Rural hospitals that don't adopt some of the strategies of their big-city rivals have little hope of fiscal recovery, a federal health expert says.

"Rural hospitals need to develop more aggressive marketing strategies, using radio and television at times, as well as aggressive community campaigns," said Jeffrey Human, executive director of the Office of Rural Health Policy for the U.S. Department of Health and Human Services."Hospitals need to be promoted within their communities," said Human. "And citizens need to know that if they don't support their hospitals, they'll lose them and the access to health care they can afford."

Human said one in 10 rural hospitals closed in the last decade. Six hundred of the remaining 2,500 are in dire fiscal condition, he said at a state rural health conference last month.

"The consequences of the closure of a rural hospital to local residents are almost always more significant than the closure of one of many urban hospitals," said Human.

Contributing to the failing health of rural hospitals, he said, are:

- Rural hospitals are paid 25 percent less than urban hospitals when reimbursed by Medicare for comparable procedures.

- Falling admissions caused, in part, by physicians referring patients to urban hospitals.

- A large percentage of rural patients unable to pay hospital bills.

- A shortage of doctors, nurses and other professionals.