The Southern Rural Access Program began making its first round
of grant awards in November 1998. The grant awards followed an
intense review by The Robert Wood Johnson Foundation (RWJF) of
one proposal from an agency in each of the eight targeted states
designated to act on behalf of a broad consortium of agencies interested
in improving access to healthcare in rural underserved areas. An
additional $2.5 million also was made available to the National
Program Office from The Robert Wood Johnson Foundation to fund
innovative projects through the 21st Century Challenge Fund, a
special opportunities fund designed to support highly innovative
pilot demonstrations or small analytic projects that address specific
healthcare problems and serve to build capacity within the state.
Based on the lessons learned and successes from the first three-year
phase of the program, the RWJF Board of Trustees reauthorized the
program for another four years in January 2002. Of the $18.9 million
in new grants made available by RWJF, $13.3 million was allocated
to core grant components, $3.5 million for additional revolving
fund seed money and $600,000 for a new effort, the planning of
a single regional forum to address healthcare challenges in the
Phase II, Round I grants were awarded for a two-year period beginning
April 1, 2002. A second round of two-year funding was awarded April
1, 2004. To encourage sustainability at the end of the Foundation's
involvement, the funding level for core grants will be gradually
reduced such that the sites will be funding 50% of core grant activities
by the fourth year of Phase II.
Providing rural Americans with access to healthcare services
has been a challenge to policy makers, researchers, providers,
and rural health advocates for decades. Despite a number of federal
and statelevel efforts, many rural areas continue to have fragmented
health delivery systems, a shortage of health professionals, inadequate
access to capital for health care infrastructure, and high proportions
of working poor people without health insurance.
However, recent policy changes provide some opportunities to
improve access to basic health care in rural areas. Significant
among these are changes in federal Medicare policy that provide
payment incentives to develop managed care options in rural areas,
and that provide an opportunity for providersponsored organizations
to participate in the Medicare+ Choice Program.
Also, it may now be easier for underserved rural areas to make
progress on persistent primary care workforce shortages. Emerging
market forces combined with medical education reforms have stimulated
significant growth in the number of students who choose careers
in primary care, such as generalist physicians, nurse practitioners,
physician assistants, and certified nurse midwives.
Additionally, support mechanisms are being developed to enhance
the capacity of underserved rural areas to recruit and retain more
primary care practitioners.
The Foundation has supported a number of efforts to improve access
to care in rural regions of the country. Key lessons from these
experiences indicate that:
- The most severe rural health care access problems are disproportionately
concentrated in certain regions of the country – particularly
- Some states have had limited resources to plan or initiate
efforts to markedly improve rural access.
- Regional clusters of states are more likely to learn from each
- No single intervention by itself is likely to improve access
to care significantly.
Based on these lessons, the Foundation believes that combining
promising interventions and working over a sustained period with
a regional group of states will provide the best opportunity to
improve access to care.