Community Vitality and Rural Healthcare
In rural communities, the linkage between healthcare and the vitality of the community is strong. A robust community helps to support and sustain quality health services for its residents by attracting quality healthcare professionals. Communities with more economic resources may also be more likely to financially support their healthcare system through having higher rates of health insurance coverage, through philanthropic giving, and by investing in infrastructure which the healthcare system can leverage. In return, a high quality healthcare system can support economic and community development initiatives. This topic guide focuses on how community and economic development can complement health services in rural areas and how collaboration between the sectors can address issues such as population health.
For tools, training, and technical assistance to measure the economic impact of the healthcare system:National Center for Rural Health Works
For technical assistance and funding to support self-sustaining, long-term rural development:
USDA Rural Development
Community Economic Development
There are more organizations related to Community Vitality and Rural Healthcare in the organizations section.
Frequently Asked Questions
- What is the economic impact of healthcare services, facilities, and providers to a rural community?
- Why should local healthcare leadership be involved in community and economic development efforts and what role can they play?
- How can the availability of healthcare services be leveraged in economic and community development efforts?
- How can our rural community illustrate the importance of healthcare to our local economy?
- Where can our rural community find the resources to determine the economic impact of our healthcare sector or a component of the healthcare sector?
- Where can our community or healthcare providers find examples of economic impact studies?
- How can rural healthcare leaders demonstrate the value of their facilities to their community to gain support for initiatives to improve healthcare services and infrastructure?
- Where can our community find training on economic impact and other tools to enhance our local healthcare services, and ultimately, enhance our local community?
- How does the vitality of a rural community affect health workforce recruitment and retention?
- How can rural healthcare facilities work with their community to improve key community factors that affect recruitment and retention of staff?
- Why is it important to consider the capacity of the local healthcare system to anticipate economic growth?
- Where can I find funding opportunities to develop healthcare capacity in my rural area?
What is the economic impact of healthcare services, facilities, and providers to a rural community?
Providing quality healthcare services in a rural community does more than provide the needed healthcare. It also has a positive effect on the fiscal health of a community. According to a 2011 AMA report “Physicians Boost the Economy” a physician in a community means real revenue and jobs.
Rural hospitals are often one of the largest employers in their community. They offer some of the best paying jobs available in rural areas, bringing professionals in to live and spend money in the community. For more on the economic impact of a Critical Access Hospital on a community, see The Economic Impact of a Critical Access Hospital on a Rural Community.
Some specific examples of how local healthcare services can impact the economy include:
- When a local hospital offers a key service such as a dialysis facility, people stay in the community for care, instead of driving to the urban centers and spending their money there.
- Rural health insurance premiums and taxes only come back to the community and create jobs if there are local healthcare providers (and people use them) to attract those dollars. (Source: Rural Health and Critical Access Hospitals: Opportunities and Challenges)
- For every job at a Critical Access Hospital there was another .38 job created within the business and industry sector within the local community. (Source: The Economic Impact of a Critical Access Hospital on a Rural Community)
Why should local healthcare leadership be involved in community and economic development efforts and what role can they play?
The rural economy is very dependent on where its healthcare dollars are spent. Rural healthcare leaders generally live in or near the community in which the hospital is located. They can, and usually do, play a role in community and economic development efforts by getting involved in local organizations, schools, chamber of commerce, and events.
Healthcare leaders know the economic impact of the healthcare facility and can bring that knowledge to local decision-making tables. They can inform other community leaders and the community at large about the jobs and dollars brought into the community through healthcare services.
Healthcare leaders’ participation in activities such as county/regional leadership institutes is another way to keep local healthcare awareness at a diverse table of current and developing leaders.
How can the availability of healthcare services be leveraged in economic and community development efforts?
Healthcare services are important to community and economic development not only in terms of the employment and labor income generated in the local economy, but also to attract and retain business and industry. Quality of life issues that include healthcare access and a robust healthcare organization are important factors for a business seeking to relocate their facilities.
In addition, retirees are more likely to move to or stay in rural communities with quality healthcare facilities, and data has shown retirees can substantially impact the local economy. For example, the report Evaluating Retiree-based Economic Development in Georgia: Golden Rules, produced by the Selig Center for Economic Growth and funded by the OneGeorgia Rural Policy Center shows that bringing retirees into the community grows and diversifies the local economy, with 55 jobs generated for every 100 new retirees in rural Georgia.
Therefore, healthcare leadership should be involved with community and economic development to assure that the healthcare services needed for attracting and/or retaining businesses, industries, and/or retirees are provided locally.
How can our rural community illustrate the importance of healthcare to our local economy?
An economic impact study of the healthcare in a rural community will illustrate the importance of healthcare to the local economy. An economic impact study can be prepared for the entire health sector, a component of the health sector, or a specific healthcare organization. The National Center for Rural Health Works is an organization that works to expand public awareness of the importance of the economic impact of the healthcare sector and healthcare’s critical role in rural development. Their approach takes into account both the direct spending by the healthcare sector - wages, purchases, and so on - and a "multiplier" that identifies additional impacts.
What is the multiplier effect?
To illustrate the multiplier effect, consider this example of a rural hospital with 100 employees. The 100 employees directly employed by the rural hospital are the direct impact of the rural hospital. The hospital and the hospital employees then spend money in the local economy, and due to their spending, additional jobs are generated in other community businesses and industries. These additional jobs generated in the local economy are the secondary employment impact of the rural hospital.
A hospital employment multiplier of 1.5 indicates that for every one job in the hospital, another 0.5 job is generated in other businesses and industries in the local economy. A hospital with 100 direct employees would create 50 secondary jobs throughout the community, for total hospital employment impact of 150 jobs.
The Center for Rural Health Works methodology provides multipliers for the following health sector components:
- All clinics (physicians, dentists, etc.)
- Nursing homes and assisted living facilities
- Home health
- Other health services (independent laboratories, private physical therapy providers, mental health providers, emergency medical services, etc.)
- Public health
Where can our rural community find the resources to determine the economic impact of our healthcare sector or a component of the healthcare sector?
If local leaders or healthcare organizations need assistance to measure the economic impact of a health sector component, the first contact should be with your State Office of Rural Health. In many states, the State Office of Rural Health, the State Agricultural Extension Service, or the State Hospital Association have trained staff available to conduct health economic impact studies at no cost or a nominal cost. There also may be partnerships between these organizations in states. For example, the Oklahoma State Office of Rural Health and the Oklahoma Agricultural Extension Office partner to provide economic impact, community health needs assessment and needs analysis, and profitability studies to rural hospitals and communities.
Each year the National Center for Rural Health Works develops new applications of the impact model that can be applied at the state, regional, county, or ZIP code level. See the Economic Impact – Tools and Templates section of their website for additional information.
For distinct health-related projects, such as those funded by grants, RAC’s Economic Impact Analysis Tool shows how your project’s spending on staff, supplies, equipment and other expenses benefits your community. It was originally developed by the Lewin Group for the Office of Rural Health Policy’s community-based grantees. This tool uses formulas to estimate the economic impact of grant program investments; however, it can also be applicable to other non-grant funded projects. The calculations produced help rural program grantees and other rural programs assess performance, and advocate for resources that contribute to program sustainability and improved healthcare for rural populations.
Where can our community or healthcare providers find examples of economic impact studies?
The National Center for Rural Health Works' Economic Impact – Tools and Templates offers templates for communities, healthcare organizations, and others to illustrate the economic impact of the various components of the health sector. This tool also provides the results of several economic impact studies focused on specific rural regions and topics. Several other general rural impact studies are available, which demonstrate the economic impact of “typical” physicians, general surgeons, and Critical Access Hospitals. When appropriate, these general impacts can be used to estimate the impact of new or revised policy considerations and can be applied at the local, state, or national level. The general impact studies of a “typical” provider or organization do not replace the need for an economic impact study for a specific rural community’s health sector. When reviewing local healthcare, a local health economic impact study should be conducted, using multipliers specific to the healthcare component(s) or organization(s) and to the medical service area.
How can rural healthcare leaders demonstrate the value of their facilities to their community to gain support for initiatives to improve healthcare services and infrastructure?
An economic impact study will demonstrate, with local data, the significance of the healthcare system to their community. This can help community members fully understand the importance of the entire health sector, any component of the health sector, or a specific health organization.
An economic impact study can engage the community to be involved in local healthcare issues. Outcomes of a community economic impact study may include engaging the community to:
- Assist in finding solutions to healthcare challenges.
- Participate in a community health needs assessment process.
- Increase local support and local utilization of a particular health service or all health services.
- Increase access to local healthcare services through the expansion of their rural healthcare system and the development of new healthcare programs.
- Gain local support for a capital improvement campaign to construct new facilities, expand current facilities, or purchase new equipment to provide the latest medical technology.
- Assist in obtaining capital funding from investment and banking institutions.
- Consider healthcare as an economic development tool to encourage new business and industry, and to attract retirees in the community.
- Ensure the ongoing existence of local health services.
Where can our community find training on economic impact and other tools to enhance our local healthcare services, and ultimately, enhance our local community?
The National Center for Rural Health Works provides training through two regional workshops each year with follow-up technical assistance. Workshops include the tools, templates, guidebooks, and methodologies for three areas of emphasis: economic impact, community health needs assessment, and needs analysis or profitability studies of a specific healthcare service.
Organizations that provide rural community development resources and training include:
Center for Rural Affairs
An advocate for federal policies supporting rural community development, resource stewardship, and small farms and businesses. Provides comprehensive rural community development services.
Heartland Center for Leadership Development
Provides training and services in leadership, community development, strategic planning, evaluation and entrepreneurship.
Provides tools and training to reverse rural decline. They also provide a framework to help identify goals and strategies using a comprehensive approach that combines strategies to energize entrepreneurs, nurture leadership, engage youth and capture wealth transfer.
U.S. Department of Agriculture - Rural Development
Administers the Community Economic Development Programs and other initiatives throughout rural America. Contact your state or local Rural Development office or your local USDA Service Center for additional information.
How does the vitality of a rural community affect health workforce recruitment and retention?
Every community has both factors that are assets and those that are challenges related to recruiting and retaining medical staff. Recruitment of medical staff occurs in the context of the other communities in that niche or geographic location. Each community’s own unique combination of factors contributes to the success or failure of recruiting and retaining a healthcare workforce to meet the needs of their population and patients. The Community Apgar Program, developed through a collaboration of Boise State University and the Family Medicine Residency of Idaho, has analyzed the relative importance of key factors for recruitment, along with the common advantages and challenges that rural communities face in this process. The factors used by the Community Apgar Program fall into the categories of geographic, economic, scope of practice, medical support, and facility and community support.
The Community Apgar Program provides communities with individualized reports that identify factors in recruiting and retaining rural family medicine physicians. Communities may benefit from an improved accounting and appreciation for which factors have a significant effect on recruitment and retention within their community. Even communities that have faced substantial difficulties with recruitment may have several assets that work together in the recruitment and retention process. Communities that already have had success in recruiting may still benefit from this information in guiding and prioritizing their advertising and strategic planning for sustaining growth or supporting staff to meet patient and community goals.
How can rural healthcare facilities work with their community to improve key community factors that affect recruitment and retention of staff?
By analyzing the common advantages and challenges in a rural community through the use of tools such as the Community Apgar Program, rural healthcare facilities and community planners can organize their efforts to meet and overcome common challenges, as well as share best practices in recruiting and retaining medical staff in rural communities.
An improved understanding of the factors that make an individual community unique is a powerful tool in the process of deciding where to invest in recruitment and how to structure the interview process and retention strategies. The goal of the Community Apgar Program is to allow communities to be self-empowered with information and strategies to work together in improving recruitment and retention success.
Why is it important to consider the capacity of the local healthcare system to anticipate economic growth?
When economic growth occurs, the capacity of the local healthcare system may need to increase to cover the new families and businesses. This, in turn, would generate additional economic growth in the healthcare sector. If the healthcare system cannot keep pace with the health needs of the growing community, the lack of adequate capacity could then affect access and quality for everyone, including both long-time community members and new residents. Families and businesses may seek healthcare outside the local area or not at all; thus, decreasing the economic impact of these new businesses and families.
It is important that economic development officials and businesses in a community share information with their local healthcare system related to expected major economic growth. This will allow the healthcare facilities to plan for growth they may see in demand for services, as well as factors that may affect their expenses, like increased competition for workers. When healthcare facilities are not prepared for major economic growth in the community, it places significant strains on facilities as they try to catch up to the changing needs of the community.
For an extreme example of how rapid expansion can tax a healthcare system, consider the New York Times article, An Oil Boom Takes a Toll on Health Care, which describes the changes seen recently in western North Dakota.
Where can I find funding opportunities to develop healthcare capacity in my rural area?
The U.S. Department of Agriculture's Rural Development offers a variety of grants, grant/loan combinations and loans to public bodies, private non-profit corporations, and Indian tribes to help finance or assist in community development. For the best program that would fit your community needs contact your local USDA-RD Service Center.
Additional funding programs can be found in RAC’s Funding & Opportunities section where you can browse by topic.