Article 122. Rural Health Care Suggestions

 

For a large rural area I like to think of Rural Health Care as clusters of health care services provided by small hospitals and general clinics all located within a thirty mile perimeter. No one small hospital in the area can afford to provide the latest diagnostic equipment or has the doctors on staff to address all the needs of the community, but specialized hospitals can serve the needs of nearly all within the thirty mile perimeter. Currently small hospitals try to address as much of the health care needs of a rural community as it can afford. If the hospital board spends too much, the hospital will become insulvant and will have to close. By spreading the cost of health care services among the small hospitals health care services can be provided to all the community. By careful planning by the state specialized health care services can be located in surrounding clusters such that they are at a convenient distant for all rural residents.

A second approach to be considered is that of a medium sized hospital in a town population of 30,000 or larger. The hospital must be able to have the diagnostic equipment and have the Doctors on staff to address most health care situations. Within the thirty to fifty mile perimeter served by the hospital each small town should have the following Fire & Trauma Center. The design of the Fire & Trauma Center consists of a Fire house which also houses ambulances and a connected 24/7 small trauma center with a few beds and heliport for transporting patients to hospital facilities.

Small hospitals and larger hospitals all share the problem of rising health care costs which in many cases results in the seeking out of ways to charge Medicare and Medicaid as much as legally and in some cases illegally as possible. I call this our Fraud Based Health Care System. The solution to this problem is for the State to enter its own competing Health Care System into the health care market. The State may require that Medicaid patients use the State Health Care system where possible.

A second and important reason for doing this that improvements and cost saving in the current health care system become profit gains for private hospitals and are not shared with the state or the state's tax payers. For example in my Article 110. Design of a Cataract Surgery Clinic, the cost of the surgery could be reduced by 90%. These savings are taken as profits and are not shared with the State. This design assumes that 20 patients per day will provide the Clinic with enough patients to run a high patient volume/low cost clinic in an urban area, rural patients will have to travel to receive these services. At least 10 other similar high patient volume/low cost clinics could be designed for urban hospitals.

The problem for rural hospitals is how do you get these savings in rural hospitals where the number of patients may be only 2 or 3. the answer is you can't, but you can get a lot closer. In small hospitals and general clinics which specialize in certain procedures the number of patients available for outpatient procedures will be larger but still not large enough to operate like an urban clinic. The suggestion is for hospital staff is to do a particular outpatient procedure for a few available patients, then switch to a second procedure and then to a third procedure. The key to savings is the efficient switching of outpatient procedures. The savings is in the reduction in planning, training time and in the identification and collection of supplies. An efficient supply ordering system is required. Planning for switching to a procedure with the highest efficiency can be developed by the State and provided to rural hospitals.

In summary my recommendations are for the State to develop its own Health Care System so it can participate in the efficient savings I have recommended (see Article 113.). The State should also follow my Two Part Reform recommendations. Part 1. The implementation of Enterprise Lean and Part 2. The implementation of Daily Plans in the design of high volume/low cost Outpatient Procedure Clinics (see Articles 109-120). The State may want to reactivate small hospitals (closed for financial reasons) as a part of its new system and implement the above savings suggestions.