Rural Healthcare Ethics: No Longer the Forgotten Quarter

Nelson, William A.; Greene, Mary Ann; West, Alan N.

doi:10.1017/s096318011000040x

Cited by 13 publications

(8 citation statements)

References 61 publications

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“…This suggests that of the total 1,305 certificated CAHs, about 520 small, rural hospitals lack an ethics committee (Rural Assistance Center 2009). This finding raises a potential concern; just as limited access and availability of rural health care services are associated with worse health status compared to urban settings, limited access and availability to ethics resources could impact the quality of care provided (Bennett et al 2008; Institute of Medicine Committee on Quality of Health Care in America 2001; National Rural Health Association 2007; Nelson et al , 2008Nelson et al , 2010Ricketts 2005;Weeks et al 2004).…”

Section: Discussionmentioning

confidence: 99%

The Presence of Ethics Programs in Critical Access Hospitals

et al. 2010

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The purpose of this study was to assess the presence of ethics committees in rural critical access hospitals across the United States. Several studies have investigated the presence of ethics committees in rural health care facilities. The limitation of these studies is in the definition of 'rural hospital' and a regional or state focus. These limitations have created large variations in the study findings. In this nation-wide study we used the criteria of a critical access hospital (CAH), as defined by the Medicare Rural Hospital Flexibility Program (Flex Program, 2007), to bring consistency and clarity to the assessment of the presence of ethics committees in rural hospitals. The Flex Monitoring Team conducted a national telephone survey of 381 CAH administrators throughout the United States. The survey covered a wide variety of questions concerning hospitals' community benefit, impact activities, and whether the hospital had a formally established an ethics committee. About 230 (60%) of the respondents indicated they had a formally established ethics committee or ethics consultation program at their CAH. The prevalence of ethics committees declined as the CAH location became increasingly rural along a rural-urban continuum. Unlike CAHs, all rural Department of Veterans Affairs Medical Centers have ethics committees. The results of this study provide an understanding of the limited presence of ethics committee in rural America and the need to consider new approaches for providing ethics assistance. A virtual ethics committee network may be the most efficient and effective way of providing rural hospitals access to a knowledgeable ethics committee or consultant.

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Section: Discussionmentioning

confidence: 99%

The Presence of Ethics Programs in Critical Access Hospitals

et al. 2010

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“…Though little data exists thus far on the rural LGBT population, at first glance rural areas appear less hospitable, in part due to increased stigma and social isolation [ 36 ]. Even non-LGBT rural populations face a complex set of barriers to health care that includes geography, lack of transportation, lack of finances or insurance, and provider shortages [ 37 – 40 ]. While disclosure of orientation or identity in rural communities may increase access to social support and appropriate healthcare recommendations, this may also increase the risk of discrimination and stigma [ 41 ].…”

Section: Introductionmentioning

confidence: 99%

Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations

2016

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BackgroundPrior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers.MethodologyLBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas.ResultsHigher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men.ConclusionsThe results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.

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“…Appropriate healthcare standards and meeting ethical considerations of rural populations have emerged as key concerns in the national discussion on disparities in the availability of healthcare services [1-9]. The launch of new reforms has opened a new stage of healthcare mandates and also brings both opportunities and challenges to achieve an equilibrium in the allocation of healthcare resources.…”

Section: Introductionmentioning

confidence: 99%

Suggestions to ameliorate the inequity in urban/rural allocation of healthcare resources in China

Chen

Zhou

Qiong

2014

Int J Equity Health

143

106

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The imbalance in the allocation in healthcare resources between urban and rural areas has become a main focus of the recent medical reforms adopted in China. However, systematic analysis has identified wide differences in the allocation of healthcare resources between urban and rural areas, including healthcare expenditures and the number of healthcare facilities, available beds, and personnel. Therefore, the aim of this report was to identify ethical considerations in current governmental policies to rectify existing problems in the distribution of healthcare resources. Our findings indicate that the inequality in the distribution of healthcare resources does not adhere to ethical standards and the policies are flawed because they give rise to differences in the availability of medical care to urban and rural communities. To optimize the allocation of medical healthcare resources, countermeasures are proposed to formulate policies to urge the flow of public healthcare resources to rural areas, strengthen the responsibilities of both governmental and public financial investments, increase the construction of public healthcare facilities in rural areas, promote the quality of healthcare resources, adjust resource allocations to rural public healthcare facilities, and improve resource utilization efficiency by establishing two-way referral mechanisms.

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Rural Healthcare Ethics: No Longer the Forgotten Quarter

Cited by 13 publications

References 61 publications

The Presence of Ethics Programs in Critical Access Hospitals

The Presence of Ethics Programs in Critical Access Hospitals

Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations

Suggestions to ameliorate the inequity in urban/rural allocation of healthcare resources in China

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