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Rural Health Care-Reply
John W. Saultz, MD
Oregon Health Sciences University Portland
Arch Fam Med. 1995;4(11):918.
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| Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings. |
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In reply
Howe's comments provide a useful personal testimonial about the forces that are now at work in the rural health care system. Since my article was published, managed care enrollment has continued to increase as our country struggles to control health care costs. Several trends seem clear about how this process occurs. Managed care enrollment increases fastest in the urban areas where there are ample hospitals and physicians to compete with one another. Because primary care is usually the rate-determining factor in how quickly each system can grow, the salaries offered to family physicians in these areas increase by 10% to 20%. Because these positions are often salaried, they offer the promise of more money and less hassle. This attracts some rural and small-town physicians to move to the city. Thus, the supply of providers in rural areas experiences increasing pressure, as Howe's letter demonstrates. In Oregon, managed care has grown
. . . [Full Text PDF of this Article]
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