Ask questions and rattle cages. And if you're interested in the quality and kinds of medical services available in your rural community, get involved in preserving or building the delivery system.

Most of us are well aware of the rapid changes taking place in an already turbulent health care field, and know the future holds more of the same. The creation of a better "system" of health care has presented challenges to all of us... federal and state legislators, industry leaders, and health care providers alike. But no one feels as out of control as the patient. Economic and demographic problems complicate the issue for those who choose the rural lifestyle.

What are we to do? Whether it involves asking the right questions about a medical condition we're experiencing or inquiring as to why our specialist left due to the medical malpractice insurance crisis, we must become more active in making our own health care decisions.

This magazine's ongoing series on rural healthcare issues is one example of how to overcome the complacency rural residents have developed with respect to health care. We must educate ourselves. Education helps us understand, and when we understand, we can plot strategy. The responsibility is also on us to educate our neighbors and other community members about the need to become more engaged. Thanks to community input, more than 40 rural Illinois hospitals are now certified as critical access hospitals, assuring adequate Medicare reimbursement for essential services.

Personally, we should all strive to maintain a healthy lifestyle, but when faced with medical conditions, we (or our advocate) must make certain we understand all the nuances of our treatment plan. There are literally thousands of public resources on diseases, drugs, hospital accreditation, clinician licensure, and any other information we might need to become an active member of our health care team.

The responsibility for determining the health care needs of the community and meeting those needs with high quality services goes beyond the hospital governing board, physicians and other clinicians, and health leaders. Community members must understand what services are available from local providers, and the network availability for more sophisticated procedures and technology.

We have a responsibility to query rural health providers and legislators and have a voice in decisions impacting our health. We owe it to ourselves to ask local news media to cover public health issues, report on hospital board meetings, and host "talk" programs on medical advancements. It's up to us to serve on the hospital or clinic board or volunteer for a hospital project committee. Some of us might even consider making health care our livelihood. After all, that's what rural health care is — neighbors taking care of neighbors.

We have to be realistic, too, about cost. A health care system must be cost efficient, which calls for system-wide cooperation and coordination among patients, providers, and payers. It's critical that all involved entities share a common vision built on what the community needs and can support.

We are our strongest advocates for rural health, but if we think we can't make a difference, we won't. I believe that the deep-seated American tradition of rural community activism and responsibility and effective leadership are the keys to success. Just as all politics is local, so is all health care, and changes start at the grassroots level. It's not a decision to leave to the other guy.

Barbara Bock Dallas just retired after almost 25 years with the Illinois Hospital Association representing the interests and advocating on behalf of the 90 small rural Illinois hospitals. A charter board member and past president of the Illinois Rural Health Association, she lives in the Jackson County community of Murphysboro.

The opinions and views of guest commentators are their own and may not represent those of the Association of Illinois Electric Cooperatives or the electric co-ops of Illinois.

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