Rural America and the Digital Transformation of Health Care: New Perspectives on the Future

Over the past several decades, public perspectives on rural health have re ected a widespread belief that rural Americans were disadvantaged in medical matters. Small towns with declining economies and aging populations encountered many problems either trying to maintain full-service hospitals or struggling to attract physicians and other health professionals . Rural health care was seen as a “special case” that required subsidies and targeted programs to provide access to basic twentieth century medicine. Ameliorative efforts, such as critical access hospitals, were successful in some communities, but pessimism about the future still prevailed. The number of Ž nancially threatened, small, rural hospitals was rising in the late 1990s, and a nursing shortage joined the physician shortage as bad news at the same time. The good news is that the outlook for rural health is decidedly more positive at the beginning of the twenty-Ž rst century. The two concepts that jointly create this special concern, namely “rural” and “health,” are experiencing dramatic change for the better. Slowly, but surely, the rural population is growing in size after many decades of decline. The rural economic outlook now is much brighter, thanks to economic diversiŽ cation, and the fact that a considerable amount of health care is moving away from the expensive conŽ nes of the traditional hospital to ambulatory settings that are Ž nancially viable in less-populated areas. This article explores the potential for positive redirection of medical services in rural America, with a special focus on contributions made possible by an unprecedented revolution in information technology. The digital