In the most extensive rural health poll ever conducted in Washington state, surveyed rural residents indicated they highly value the availability and quality of health care in their communities, but most residents lack awareness of the precarious financial situation threatening a large number of rural clinics and hospitals.

Based on a telephone survey from late April through early May, the poll of 605 heads of household included rural residents from all areas of the state. Of those surveyed,

l 45 percent were from rural areas of urban counties (urban fringe),

l 26 percent were from large towns ranging from 10,000 to 50,000 in population, and

l 29 percent were from small towns under 10,000 and isolated rural areas.

“This is the most comprehensive effort to understand the rural perspective of the health system as it now works,” said Greg Vigdor, President and CEO of Washington Health Foundation, which sponsored the poll. “It was extensive enough to answer a common critique of rural polling: that not enough numbers are involved to be statistically valid. To meet that concern, we did a larger scale of polling than ever previously attempted.”

Key Findings

l Half of those interviewed said the state health care system needed a “fundamental overhaul” (22 percent) or “major changes” (28 percent).

l Two-thirds gave their local health care a positive rating.

l Access to care for the community is seen as worthy of some sacrifice. Most polled were willing to pay higher local taxes (56 percent), pay higher fees or co-pay (56 percent), and accept limits on their own access (61 percent) to maintain health care availability to the larger community. However, two thirds were unwilling to be limited in choice of provider.

“The poll indicates rural residents value having high quality health care available in their community, a point strengthened by their general willingness to make changes to maintain that service,” said Piper McGregor, Rural Health Policy Analyst for Washington Health Foundation. “But looking a bit deeper at the data shows that in the greater community many are not aware of the challenges facing health care providers locally.”

While two-thirds of respondents gave positive ratings based primarily on quality, the awareness of the financial challenges of their local health care facilities was limited. More than half (57 percent) reported their hospital as financially strong, yet according to the latest available statistics from Department of Health, 27 out of 41 rural hospitals (65 percent) operated in the red during the last reporting cycle in 2001.

To gain a deeper understanding of the attitudes and behavior in isolated rural areas, the polling included a supplemental sample of residents living in communities of 10,000 residents and fewer. In comparison to larger rural towns, key differences emerged.

l People in small towns were two times as likely to be without health care coverage.

l Respondents in small towns were more likely to give local care a negative rating than residents of large towns or urban fringe areas.

l Small town residents were more willing than residents of larger communities to make sacrifices to maintain local services.

l Overall, the small town residents were more aware of the financial condition of the local hospital.

l The majority of small town residents were very likely to take some type of political action to maintain local facilities, with 75 percent very likely to take some political action to prevent the closure of a facility.

Part of an overall Washington Health Foundation effort aimed at fundamental health system change, the rural poll follows two statewide polls conducted within the last year. The poll data will be linked with additional information gathered from the just-completed Community Roundtables 2003, civic meetings on people’s view of health and health care held earlier this year in every county of the state. A report of those findings-the Washington Health Values Map-will be presented at the upcoming Washington Health Leadership Summit, which will include participation of leaders from more than 100 communities throughout the state.

“By listening to the public, by probing deeper to find the underlying values held in rural communities, we can help leaders to better reflect and act upon the concerns of the people of this state,” said Vigdor.

The rural poll results are from propriety questions developed by the Washington Health Foundation and Elway Research. The poll was conducted by Elway Research from April 24 through May 1, 2003. The sample design was aided by the Office of Community and Rural Health. Sampling error for the poll is plus or minus 5 percent.

For a summary of poll results and more information about the Oct. 27-28 Health Leadership Summit, go to www.whf.org and see the links on the right side of the home page.

Martin Perlman represents the non-profit Washington Health Foundation.