Directly respond to at least one classmate in a way that extends meaningful discussions, adds new information, and/or offers alternative perspectives.

Joe: What are ancillary services?
Ancillary services are services provided to patients of certain populations that support the work of the primary care providers. There are a wide range of ancillary services that fall into three categories; diagnostic, therapeutic, and custodial. Examples of ancillary services are laboratory for lab studies for patients with high cholesterol, infection, or diabetes; physical therapy for orthopedic and stroke patients; and long term nursing facilities for patients that are unable to care for themselves due to their medical / health condition or do not have a caregiver. Approximately 30% of healthcare spending is used on ancillary services.
How do ancillary services offered in rural and urban areas differ?
Ancillary services in rural areas are a scarce resource compared to urban areas. There are not as many facilities that provide ancillary services and may require longer travel time in rural areas. The healthcare workforce in general are more densely concentrated in urban areas than rural areas. According to the Rural Health Information Hub(n.d.), 20% of the population lives in rural areas however only 11% of providers work in rural areas.
Regarding ancillary services, what are some disadvantages to consumers (patients) living in rural populated areas?
Lack of access, long travel time and distance to facilities that provide ancillary services are some of the disadvantages of the rural population. There may also be inability to pay for services even with insurance coverage but according to Rural Information Hub(n.d.), 9% of those who live in rural areas do not have insurance. According to Douthit, N., et al (2015), “Reluctance to seek health care in rural areas was based on cultural and financial constraints, often compounded by a scarcity of services, a lack of trained physicians, insufficient public transport, and poor availability of broadband internet services.”
What recommendations would you provide as a health care leader to lessen these disadvantages?
As a health care leader, I would increase resource availability and access in my facility by becoming affiliated with a large healthcare network to improve or add ancillary services. According to Oyeka, O., et al. (2018), “System affiliations may provide rural hospitals access to technology, staff recruitment and retention, expanded health care and operational services, group purchasing, and reduced cost of capital.” The larger network will introduce resources that are sufficient enough to provide ancillary services. The rural medical facility would then be able to provide face to face and telehealth services that might not have available in the past. By becoming affiliated with a large health care network, there will be changes in some of the control within the rural facility but that will also improve delivery, quality, and availability of services. The affiliation will eliminate some of the barriers to receive needed ancillary services but not all. Some of these barriers such as transportation might be more challenging to overcome, there are resources available to set up some sort of transportation system through the healthcare network, such as a shuttle or car service.
References

Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care access in the rural USA. Public Health. 2015 Jun;129(6):611-20. Retrieved from: doi: 10.1016/j.puhe.2015.04.001
Cyr, M.E., Etchin, A.G., Guthrie, B.J. et al. Access to specialty healthcare in urban versus rural US populations: a systematic literature review. BMC Health Serv Res 19, 974 (2019). Retrieved from https://doi.org/10.1186/s12913-019-4815-5
Oyeka, O., Fred Ullrich, F., MacKinney, A., Lupica, J., & Mueller, K. (2018) The Rural Hospital and Health System Affiliation Landscape – A Brief Review. Retrieved from https://rupri.public-health.uiowa.edu/publications/policypapers/Rural%20Hospital%20and%20Health%20System%20Affiliation.pdf
Healthcare Access in Rural Communities. Retrieved from https://www.ruralhealthinfo.org/topics/healthcare-access#services
Rural Health Disparities Retrieved from https://www.ruralhealthinfo.org/topics/rural-health-disparities