Ludke R L
College of Medicine and Graduate College, University of Iowa, Iowa City.
Health Prog. 1991 Sep;72(7):60-4.
As the rural healthcare environment changes, the abilities to assess the situation quickly and to implement decisions under conditions of uncertainty are crucial success factors. Rural healthcare providers and rural communities must examine certain assumptions underlying the delivery of healthcare services in rural areas, including the following: The rural renaissance of the 1970s will return. Rural communities need and want hospitals. Local physicians are the backbone of rural healthcare delivery. Transportation is a major barrier to healthcare service delivery. Competition in the delivery of healthcare services is appropriate for rural areas. The questionable validity of these assumptions implies that the current infrastructures for delivering rural healthcare services may no longer be appropriate. To adapt to changes, providers must (1) ensure changes fit with local conditions, (2) consider regionalization, (3) integrate all human services, not just health services, into a cooperative arrangement, (4) consider alternative configurations for providing physician services, and (5) place greater emphasis on transportation and telecommunication systems as means for ensuring timely access.
随着农村医疗环境的变化，在不确定的情况下迅速评估形势并做出决策的能力是取得成功的关键因素。农村医疗服务提供者和农村社区必须审视农村地区医疗服务提供背后的某些假设，包括以下几点：20世纪70年代的农村复兴将会重现。农村社区需要且想要医院。当地医生是农村医疗服务提供的支柱。交通是医疗服务提供的主要障碍。医疗服务提供中的竞争适用于农村地区。这些假设的有效性存疑意味着当前提供农村医疗服务的基础设施可能不再合适。为了适应变化，医疗服务提供者必须：（1）确保变革符合当地情况；（2）考虑区域化；（3）将所有人类服务，而不仅仅是健康服务，纳入合作安排；（4）考虑提供医生服务的替代配置；（5）更加重视交通和电信系统，将其作为确保及时就医的手段。
