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• Compliance with numerous/redundant regulations • Obvious stuff: lower reimbursement, older/sicker populations, urbans/suburban competition, etc • Local economy typically dependent on 1-3 major employers - struggling to provide health benefits • Lower volumes • Spiraling health care costs (particularly pharmaceuticals) • Patients demanding choice/quick fixes, but not as willing to be accountable for their own health/wellness • Information overload • The increase in charity care, primarily it appears to be due to the increase in foreign labor, either associated with the tourism business or with agriculture • The lack of specialists and our ability to support their life style in terms of on call time • Change in reimbursement for long term care, it is getting more and more difficult to break-even in the long term care business • Some hospitals with long term care are saying if it was not part of their mission they would jettison that part of their business • Future employees: Young people are not wanting to stay or return to their home communities, they want to flee to the more urban areas that can give them a richer life style (in their eyes) • If it doesn t happen locally, it will happen regionally (needs will be met outside of the local area) • Lack of technology viewed as inability to achieve high quality levels • Statements that measures are not applicable to rural health may imply poor quality can t be improved • Small sample size limits proof of improvement may be difficult for consumers to interpret—big will look better because data is available • Increasing of uninsured/underinsured and declining reimbursements from state, federal and private payers.
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