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Abstract
Most discussions of rural health policy overlook
the key role that states play in crafting and delivering
programs that directly affect the access, cost, or quality
of health services to rural residents. However, policies
such as regulations embodied in medical practice acts,
education programs, and funding for local public
health programs are the subject of debate in state capitals.
Moreover, the current climate of devolution and
block grants serves to increase the state government
role in shaping the effectiveness of rural health programs.
Despite the lack of discussion of the state role
by rural health researchers, state governments play a
vital role in rural health. This paper provides statelevel
policy makers with an overview of the key issues
in rural health and principles for developing policies
and programs in this area. Furthermore, this paper
argues that states should adopt a “rural lens” in health
policy formulation. That is, states should explicitly
account for the differences in medical geography of
their rural areas when crafting and implementing
health policy. Additionally, this paper suggests scrutiny
of current rural health policies so that significant
rural people (the intended beneficiaries) do not lose
benefits from the policies through rent-seeking behaviors
of powerful interests in the health care arena on
the provider side (physicians, hospitals, medical
schools).