FAMILY-PLANNING, MANAGED CARE, AND RURAL AMERICA

Within the United States, rural residents encounter a greater number o f barriers in accessing health care services than their urban counterp arts. In general, rural Americans have less access to both family plan ning services and managed care delivery systems. Given the rapid chang es in health care, we reviewed the implications for the provision and integration of family planning and managed care services in rural area s, where there is limited experience in establishing working relations hips between those services. In many instances, family planning servic es are well established in rural areas where managed care has not yet penetrated. Our case study in Minnesota suggests that, although manage d care and family planning services are developing in rural areas, the re is little evidence of collaboration. Several innovative and success ful family planning projects do exist in rural areas, however, and ser ve as models of successful population-based programs that could work w ell with health plans. Although this study concentrated on the provisi on and utilization of subsidized family planning services, there is a compelling need for further work to determine accurately where rural r esidents are accessing such services and how the expansion of managed care will affect the delivery of reproductive health care.