Harlan AR HospIn the 1970’s, I worked on a project to introduce health science students to rural health care systems and issues. We would take teams of students to rural communities in Kentucky and the most memorable towns were in the Appalachian mountains. Health care here was scattered and sparse but local home health nurses and Miners Memorial Hospitals tried to fill the gaps. These hospitals (called the Appalachian Regional Hospitals when I was there) were the heart and soul of the rural communities where they were located.

Rural hospitals have always had a difficult time making financial ends meet. Because they are set in farming and mining communities with widely scattered populations, who often do not have health insurance, rural hospitals have come and go as the economy and health policies fluctuate.  A quick overview of these swings in rural care can be found in Lieb’s two articles cited below and the web site about Man Community Hospital.

I saw Lieb’s article in the Austin American Statesman and it got me to thinking about this issue. I’ve been in a lot of rural hospitals and they pretty much all were local operations, greatly beloved by the community, and funded by creative solutions that took a great deal of community involvement. This is all very good but things change and hospitals are slow to adapt. And adapting is difficult because new ideas often are not revenue generating or limited for some reason or the other. They might not be approved by Medicare/Medicaid, not reimbursed by insurance, not allowed by statute or practice guidelines, etc.

Another Op Ed piece in the selfsame Austin American Statesman by Sid Miller, Agriculture Commissioner, repeats these issues and suggests that telemedicine might be one key to the rural healthcare puzzle. And in my April 15th column, I commented on the issues surrounding the wider use of telemedicine in Texas. So, here is a possible help for rural care that is bogged down in policy.

There are solutions and good people can find them. I have hope.


  1. Lieb, D. A. Q&A: Why have rural hospitals been closing? Idaho Statesman, 5-1-15.
  2. Lieb, D. A. Rural hospitals struggle to stay open, adapt to changes. Austin American Statesman, 5-1-15.
  3. Miller, S. Don’t pull the plug on rural health care. Austin American Statesman, 5-5-15.
  4. Appalachian Regional Healthcare. Site accessed on: 5-6-15
  5. Man Community Hospital. Web site: Abandoned – Telling the story of a forgotten America. Site accessed on: 5-6-15

I’ve visited my experiences in Appalachia before in this forum:

Join us for a real-time discussion about ideas raised by this essay on Friday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.