The Importance Of Health Care In Arkansas

Crawford County, Kansas is very familiar to me; it is where I was born and raised and now, as an adult, it is where I work as a nurse. Barriers to healthcare exists in every community. There is a high amount of poverty in Crawford County that contributes to barriers to access to healthcare. Furthermore, Crawford County has several stakeholders that influence the health of the community and advanced practice registered nurse (ARNP) practice. In this assessment of my community, I will identify Crawford County, as well as prevalent health care barriers and important stakeholders in my community.

Conklin, T. P. (2002, Fall). Health Care in the United States: An Evolving System. Michigan Family Review, 07(), 5-17. Retrieved from

The patient centered medical homes (“PCMH”) approach “focuses on keeping people well, managing chronic conditions like diabetes or asthma, and proactively meeting the needs of patients.” According to the Arkansas Department of Health, chronic diseases like cancer heart disease or diabetes affect approximately over fifty percent of adult Arkansans. Yet chronic diseases are often preventable. The high rate of chronic diseases can partly be attributed health insurance coverage—“when people don’t have health insurance they tend to avoid seeing doctors. People

Similar to my home state of Louisiana, Tennessee has also struggled with a chronic shortage of rural primary care physicians. While this statistic does depict a true challenge for our two states, over the years Meharry Medical College has done an exceptional job in inspiring medical students to one-day practice in a rural setting and bring about better health care to underserved individuals, regardless of race or ethnicity. This aspect

Expansion of Physician Assistant (PA) programs across the United States occurred rapidly during the 1970s following the introduction of the profession in the 1960s. According to Hooker et al. (2010), the first era of the development of PA programs was followed by a decline in the 1980s. This was due in large part to a belief by the Graduate Medical Education Advisory Committee that there would be a surplus of physicians in the 1990s. Contrarily, there was a still a large discrepancy in the number of accessible providers and providers themselves which continues to this day. Many saw the cost effective advantage of training PAs and seized the opportunity

The underserved populations have increased exponentially. The Rural Policy Research Institute (2009) defines the medically underserved as, “the ratio of primary care physicians per 1,000 population, the infant mortality rate, the percent of the population with incomes below the poverty level, and the percent of the population age 65 and over.” By that definition, over half the state is considered to be an underserved population. With the demand and needs of the state, it is no surprise that the FNP has become a more utilized provider of healthcare is many settings. There has also been a recent emergence of nurse-managed health centers or (NMHCs), as a form of primary care delivery. According to Espirat and Debisette (2012), NMHCs reduce Medicaid costs, are a great Segway to community outreach and provide quality primary prevention.

Such data suggests that rural areas were actually better off in terms of medical care prior to the enactment of the Affordable Care Act than they are now. Before ACA implementation, the rural population was significantly more likely to be covered by Medicaid (21%) or other public insurance (4%) than the metropolitan population (16% and 3%, respectively). Therefore, while urban individuals on average had more healthcare benefits due to the nature of their insurance provider, since Medicaid made up some of the gap in employer-sponsored coverage in rural areas, the uninsured rate was similar in rural and urbans populations prior to the ACA (Figure 2).

One of the most controversial issues in politics today is healthcare, specifically ObamaCare, also known as Affordable Care Act (ACA), which has effectively insured millions of low-income American households. Under the ObamaCare, Medicaid has been expanded to states that want to participate. It plays an exceptionally crucial role in the healthcare coverage, and access for rural communities as they are more likely to “be poorer, less likely to have insurance, and less intense users of medical services overall” (Richards et al., 2016, p. 573). A study conducted by the Health Services Research found that Medicaid patients received appointments nearly 80% of the time in rural areas, but only 60% in nonrural areas (Richards et al., 2016, p. 570).

Given that there is a shortage of physicians nationwide it is important to expand the scope of mid-level practitioners such as nurse practitioners and physician’s assistant, who are pivotal in treating the mass influx of patients, especially in underserved areas. Rural communities tend to be poorer, and unable to afford to hire enough physicians, and many rural Americans are less well insured, driving the cost of treatment up (RHF, 2015). The lack of resources and funding in underserved areas means even less incentive for physicians to practice in rural areas. Mid-level practitioners are trained to treat patients with low-level illnesses, provide care to patients with chronic and acute diseases, as well as refer patients with more complex issues

Americans will have insurance coverage. The US has an unequal distribution of the primary care, thus; the rural areas have been left with only few physicians. Many physicians prefer practicing in urban areas because of the lucrative advantage, better technology or demographic preference. Many sources including Green et al, of Anita Phigpen Perry School of nursing confirms that the reason for the shortage of physicians in the rural areas is due to the tendency of people in the rural areas being poorer, sicker and older . This segment of people tends to be uninsured, and physicians are attracted to urban and suburb areas where revenues are. Today with the ACA policies, people in the underserved area have better access to physicians, although the shortage persists. The US Department of Health and Human Services, states that to help strengthen access to the primary care workforce, the Affordable Care Act invests in health work force training, including: a $ 1.5 billion investment in National Health Service Corps Scholarship and loan repayment programs and $ 230 million over five years to primarily train medical residents in community-bases. However, do we have enough experts?

Why is Medicaid a huge topic in Texas and how does it relate to me? This is one important question to consider. Well, this paper will help shed light on the matter and illustrate the urgency for such an action. Just recently Texas had an option to extend Medicaid, but hastily decline to expand it. Medicaid expansion was part of the Health Care Reform or also known as the Obama Care; the federal government gave the 52 states an offer to expand the current Medicaid in ways that would include the coverage of more children and lower income adults as well. The latest on the issue is Texas had just agreed on a deal to reinstate Medicaid temporarily. The agreement on the reform has given Texas some time to see how the plan fairs across the other

One of the trends that is consistent between Pennsylvania and Kentucky is the discrepancy between physicians available in rural areas versus urban areas. For example, in Pennsylvania in 2012 for every 100,000 persons in an urban area of the state there was 273 physicians available. While in the rural areas per every 100,000 in population there was only 150 physicians. (2012 Pulse of Pennsylvania’s Physician and Physician Assistant Workforce, 2014). The reason behind this trend is simple, the larger the area the greater the financial opportunities. Also urban areas tend to have larger hospital facilities that provide access to well-equipped facilities, with lab services, radiology departments, staffed surgical suites, new medical devices to assist in surgery such as laser and robotics, and updated imaging devices. (Johnson and Cooper, 1982). These statistics highlight the need to institute methods that will attract providers to the rural areas. Whether this is through scholarship programs for those who intend to work in a rural area upon graduation, accepting federal funds to expand rural hospitals and improve technology, accepting federal funds to expand Medicaid programs, or a combination of all three providers need incentive to move into the rural areas. The standard of care needs to be consistent across the state no matter what area a patient lives in.

Quality healthcare in the more rural areas of the United States is not only getting more difficult to obtain, but difficult to afford. American citizens living in rural areas have the highest rates of chronic disease, higher poverty populations, less health insurance, and there is less access to primary care physicians. When the economy is at its lowest point it causes an increase in a number of access and health issues that have already had prior problems in communities and in rural areas, therefore the main goal of the national health care tax of 2010 was to allow coverage to all residents of the United States, and also by transferring necessary health care to places that were farther away, such as the

Rural Americans depend on their community hospitals as critical component of the area’s economic and social material. These hospitals are usually the largest or second largest employer in the community, and often stand alone in their ability to offer highly-skilled jobs. According to, The Opportunities and Challenges for Rural Hospitals in an Era of Health Reform; “For every job in a rural community, between 0.77 and 0.3 less jobs are created in the local economy, spurred by the spending of either

There are two principal conditions leading to physician shortages in rural communities according to Wright and colleagues. They are “demand-deficient”, meaning they have insufficient populations and resources to support a physician practice, they are “ambiance-challenged,” meaning they are isolated, lack quality services and amenities, and/or are in geographically unattractive settings, or a combination of the two sets of conditions. Inner-city physician shortages are a more recently recognized issue. They are affected by the same conditions, though the specifics are different (Wright, Andrilla, and Hart 2001).