During the past year, Mary Zimmerman, Ph.D. and colleagues at the University of Kansas Medical Center and the University of Kansas Policy Research Institute have examined the extent and patterns of local public funding for health care services in nine predominantly rural states in diverse regions of the county. Results from this HCFO-funded project provide important insights into the conditions under which counties are willing to tax themselves to support health care. The results also highlight the fact that cooperation and consolidation may be needed as rural areas struggle to maintain local health care services.

Zimmerman found that counties in largely rural states often spend a sizable portion of their tax monies to support health care services. Kansas, for example, spent nearly 10% of tax funds to support health care in 2001. County-level spending, as a percent of county budgets spent on health care, ranged from 2.5% in South Dakota to 9.1% in Kansas. Absolute average dollars spent on health care per county in the states examined ranged from $1.8 million per county (Georgia) to $160,000 per county (South Dakota).

Zimmerman notes "Our findings underscore the key role that local taxation plays in funding basic health care services in many rural areas. What has surprised us is that this funding stream, while so vital to individual communities and citizens, is both understudied and largely unrecognized in national policy discussions. Real health care spending by counties increased between 1997 and 2001 in most of the states we studied. Declining populations and increasing budgetary pressures, however, raise serious questions about the ability of local communities to sustain this level of support and add weight to long-standing calls to rethink and reorganize rural health care services."

In addition to her work on health care services in rural areas, Zimmerman's research portfolio covers a wide variety of subjects in areas including long-term care, social inequality, and adverse birth outcomes. She says that "through the various strands of my work I try to investigate and understand the human impact of health care policies and health-related social policies-how national or regional policies shape community and individual outcomes as well as how communities and individuals respond-with the hope of a more informed policy process."

As part of her current position as professor in both the Department of Health Policy and Management, School of Medicine and the Department of Sociology, Zimmerman teaches a summer course in Scandinavia where she and U.S. students learn more about health care systems outside of the United States. "Studying how other advanced economy countries organize and finance health care inevitably leads students to better understand health care arrangements here at home. In fact, it was the decentralized, county-level tax financed health care system in Sweden that sparked our initial curiosity about the extent of local public funding in the U.S.," says Zimmerman.

Zimmerman received her Ph.D. and MA in sociology from the University of Minnesota, and her BA in sociology from the University of Michigan. She has also done post-doctoral work in epidemiology under an NIH Research Fellowship. Zimmerman was a Fulbright Scholar in 1990 and a 2000-2001 recipient of a W.T. Kemper Fellowship for Teaching Excellence at the University of Kansas.

Articles from HCFO-funded project

Zimmerman, MK and McAdams, R. “Public Support for Rural Health Care: Federal Programs and Local Hospital Subsidies” Accepted for publication in Research in the Sociology of Health Care, 2005.