Buried somewhere in the contentious debate over the federal budget and Medicare/Medicaid reform is a program that holds great promise for healthcare in rural communities.
Montana's experiment with medical assistance facilities (MAF) in remote areas has proved an efficient and economical way to ensure decent access to healthcare for rural residents. The program seeks to guarantee basic emergency care, outpatient services and limited inpatient/skilled-nursing services in communities where hospitals had closed or were at risk of shutting down.
Relaxed licensing requirements are at the core of the MAF program. Nine MAF units currently are operating, and Congress has authorized the program until July 1, 1997.
With the political carping and fiscal uncertainty in Washington, Montana Hospital Association officials were hoping to win permanent approval. However, such language was stripped from the Senate budget bill even before the great stalemate on Capitol Hill.
Montana's approach to downscaling medical services without sacrificing access for emergency cases and basic healthcare needs is a concept that deserves strong support on all sides of the political spectrum. Full-service hospitals simply aren't viable in every rural area. Those that survive into the new millennium must shift their focus toward meeting the community's need for primary, emergency and long-term care.
Taking it a step further, Wisconsin's Prairie du Chien Memorial Hospital collects data on community benefits provided beyond the hospital's walls. Child care, meals on wheels and home health visits are among the daily units of health services tabulated by the hospital's management.
No single blueprint exists to protect the future of rural hospitals. But those with the best chance are innovative and flexible as they position themselves as building blocks for healthcare networks serving rural communities.