In this paper, we identify and discuss unique issues for rural communities and providers raised by the health care reform efforts of the early 1990s. The first section discusses the ways in which rural providers might be organized as networks and the ways in which these networks might relate to health insurance purchasing cooperatives. The second section discusses alternative reimbursement arrangements for rural providers participating in health plans or contracting with HIPCs. Section three raises issues relating to service delivery and the recruitment and retention of providers in rural networks under the marriage of managed competition and global budgets. Section four discusses potential roles for state government under health care reform.
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