Assessing the Unintended Consequences of Health Policy on Rural Populations and Places

The purpose of this paper is to illuminate the unintended consequences of health policy so that past is not prologue to future. The Panel explores a series of health policies that have affected, or had the potential to affect, rural people, places, and/or providers in ways counteractive to policy intent. Two realities drive the need for this analysis: 1) Rural health care systems are living with the legacy of policies having unintended consequences because the full impact of such policies on rural stakeholders was neither predicted nor understood; and (2) Policymakers have recognized the need to apply a rural lens to new and ongoing programs and policies to inform the pathways by which equitable rural health status and health care can be achieved, as articulated by the Centers for Medicare & Medicaid Services (CMS) Rural Health Council in its first explicit Rural Health Strategy. The Panel concludes with a framework for health policy evaluation that considers potential and unintended rural impacts. [Author Abstract