Rural Health Services: A Management Perspective
Joyce E. Beaulieu and David E. Berry, editors
AUPHA Press/Health Administration Press, Ann Arbor, MI
1994, 297 pp., $37 (paperback)
A traditional academic textbook, Rural Health Services: A Management Perspective contains current data on rural populations in the United States, an overview of current policy and research on rural health system problems and their solutions, and information on rural health services organization and delivery from an administrative perspective. As textbooks go, this one is straightforward — set forth with purpose, methodically addressing the topic of rural healthcare delivery.
The book's 10 chapters were written by 16 authors whose backgrounds include a range of rural health experiences and operational practices, providing a valuable blend of real-world understandings with some academic theory and perspective. Rural Health Services is not an "ivory tower" tome, but it is not simply a collection of trade magazine articles either.
The first five chapters ("Part I: Organization of Rural Health Services") define "rural," describe policy initiatives and the major issues, and examine the supply of resources — staff and facilities. Chapters 6 to 10 ("Part II: Management of Rural Health Services") discuss management challenges, strategic choices, and concerns about the delivery of primary care and other services to the rural elderly and disabled.
Chapter 10 focuses on the future of rural health systems. It offers predictions about new technologies that will affect rural healthcare and the authors' belief that rural healthcare will become systemically regionalized with different levels of care: community clinic and regional primary care centers. Regionalization seems likely because one community may not be able to support local services. Instead, technology, such as telemedicine, may be more appropriate in rural communities. This chapter is significant because, although it is important to understand the past, the successful rural health facility must look forward and position itself to manage oncoming changes.
This textbook's strengths are its logical organization, the fairly current data sets and their interpretation, and the authors' attempt to explain rural matters without getting bogged down in esoteric jargon. Some of the chapters that avoid the use of complex terminology are suitable for healthcare organization board members who want to understand more about rural healthcare but are unfamiliar with healthcare issues and complex systems management.
On the other hand, Rural Health Services is too general. It does not provide a substantive review of rural health management. The overview of the skills needed in the practice of rural health administration is superficial. Three separate but similar discussions on federal health policy initiatives such as the National Health Services Corps make for some redundancy. In addition, the definition of rural varies (a result of poor critical editing).
Aside from problems with style, the book's main weakness is its emphasis on the history of rural healthcare delivery, which shortchanges development of key trends emerging in rural care such as managed care, telemedicine, and recruitment and retention of health personnel in rural areas. The authors mention these points but do not develop them functionally for the practitioner. This limits the book's usefulness for persons just entering rural healthcare.
Other important omissions are descriptions of how to understand and work with rural medical staffs and the conflicts that arise in maintaining stable, high-quality healthcare within a rural community. Perhaps the editors intend to publish a sequel that is more focused on likely future developments.
John T. Porter
Presentation Health System
Richard W. Thompson, PhD
Center for Rural Health and Economic Development
Presentation Health System
Copyright © 1995 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.