Critical telecommunication and work force challenges contribute to greater disparities in access to health care in rural areas, according to panelists at a House Agriculture Subcommittee on Specialty Crops, Rural Development and Foreign Agriculture hearing last week, CQ HealthBeat reports.

Wayne Myers of the Maine Health Access Foundation, representing the National Rural Health Association, said it is "extremely difficult and expensive" to recruit and retain physicians and health care providers in rural areas. Tom Morris, acting associate administrator for HHS' Health Resources and Services Administration's Office of Rural Health Policy, discussed current programs meant to retain doctors in rural communities including the National Health Service Corps -- where more than half of the participants go to practice in rural areas -- and the National Rural Recruitment and Retention Network, which over the past four years has placed about 2,900 clinicians in rural areas.

Subcommittee Chair Mike McIntyre (D-N.C.) said that federal grant and loan programs are essential to improving rural health care. McIntyre said, "With limited dollars available for rural health care programs, we must ensure they are used in ways that address the challenges and with sufficient federal coordination."

Karen Rheuban of the University of Virginia Health System said that rural grants are of little value without an effective Medicare reimbursement system for telehealth services, which improve rural health treatment options. According to Rheuban, Medicare has a "far less inclusive" definition of rural than that of USDA or Federal Communications Commission and, "The largest challenge we face, quite frankly, is a lack of reimbursement" for providing telehealth services.

Thomas Dorr, undersecretary of Agriculture for rural development, highlighted USDA's Community Facilities Program, which has invested more than $1.75 billion in more than 1,000 rural health care facilities since 2001 (Parnass, CQ HealthBeat, 7/25).