For children in rural areas, accessing health care can be difficult. About 20% of hospital pediatric units in the United States have closed in the last 10 years. At Intermountain Primary Children’s Hospital in Salt Lake City, 30% of patients travel three hours or more because they can’t get pediatric specialty care closer to home.
The results are significant. Rural children experience more frequent readmissions, more expensive hospitalizations, and high rates of medical complexity.
Children’s hospitals like ours are working to address these issues. For example, virtual care enables pediatric emergency medicine, critical care, and trauma specialists to help adult ED physicians manage the care of children. Through partnerships, pediatric surgeons perform specialized procedures at rural hospitals. Through mobile clinics, pediatricians and pediatric specialists meet rural patients where they live.
These programs improve access to care and reduce costs for families, insurance companies, and taxpayers. The problem is we don’t get reimbursed adequately for these services — not for staff time, technology, or infrastructure. When we do receive payment, it often doesn’t cover the costs.
Additionally, our services are delivered by pediatric specialists, who are in short supply. Our system, serving six states spanning 600,000 square miles, has experienced severe shortages in numerous key specialties. Even for roles requiring less education, vacancy rates can run as high as 40%.
Creative solutions
Children’s hospitals understand these problems, but what can we do? Of course, advocacy efforts should focus on increased Medicaid reimbursement, funding for pediatric training, and incentives for those who pursue careers in pediatric health care and in rural areas.
These solutions are systemic changes and will take years to implement, even with much-needed congressional action. In the meantime, we must be creative in program design, financing, and workforce development. This can include unique partnerships with the state, public health organizations, nonprofits, and more.
We partnered with the Utah Department of Health and Human Services on a stabilization and mobile response program where we visit patients’ homes during a mental health crisis. The program has resulted in fewer emergency department visits, fewer inpatient admissions, better patient-reported outcomes, and lower costs. The state agreed to finance the program due to the high return on investment.
For workforce, children’s hospitals can train rural staff through programs and simulations, reskill existing staff, expand partnerships with colleges to provide rural health care experiences, and enhance school-based programs, including developing new school-based roles to facilitate virtual care.
Children’s hospitals should be the spark and catalyst for creativity while rallying support from the private sector, the state, and the federal government. I am encouraged by the work of children’s hospitals nationwide. By sharing our stories and ideas, we will rise to the challenges before us.
