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Access to Affordable, High-Quality Health Insurance for Rural Residents and Its Impact on Their Health and on Rural Hospitals

Goldfield, Norbert I., MD; Fuller, Richard L., MS

The Journal of Ambulatory Care Management: April/June 2019 - Volume 42 - Issue 2 - p 78–85
doi: 10.1097/JAC.0000000000000270
Original Articles

Access to rural health care is an ongoing challenge for those living in America's countryside. Hospital closures, a fragmented and dislocated care delivery system, disproportionate levels of chronic illness, and poverty combine to present significant obstacles to health reform. This article highlights the major challenges in rural health care and specifies financial and delivery policy options that can strengthen rural health care. In particular, this article suggests a return to a prepaid approach within the umbrella organizational framework of what we term “rural convening entities.” These entities would serve as the control of telehealth hubs for the communities they serve.

Ask Nurses and Doctors Inc, Northampton, Massachusetts (Dr Goldfield); 3M Health Information Systems, Silver Spring, Maryland (Mr Fuller).

Correspondence: Richard L. Fuller, MS, 3M Health Information Systems, 12215 Plum Orchard Ln, Silver Spring, MD 20904 (

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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