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As the American population ages, the Nation’s health resources are bearing an increased burden. The elderly are the primary users of health care services, and as their numbers have increased so has spending for the Medicare program. Balanced budget legislation introduced many changes to the Medicare system in an attempt to curb spending. The legislation creates opportunities to improve the rural health delivery system, but low population density, limited managed care experience, and less access to health care providers in rural areas make market-based efficiencies and equity difficult to achieve in rural areas.


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