Many rural hospitals are endangered by current reimbursement and regulatory constraints. Iowa s hospitals receive lower than average Medicare payments per inpatient stay than most of the other states in the midwest region. Changing economic circumstances have resulted in the closure of many small rural hospitals. The closure or a rural hospital often commences the final chapter in the viability of a rural community. The health provider workforce in rural communities reflects difficulties in recruitment and retention.
Rural physicians are professionally, and often physically, isolated.
This isolation results in inadequate access to information and services available in secondary and tertiary level institutions. Such conditions create a barrier to optimal patient care and to the professional satisfaction that could potentially keep physicians practicing in the rural primary care setting. The challenges to rural health care delivery outlined here have combined with other variables to make the study of telemedicine a promising focus for research in the state of Iowa. Health care reform measures currently under discussion, such as managed competition, will put additional responsibility on the rural health care provider to become the requisite gate-keeper for such systems. The rural primary care provider will be required to make increasingly complex decisions about the care and referral of patients.