Mo. journalist reminds us that reform does little to improve actual delivery of care

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at

“Health reform” is the term we use to describe the changes being made to the U.S. health care system under the Affordable Care Act. But as we’re reminded from time to time, for example in a blog post by Austin Frakt earlier this month at The Incidental Economist, the ACA is more accurately defined as health insurance reform.

Jim Doyle

Jim Doyle

Certainly insurance reforms are badly needed, but these reforms alone are doing little to reform the actual delivery of care to patients. Jim Doyle, who covers the health care industry for the St. Louis Post-Dispatch, makes this point in on a series on health care access and the fraying safety net.

In a new “How I Did It” article, Doyle explains what he found when reporting from rural parts of Missouri and Arkansas is that, while the Affordable Care Act will bring changes to the health insurance marketplace in these areas, it only goes so far in helping the poor access health care services.

“If you report on rural hospitals, you’ll soon recognize the parallels between the health care disparities the poor face in rural areas and in the inner cities and that health insurance reform only goes so far, causing many safety-net organizations to struggle,” he writes.

Of particular interest to health care journalists is how Doyle approaches his work. “It’s important in this endeavor to challenge conventional wisdom – to aim to test everything, including experts’ conclusions and my own assumptions and tentative findings,” he adds.

Health care journalists also may find it useful to review Doyle’s impressive list of resources he uses to inform his reporting.

1 thought on “Mo. journalist reminds us that reform does little to improve actual delivery of care

  1. Robert C. Bowman, M.D.

    About half of the physician workforce in rural areas, counties with lowest concentrations, or zip codes outside of physician concentrations is primary care. About 50% of primary care or 22 – 27% of total local workforce is supplied by family medicine. Internal medicine is number 2 at 12 – 14% but is being cut in half as office primary care result since the 2000 class year has been only 1500 per class year, not the 3000 per class year prior to 2000, Pediatrics is 6% and stable. General surgery has decreased to 4%. ER is moving up slightly at 5% – about the only one. General ob-gyn and general orthopedics are also decreasing. Internal medicine specialties are no change.

    This losses of internal medicine and general specialties help defeat primary care and basic services where workforce is most needed – the same services that are nationally designed with lowest reimbursement. Rural and underserved areas have higher proportions of lowest paying plans and there is no rescue by highest paid specialized services. Higher proportions of elderly, chronic disease, and poverty complicate care along with lower levels of education, health literacy, employment, and clinician support.

    Sources are the AMA Masterfile and County Health Rankings data applied to RUCA 2.0 rural zip codes, 2400 counties lowest in physician concentrations with 30% of Americans, and 40,000 zip codes outside of physician concentrations where 68% of Americans reside with only 30% of the physician workforce.

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