Competition and Rural Primary Care Programs*

Abstract

Rural primary care programs were established in areas where there was thought to be no competition for patients. However, evidence from site visits and surveys of a national sample of subsidized programs revealed a pattern of competitive responses by the clinics. In this study of 193 rural primary care programs, mail and telephone surveys produced uniform data on the organization, operation, finances, and utilization of a representative sample of clinics. The programs were found to compete in terms of: (1) price, (2) service mix, (3) staff availability, (4) structural accessibility, (5) outreach, and (6) targeting a segment of the market. The competitive strategies employed by the clinics had consequences that affected their productivity and financial stability. The strategies were related to the perceived missions of the programs, and depended heavily upon the degree of isolation of the program and the targeting of the services. The competitive strategy chosen by a particular program could not be predicted based on service area population and apparent competitors in the service area. The goals and objectives of the programs had more to do with their competitive responses than with market characteristics. Moreover, the chosen strategies may not meet the demands of those markets.

Access to Transportation and Health Care Utilization in a Rural Region

“…These rural transportation programs are expensive to run. 37 At the same time, there is often low use of these transportation services, possibly as a result of their limitations, making them easy programs to cut when budgets are reduced. Providing effective public transportation systems is difficult.…”

“…Providing effective public transportation systems is difficult. As Ricketts 37 shows, these are expensive services that are more easily cut during difficult economic periods than are direct patient services.…”

Rural Health Care Providers in the United States

“…Supplementary Medical Incentive Payments to providers in designated rural health shortage areas and cost-based reimbursement for authorized Rural Health Clinics are another example. The direct service programs include but are not limited to Community Health Clinics (CHCs), the National Health Service Corps (NHSC) scholarship and loan programs, Area Health Education Centers (AHECs), Title VII and VIII health professional training funding, the Rural Outreach Grant Program, Indian Health Service, and the Rural Network Development Grant Program (Geyman et al, 2001;Ricketts, 1999b). Each of these programs signifi-cantly affects the distribution and other aspects of rural physician supply.…”

The interface between health systems and vertical programmes in Francophone Africa: the managers’ perceptions

“…Our research further revealed that the presence of multiple VPs leads to competition that results in health care personnel prioritising activities or programmes in which they have particular stakes while neglecting others (Ricketts 1990; Cavalli et al. 2010).…”