Rural health care in the U.S. is struggling with headwinds, including aging populations, a shrinking physician workforce and consolidation of health care services. Some rural communities can access major health systems by interstate travel, while others are isolated by many miles, mountains and rough terrain, and lack adequate broadband and emergency services. When a rural hospital closes, it is an economic blow to a community as well as a blow to local health care access.
This report is a snapshot of the state of rural primary care in the U.S. It includes a literature review, a description of federal legislative trends affecting rural primary care, a quantitative analysis of primary care trends (comprehensiveness, primary care spending, and primary care workforce) and five case studies that describe current rural practice models. The report concludes with policy recommendations to strengthen and sustain rural primary care so that all types of rural communities can thrive with better health.
The report’s five case studies highlight rural primary care practices in a range of geographies and practice models, including federally qualified health centers (FQHCs), a Direct Primary Care (DPC) private practice supported financially by patient membership fees, a private practice led by nurse practitioners (NPs) and a rural hospital perspective.
By using a mixed-methods approach — quantitative and qualitative — that includes in-depth interviews of practice leaders and other rural health leaders, the report provides insights for stakeholders and policymakers as they consider strategies for strengthening rural health and the key role played by primary care.
Key Findings
- Rural primary care services are more comprehensive than non-rural primary care services
- Spending on primary care is falling in rural and urban areas
- The rural primary care workforce is changing; the share of physicians is declining
- Primary care makes care more affordable
Policy Recommendations
To enhance access and quality of primary care in rural communities, policymakers should:- Measure primary care spending regularly and establish benchmarks and targets for increasing investment
- Increase investment in the proven programs that sustain rural primary care
- Despite Medicaid reductions, states should refrain from reducing primary care reimbursement rates
- Center comprehensive, whole-person primary care at the foundation of programs funded by the $50 billion Rural Health Transformation Program
- Ensure VBP models are “rural friendly” and consider the unique characteristics of rural primary care
