RURAL PHYSICIANS, RURAL NETWORKS, AND FREE-MARKET HEALTH-CARE IN THE 1990S

The changes brought about by managed care in America's urban communiti es will have profound effects on rural physicians and hospitals. The r ural health care market characterized by small, independent group prac tices working with community hospitals is being offered affiliations w ith large, often urban-based health care organizations. Health care is evolving into a free market system characterized by large networks of organizations capable of serving whole regions. Rural provider-initia ted networks can assure local representation when participating in the new market and improve the rural health infrastructure. Although an e xtensive review of the literature from 1970 to 1996 reveals little def initive research about networks, many rural hospitals have embraced ne tworking as one strategy to unify health care systems with minimal cap italization; These networks, now licensed in Minnesota and New York, o ffer rural physicians the opportunity to team up with their community hospital and enhance local health care accessibility.