PowerPoint® PowerPoint® PresentationPresentation

Tom Ricketts

The The Point of this of thisPresentation

is that Rural Health is that Rural Health Policy needs needs stewardshipstewardship

The The PointPoint of this of thisPresentationPresentation

is that Rural Health is that Rural Health PolicyPolicy needs needs stewardshipstewardship

Welcome toArt Appreciation 101

fall semester, 2007

Professor Ricketts

The POWER to compel people toget on airplanes in August to

come to Washington, DC—that’s real power

Real POWER

Happy 23rd

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In the tradition of America’s In the tradition of America’s first grant writerfirst grant writer

Franklin was proposinga totally new projectto a distant bureaucratin a faraway city withreally big buildings,fountains, and a largebureaucracy that ranthe place

He got the funding!

• But implementation met with serious problems, people fighting and arguing

• The project didn’t meet its timeline• The outcome ended up being a

conference in Philadelphia• The funder eventually lost interest—and

his head

Rural America:Big Politics

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Politics can be strange these days

OMB’s New Micro-politan

PARADIGM STICKPARADIGM STICK

Access vs Finance

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RICHPOORRURALURBANRICHPOORRURALURBAN

Geographic Rate Ratio 2:1

Regional Rates, all causes, black males

Geographic Rate Ratio 4:1

RURALITY•NONRURALITY AND HEALTH

• How does ruralrelate to health

• Is there somethingunique ABOUT

NONURBAN health”

Communities of need and communities of solution.

Figure 1: Communities of Solutionfrom Health is a Community Affair

Source: (National Commission on Community Health Services, 1966, p. 3.)

Describing problems in terms of inequity and disparity tends to divorce communities of solution from the problem.

The political economy of underservice

…where need has value!

HPSA Trends

0100020003000400050006000700080009000

Number of HPSAS No. of Primary Physicians Needed

underserved

Lots of little color-coded indicators

Pointillist evaluation…how the big picture can look

PART Assessments

Fairness of outcomeversus

fairness of process

What did we want to happen then?

How can we make that happen now?

Stop Now!

Setting Standards has Setting Standards has consequences…consequences…

Thomas Edison andThomas Edison andGeorge WestinghouseGeorge Westinghousefought over whether to usefought over whether to useAC or DC current in powerAC or DC current in powertransmission…Westinghousetransmission…Westinghouse(AC) won because it was (AC) won because it was thought transmission would be thought transmission would be over short distancesover short distances

AC is less efficient than DC and requires huge “high

tension” wires to transmit

“Paradigm Stick”