Strategies for Promoting a Viable Rural Health Care System*

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Abstract
Strategies for promoting a viable rural health care system in the context of the rapidly changing rural health care environment are presented. Also included is a series of guiding principles that support rural health care. They focus on the need for cooperation rather than competition among rural communities and health providers; the need for leadership and empowerment in rural communities; the dependence of rural health on generalists; the need to transform the reimbursement system to reward rural health services; the importance of quality of care for rural providers; the challenge of providing health and social services to the aged; and the instability caused by uncertain government attention to rural concerns. Examples of current activities that exemplify the effective use of these principles with respect to rural hospitals are discussed. These include the proposed demonstration of a new health care institution called the Medical Assistance Facility, the development of rural hospital consortia, the establishment of a rural health care transition grants program, and the activities of the New York State Legislative Commission on Rural Resources.