Primary Health Care Research & Development


Trends in Rural Health Clinics and needs during U.S. health care reform

Judith Ortiza1 c1, Natthani Meemona2, Yue Zhoua3 and Thomas T.H. Wana4

a1 Research Associate, College of Health and Public Affairs, University of Central Florida, Orlando, Florida, USA

a2 Lecturer, Social Science and Humanities, Mahidol University, Salaya, Butthamonton, Nakorn Pathom, Thailand

a3 Graduate Research Assistant, College of Sciences, University of Central Florida, Orlando, Florida, USA

a4 Professor and Associate Dean for Research, College of Health and Public Affairs, University of Central Florida, Orlando, Florida, USA


Aim Rural Health Clinics (RHCs) are primary care clinics certified through Medicare and Medicaid to provide health care to the medically underserved in rural areas of the United States. The purpose of this paper is to describe how the characteristics of RHCs have either changed or remained stable over a 10-year period in the past: from the late 1990s to 2007. In addition, it is also to describe some of the outstanding needs of RHCs as they navigate the transitions of U.S. health care reform.

Methods Using a panel of RHCs continuously in existence from 2006 through 2007, we calculated and compared statistics with corresponding statistics from the literature. We described the geographic distribution of RHCs, demographics of their counties of location, and characteristics of RHC structure and staffing. We also explored the implications of the recently enacted health reform law (the Patient Protection and Affordable Care Act or ACA) for RHCs, and the improvements that RHCs need as it is implemented.

Findings By the end of the study period, the highest percentages of RHCs were in the South and Midwest, the percentage of RHCs in the West had grown, and that in the South had declined. RHCs served counties with increasing proportions of individuals below poverty and Hispanics/Latinos. The percentage of independent clinics had grown, as had the percentage of for-profit clinics. Finally, the percentage of nurse practitioner full-time equivalents had grown as a proportion of the total for three providers.

Conclusions In investigating the performance of RHCs, many managerial and operational factors are not well understood. It is imperative that RHCs gather the information that could help them maximize the elements of their performance that would keep them financially stable. In addition, a broader awareness of the unique challenges that RHCs face in this era of health care reform is needed.

(Received March 04 2012)

(Revised September 02 2012)

(Accepted September 18 2012)

(Online publication October 24 2012)

Key words

  • primary care;
  • rural health care delivery;
  • Rural Health Clinics


c1 Correspondence to: Dr Judith Ortiz, PhD, College of Health and Public Affairs, University of Central Florida, PO Box 162369, Orlando, FL 32816, USA. Email: