Respondents at eight sites believed state and federal regulations affected their activities in two different ways. At a general level, reimbursement restraints (particularly Medicare’s) and operating regulations were seen as detrimental to rural hospitals and, therefore, as indirect constraints to consortium development. More specifically, at several sites, respondents attempting bed conversions or diversification activities saw state regulations as barriers to achieving program objectives. It may be that the more complex such consortium activities are, the more likely they are to be influenced by regulatory programs. In four sites, however, respondents saw good relations with state officials as facilitating implementation of programs. As with the competitive threat of urban hospitals, respondents at three sites believed that onerous federal and state regulations had created incentives for rural hospitals to pool resources and make difficult collective choices. Access to Health Care in Rural Areas Essay
Several other environmental factors were identified less frequently as constraining or facilitating consortium development. These include hospital/medical staff relations, economic conditions in the region, and public awareness of consortia created by local media.
RESOURCE FACTORS.
Relative to environmental factors, respondents identified fewer resource-related issues as facilitating or constraining implementation. The resource-related factor that was identified at the most sites (twelve) as facilitating consortium development was the involvement of an external party, particularly at the consortium conceptualization stage. Third parties included health system agencies, urban hospitals, consulting firms, state offices of rural health, universities, and state hospital associations. In many cases, individuals associated with these organizations made their expertise available to consortium participants without cost. In a few instances, assistance was provided with the understanding that the organization and consortium would develop a long-term relationship once the consortium became operational. Respondents consistently identified the assistance of an external party as critical to consortium development. Access to Health Care in Rural Areas Essay
Several other resource issues pertained to the difficulties of recruiting personnel to rural areas. At eight sites, respondents mentioned physician recruitment as a constraining factor both in general, as it related to the overall viability of their hospitals, and specifically, as it related to the ability of the consortium to implement its planned initiatives. Similarly, five sites identified the recruitment of nurses and other personnel to rural hospitals as a constraining factor. Respondents at four sites saw problems in recruiting consortium (as differentiated from hospital) staff as a constraint for consortium development and program implementation, while at four sites, turnover of administrators at participating hospitals also was seen as hindering consortium development. Access to Health Care in Rural Areas Essay
ORGANIZATIONAL FACTORS.
Compared to environmental and resource-related factors, respondents identified a wider array of organizational factors as influencing consortium development and implementation. While most of these factors were present in four or fewer sites, there were two noteworthy exceptions. First, historical relationships among participating hospitals were seen as facilitating implementation at eleven sites and constraining it at six sites. The interview responses revealed that, in virtually every case, at least some participating consortium hospitals had experience in less-structured cooperative efforts before the consortium was formed, such as meetings to identify common interests with respect to state legislative initiatives. This facilitated consortium development since, in these cases, the rural hospital administrators had become comfortable with each other, gained a better understanding of common problems, and enjoyed some success in pursuing joint endeavors prior to creating a more formal consortium. Access to Health Care in Rural Areas Essay
At about half the sites, previous relationships among rural hospitals were seen as impeding the development of a consortium. At these sites, some rural hospitals were perceived as still being in a “competitive mode” with each other. In most cases, however, this was believed to be breaking down in response to external pressures that created incentives for cooperation. In particular, the loss of patients to urban providers was viewed as a more salient, and certainly more widespread, threat than the loss of patients to neighboring rural institutions.
A second organizational factor that was frequently identified as affecting consortium development was the assumption of a leadership role by one of the partici
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