(Mechanic, 2006, p. 11) (Sparrow, 2000, p. 9) Lastly, low reimbursement may be a the center of concerns about cost shifting to private insured persons, private insurance reimbursement contracts and those with the least bargaining power private pay patients, though there is good evidence that this is limited in rural provider offices and institutions as compared to those in urban settings. (Kula, 2004, p. 490) This phenomena known as cost shifting effects both urban and rural settings, on an economy of scale, as well as by the sheer fact that rural communities are then afforded more limited care. (Kula, 2004, p. 490)
In closing low reimbursement of available care in rural areas negatively affects both availability of care to those living their as well as quality of care, the ability of the community to recruit better service providers and the nation in the sense that even the urban areas are affected by the national cost shifting that may occur as a result of problems and/or abuses in rural and urban settings. These problems may accelerate significantly as many traditional providers age and retire from provider services in rural areas.
Additionally, local rural hospitals and clinics are closing in record numbers or providing only very limited care as a result of the low reimbursement demographic associated with rural opportunity and limited incomes. This effects the whole nation in the fact that these services must be provided and if they are not shifts will be seen or the whole of the rural population will simply continue to live at risk of health disparity. (Showalter, 1997, p. 75) (Romzek & Johnston, 2002, p. 423) (Havighurst & Richman, 2006, p. 7)
Havighurst, C.C., & Richman, B.D. (2006). Distributive Injustice(s) in American Health Care. Law and Contemporary Problems, 69(4), 7.
Kula, M.C. (2004). U.S. States, the Medicaid Program and Tax Smoothing. Southern Economic Journal, 70(3), 490.
Mechanic, D. (2006). The Truth about Health Care: Why Reform Is Not Working in America. New Brunswick, NJ: Rutgers University Press.
Romzek, B.S., & Johnston, J.M. (2002). Effective Contract Implementation and Management: A Preliminary Model. Journal of Public Administration Research and Theory, 12(3), 423.
Showalter, M.H. (1997). Physicians Cost Shifting Behavior:.