Alternative models for the delivery of rural health services

A number of alternatives to the solo, fee-for-service physician model have been pursued in an attempt to alleviate some of the specific problems associated with the delivery of primary care in rural areas. This article reviews and critiques the literature published in the 1980s for four alternative models: organized group practices, community health centers, community-oriented primary care and managed care systems. The review examines the strengths and shortcomings of the existing literature, and identifies high-priority research areas for each model. These four alternative models were introduced and promoted during the 1970s with little in the way of research evidence to support them. The subsequent literature pertaining to their performance was primarily descriptive. Of the quantitative studies, many utilized 1970s data. Therefore, the effects of the many environmental changes in rural areas during the 1980s on the viability of these models is unknown. In addition, little, if anything, is known about the life cycle of these models. While longitudinal, cross-organizational studies present several logistic difficulties and require considerable resources for data collection, they hold the promise of extending the existing knowledge concerning alternative models beyond its present states.