er ambulatory services. Medicaid is for low-income and medically needed persons, with Title XIX of the 1965 Social Security Act amendments being the authorizing legislation.
For community/rural areas, the sources of reimbursement are the same as for metropolitan areas; however, the distribution of reimbursement between private and public sources diverges dramatically. Note that, for example, during the 1975-1976 time-frame, the County of Multnoma in Oregon had reimbursements consisting of 71.9% from private sources; while 13.5% were from Medicare; 7.2% were from welfare (i.e., categorically needy) patients; and 7.4% was from other sources for non-welfare but poor patients. In contrast, for the City of Portland, Oregon during 1976-1977, 22.5% of reimbursements were from Blue Cross; 13.3% were from Blue Shield; 4.2% were from Aetna; and 18.0% were from other private sources. For health maintenance organizations, Kaiser accounted for 16.7%; while Portland Metro Health Cascade accounted for 0.8%; the Physicians Association of Clackamas County accounted for 0.8%. For welfare reimbursements, 3.8% was indicated; with 6.2% for Medicare (Gay & Jacobs, 1982, pp. 17-18).
Rate Differences and Impact of Reimbursements
The Institute of Medicine (1989) reports that there are no differences relative to the rate of reimbursement between rural and urban health-care facilities and/or practitioners. That is, rural health-care providers are reimbursed using the same formulas as are metropolitan providers. There are, however, several factors which influence the total amount of monies garnered by rural health-care facilities and/or practitioners. First is the fact that, although approximately 25% of the nation's population resides in rural areas, these areas tend to be more sparsely populated than metropolitan areas, As a result, the catchment area for the health-care providers tends to have fewer potential and actual patients for servicing...