The High Performance Rural Health Care System of the Future

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Cutler Institute, Population Health and Health Policy, USM Aging Initiative, Health and Wellness


Public policies during the past 30 years have helped build and stabilize the rural health care delivery system. Positive policies include bonus payments for services delivered in provider shortage areas, the Medicare Rural Hospital Flexibility Program (including the grant program), the rural health clinic program, tele-health support, and pipeline programs in health professions education. Yet policy successes have required political capital and developmental resources to support a health care system that delivers discrete services by specific professionals and institutions, each paid on a per-service basis. Partly as a result of these system characteristics, health care services are often fragmented, uncoordinated, and excessively costly. Health care system challenges are compounded in rural America by disproportionally ill and disabled rural citizens, under-financed primary care, and geographically isolated rural providers. To answer these challenges, pioneering work by the Institute of Medicine (especially the Rural Health Committee document Quality Through Collaboration: The Future of Rural Health), the Commonwealth Commission on a High Performance Healthcare System, and other organizations document effective strategies exist to improve and sustain the health of rural populations. Opportunities are emerging in public policy and the private sector to change the organization, financing, and delivery of rural health care services. What might appear to be threats to rural health care, such as challenges to current special payments or new administrative requirements, may instead be opportunities to update and improve outdated and unsustainable service configurations. But as Yogi Berra famously said, "You've got to be very careful if you don't know where you're going, because you might not get there." So in the spirit of getting us “there,” the RUPRI Health Panel offers an aspirational vision, for a high performance rural health care system.


The RUPRI Panel is solely responsible for the content of this paper.

Funding Organization

This project has been supported by the Office of Rural Health Policy, Health Resources and Services Administration (Grant Number U18RH03719) and the Robert Wood Johnson Foundation.