase in AIDS cases from 1992 to the beginning of 1993 in rural areas with populations of less than 50,000. Meanwhile, the rate of increase in AIDS cases was 3.3% in metropolitan areas with populations of between 50,000 and 500,000, and was 3.1% for metro areas with populations of 500,000 and above.
Ms. Gebbie is proposing a $579 million fiscal 1995 budget for the federal Ryan White Care Act program, which provides healthcare providers with block grant money for outpatient AIDS care. Of that budget, $19 million will be allocated toward primary care, an avenue Ms. Gebbie said is suited for rural hospitals and other rural providers.
"If the Clinton bill does not get universal coverage, we hope to expand `Ryan White' and plug those holes," Ms. Gebbie said.
Rural hospitals are not financially stable enough to care for the high costs of AIDS care as stand-alone facilities, Ms. Gebbie said.
"Rural hospitals need to be structured into a managed-care system," Ms. Gebbie said. "More resources will be available in a system like that than standing alone."