New Foundation for Rural Health Leadership

Rural healthcare concerns usually don't top planning agendas for politicians and policy wonks at state and federal levels. They're more interested in bang for the buck.

"If you are at the state and national level, the focus is on ‘Where can I make the biggest difference most quickly if my goal is related to quality or cost savings?'" says Prof. Keith Mueller, who leads the University of Iowa's Department of Health Management and Policy. "So of course you are going to gravitate towards the biggest population concentrations because ‘I can make the biggest splash there first.'"

As a result, the special needs and smaller economies of scales that rural providers face can often get shoehorned into programs and policies designed for larger urban settings.

"I wouldn't call it an afterthought. I'd call it a lack of awareness," Mueller says.