Bringing Health Care to Appalachia: The Long-Run Impact of a Rural Health Care System

The U.S. government has supported rural hospitals through direct subsidies and staff recruitment programs. However, little is known about the long-run impact of large-scale changes to rural health care. The authors explore the long-run trajectory of Appalachian counties where a coal mining union introduced a pioneering rural health care program in the 1950s, anchored by a chain of high-quality hospitals. Hospital beds per capita in counties where the union built its hospitals are persistently high through 2006, even when compared to similar counties and accounting for a variety of supply- and demand-side factors. In particular, union counties defied a national hospital consolidation trend starting in the 1980s. Results are consistent with a supply-side explanation where the scale and/or innovation of the union's investment allowed hospital markets to thrive and attract patients from a broad geography.

An Exploration of Midwives’ Experiences of Reducing Maternal Morbidity and Mortality From Postpartum Haemorrhage (PPH) in Rural Communities in Eastern Nigeria.

Background Postpartum haemorrhage (PPH) is one of the major complications of childbirth which results in maternal morbidity and mortality especially in low and middle-income countries like Nigeria. Midwives play a vital role in preventing and managing PPH in Nigerian rural communities. The aim of this study is to understand the experiences of midwives in rural maternity care settings in order to provide appropriate support and improve practice. Methods An exploratory qualitative study of a purposive sample of 15 practicing midwives was carried out using semi-structured interviews from November 2018 to February 2019. Data were transcribed verbatim and analyzed using content analysis. Results Four themes were identified; intervention for preventing PPH, approaches to managing PPH, challenges of preventing and managing PPH, and ways of supporting midwives to overcome the challenges of preventing and managing PPH in rural health care settings. Midwives employed various strategies, such as antenatal education, diagnosis, and treatment of anaemia to prevent PPH. Their understanding of the condition as a life-threatening condition enabled the midwives to provide holistic and effective management that sometimes involved multidisciplinary team approach. However, inadequate resources and delay in seeking health care services militate against their efforts. The midwives also identified the need for continuing education and training as means of enhancing their standard of care. Conclusion These midwives in Nigerian rural health care setting engage in preventive practices and active management of PPH though not without barriers, such as inadequate resources. There is need for the midwives in rural areas to have cultural competence, be provided with adequate resources and participate in ongoing education to be more effective.

Insights for rural health care provider retention : a quantitative survey analysis

Due to rural health disparities and an uneven distribution of health providers across the rural urban continuum, retaining the existing rural health care provider workforce may be an important strategy to maintain existing rural health care provision. While a large body of literature addresses how to recruit health care providers to rural areas, less is known about how to retain these providers. Even less literature has focused on the role of rural communities in health care provider retention. In this thesis, I examine the role of provider background and familial characteristics, workplace characteristics, and community characteristics that may impact a provider's likelihood to consider leaving a rural community. I use data from a survey of over 900 rural health care providers across nine states and a probit model to estimate the impact of these characteristics on a provider's propensity to consider leaving. I find that establishing social ties and integrating within the community through volunteering reduces providers' likelihood to consider leaving by 10 percent. Additionally, providers who engage in entrepreneurship by investing in part or all of their practice are 12 percent less likely to consider leaving, all else being equal. I also find that having unacceptable on-call responsibilities increases a provider's likelihood to consider leaving by 17 percent. This thesis contributes to the existing literature by estimating the effects of work-life balance, entrepreneurship, and the role of family and personal integration on provider retention. Furthermore, it emphasizes the role of communities in provider retention. These results offer insights to rural communities and decision-makers seeking to identify how to maintain their existing rural health care workforce.