The changing landscape of health care financing and delivery: How are rural communities and providers responding?

Rural communities have not kept pace with the recent dramatic changes in he alth care financing and organization. However, the Medicare provisions in t he Balanced Budget Act of 1997 will require rural providers to participate in the new systems. Case studies revealed the degree of readiness for chang e in six rural communities and charted their progress along a continuum, as reflected in three sets of activities: the development of networking; the creation of new strategies for managing patient care; and the adoption of n ew methods for contracting with health insurers. Some communities had const ructed highly integrated systems, whereas others were just beginning to cha nge their billing practices; a few were signing contracts fbr capitated far e, in contrast to those that were resisting discounts in current fee struct ures. These six rural areas still have considerable ground to cover before their health fare organization and financing reach the levels achieved by u rban communities.