The patient base in a community with 10,000 or fewer residents and a hospital with 50 beds or less is typically two-thirds elderly. It would not be feasible to develop a managed care plan for the remaining third of the community. However, rural areas need some form of managed cooperation. In order to do this, they must develop relationships with other providers and network among their communities to spread the risk. Joining with another hospital or health system may provide the rural hospital the option of bringing in a specialist periodically that it could not afford on a full-time basis.
Physician recruitment is also a significant reason to affiliate with other, larger providers.
Although it is typically difficult to convince physicians to practice in rural areas, some doctors and their families see the benefits of working in these communities. They offer a broad range of sports and recreational opportunities and can be picturesque settings. Many physicians feel that rural areas improve the quality of family life with clean air, low crime rates and schools with smaller classes that provide more personal attention to students. While rural hospitals are starting to explore the possibilities offered by integration, not everyone is convinced that this is a viable option. Because of capitation, managed care organizations usually rely on a strong patient base to keep them financially sound.