Frontier hospitals: endangered species and public policy issue.

Frontier hospitals are the most geographically remote acute care facilities in the United States, and they are rapidly becoming and endangered species. Like other small rural hospitals, especially those under 50 beds, they are experiencing considerable distress and more and more are facing the possibility of closure (American Medical Association 1985; Mullner and McNeil 1986; Van Hook 1985; Cordes and Wright 1985). Frontier hospitals play a key role in acute care, serve an important function in the recruitment and retention of physicians and health personnel, and contribute to the community's economic development. However, the local economy surrounding them may be inadequate to prevent socially undesirable facility closures. Present public policy, which is primarily based on a market approach, is incapable of addressing the problems faced by frontier hospitals. A reexamination of this does not mean that the only other option is to follow the patterns of highly regulated states such as Massachusetts, New York, and Connecticut. United States health care has both competitive (market-driven) and regulatory aspects. Several other options or approaches between the extremes are explored.