REGIONThe outlook for rural health care in Idaho is looking brighter, thanks to state and federal legislation aimed at increasing the number of health-care providers in small towns.

But Idaho is still tied with Mississippi for last place in terms of its physician-patient ratio - 113 per 100,000. That compares with a national average of 186 per 100,000.

Dick Schulz, Division of Health director for the Idaho Department of Health and Welfare, said Idaho has 107 spots that have been federally designated as health manpower shortage areas; 15 of those are entire counties.

Schulz recently applied to the Public Health Service to list another 24 sites, seven of those counties. If they qualify - and Schulz is confident they will - half of Idaho's 44 counties will be recognized as critically underserved areas.

Now, the good news.

At the urging of the Division of Health, the Legislature passed a bill this year paving the way for a loan repayment program to attract primary health-care providers to needy rural areas. The bill includes doctors, nurse practitioners and physicians' assistants.

It targets health-care workers not currently practicing in Idaho, with preference given to former Idaho residents. The amount of each loan repayment is $20,000 or less per year for up to four years.

The amount paid will be based on the cost of each individual's education. In return, participants must serve at least two years in a designated underserved area.

Although no money was appropriated to fund the program, Schulz is optimistic that it will receive money next year.

"The bill moved through committee quickly, and there appeared to be a great deal of support for it," he said.

The Division of Health had requested $140,000 to start up the program, with roughly $100,000 to be spent directly on loan repayments.

In the meantime, Schulz and others are busy drafting the regulations for the program so next year, if funding is made available, it will be ready to go.

The Division of Health has also applied for a $130,000 grant from the National Health Service Corps to establish an Office of Rural Health to coordinate existing rural health services in Idaho and instruct communities how to attract and keep providers.

Schulz is hopeful the two-year loan repayment commitment will evolve into a long-term relationship.

On the federal level, Republican Sens. Steve Symms and Larry Craig introduced a bill in March designed to exclude all rural areas from reductions in Medicare reimbursements to physicians based on the number of years in practice.

The Omnibus Budget Reclamation Act of 1990 reduced Medicare payments to new doctors to 80 percent for the first year, graduating to 100 percent by the fifth year of practice. Although doctors practicing in health manpower shortage areas are exempted, not all rural areas in need of primary care providers are so designated.

Symms and Craig propose to extend the exclusion to all rural areas because they typically have a higher percentage of Medicare patients.

Young physicians with $100,000 or more in medical school debt can hardly afford to consider practicing in rural areas as it is. But the Omnibus Bill, by penalizing them for their inexperience, makes practice in a rural area out of the question, the bill states.