Centralization and Regionalization

Policies that can devastate rural communities


Learn about what new rule changes will do to allow banks to forego responsibilities to rural communities.


Longer version at Centralization of State Educational Resources and Impact on the Location of Young Professionals


Rural areas of the nation face daunting challenges. Some are easily identified, such as international competition, droughts, and the supply and demand issues of natural resources. Some are less easily identified, such as inequities in the distribution of public health resources where rural areas receive only one-third the resources of urban (publ health reference).


Such inequities do not result overnight. Over a number of decades large inequities can result as areas with more population or political clout or more perceived need receive attention. Such changes are magnified by routine government decision-making. Once inequities start, it can be difficult to even identify them. Subtle changes in reimbursements to physicians began decades ago. They resulted in wide variations in Medicare costs to the nation where rural Nebraskans on Medicare received $200 per person per month whereas New York City and Miami recipients received over $700. The same Americans with the same health needs receiving the same quality of care with grossly different price tags. Of course the rural areas are receiving far fewer dollars in the transactions.


One of the most damaging practices in state government is the centralization of state resources. It remains a minor problem in the good economic years, but in difficult times and budgets, it is devastating. The scenario goes like this:


1.      State departments and divisions are asked to cut back jobs.

2.      Sometimes there are vertical cuts with loss of entire programs. More commonly those in control make horizontal cuts that impact the entire department with offices across the state.

3.      The end result of centralization is the loss of state jobs in rural areas as jobs and duties are consolidated into centralized regional locations.


In countries such as Canada regionalization is already identified as a major problem for rural areas. This is a common practice in business, where a competitive edge is necessary and the movement of employees has few consequences. However, continued movement of state jobs and employees to more urban areas contributes to progressive decline in rural economics, population, and services. In health care the difficulties mount when you consider the critical mass of physicians needed to sustain a hospital, or to support each other for call. Beyond a 4 primary care doctor (usually FP) threshold, this is difficult.


Perhaps no other area of centralization is as devastating as centralization of educational resources. When state higher education budgets are cut back, a series of decisions is set in motion. Often this leads to closure of certain departments in colleges or even entire schools. These cuts seem to make sense – if the impact on rural areas is not considered. For example, preprofessional preparation courses for medical school are expensive courses needing more costly professors and labs and involving only a few students at the college. However cuts in these programs can mean fewer rural physicians for the state.


Cuts in central state higher education budgets lead to cuts in smaller and smaller schools, larger schools can absorb changes better and often have more powerful alumni. Smaller schools are away from the urban centers and government. They have fewer resources and must make tough choices that lead to the loss of several areas of preprofessional training.

  1. Impact on the schools - As these schools have lost their competitive edge, fewer students have been able to do well enough to get into medical school and other professional training. As a consequence, fewer high school students have chosen these colleges and this has impacted the courses. The loss of such students also impacts the quality of the academics at the college.

  2. Impact on the students - When rural high school students are forced to go to urban colleges, they are forced into an uncomfortable environment where they are less likely to perform well. They also tend to meet and marry spouses that are urban or highly specialized.

  3. Impact on rural areas - This means college-bound are far less likely to return to a rural area to practice medicine or law or teach, etc. This means fewer services, worse economics, and decreasing rural populations.

  4. Impact on higher education – The changes of centralization are slow and subtle. Who can fault state or higher education or college officials for making some hard and difficult financial decisions in tough economic times? Of course there are some serious side effects:

As rural areas decline and tax bases melt away, this means expensive economic development programs and other incentives from the state and feds, if they can pay, if not then.....

Feb 2003 News from Tom Rowley at www.rupri.org/articles/  On the education front, the President’s budget once again gives zero dollars to the Rural Education Achievement Program, prompting Paul Houston of the American Association of School Administrators to say in a statement, “For the second year in a row the president’s budget proposal sends a message to rural school districts that they do not need increased funding to overcome additional costs generated by their geographic isolation, smaller number of students and increased poverty…Loss of this funding means a loss of the only funding stream dedicated to rural education.”      Hopefully Congress will renew this but...


Educational interventions provide innovative ways to reverse centralization and address many of the consequences:


The Rural Health Opportunities Program admits rural high school students directly to medical school. The students spend four years in a small rural state college before beginning their medical education at UNMC. This program gives rural students a chance to stay in rural areas for college where many prefer to maintain connections with family, community, and the rural lifestyle. The choice of a rural location for college also is a key factor in the choice of rural practice after graduation from medical training. Medical schools looking for those who will really go to rural areas after practice would do well to choose such students.


The impact of RHOP is not limited to the few students each year who may eventually return to rural areas to practice. The program has attracted the attention of a number of outstanding students from rural high schools. These additional students have improved academics, finances, and admissions numbers at Chadron State and Wayne State at a time when many small rural colleges are experiencing the opposite. In addition, high school students from rural areas are receiving important information about health careers and see students from towns just like theirs fulfilling their dreams.


Taken together as a whole, the RHOP intervention has made it more likely that more young professionals will choose rural areas in Nebraska. Program has been an excellent and inexpensive example of how working with rural high school students can help reverse economic decline in rural areas.


The reverse fate for community colleges is all too common. Community colleges are important resources. When jobs, economics, and businesses change, small colleges and technical schools help the workforce adapt to the skills needed to attract and maintain jobs.


The closing of the community college at Fairbury was a devastating blow to the entire south central region of the state, perhaps even more than the loss of Rock Island and major manufacturers. With the loss of the college, the city and region has suffered from the loss of good paying jobs, the loss of educational leadership, the loss of young professionals, and the loss of educational and technical training for the workforce in the region. The impact of changes in major employers has likely been magnified by loss of the college, sending the region into a downward spiral with less and less resources to mount a recovery.


The value of programs such as RHOP are not limited to rural areas. The same principles apply to diverse populations as well. Medical leaders such as William T. Butler recognized this over a decade ago. Baylor and other medical schools have instituted inner city programs working with high schools and stimulating education and professional careers and leadership where they are most needed in our nation. Programs impacting earlier levels are active in West Virginia and in tribal schools. The coalition of higher education, underserved communities, and small colleges can result in more young professionals and restoration of communities of poverty and hopelessness.


A century ago a high school principle named Abraham Flexner initiated reforms in medical education that stimulated colleges and high schools to improve education across the nation. He and medical education leader since have lamented that underserved areas have been left behind. Programs such as RHOP hold the potential to allow rural areas access not just to physicians, but to the young professionals that they have invested in and deserve to retain for their future and the future of the nation.




The Impact of Centralization Is Slow and Steady Over Decades



  1. Loss of competitive edge and academics

  2. Loss of jobs

  3. Fewer course offerings

  4. Declining small college admissions



  1. Forced to go to urban colleges which may impact on their short or long term performance

  2. Less likely  to return to rural areas, having met urban and specialized spouses


Rural areas

  1. Fewer jobs over time

  2. Less services

  3. Poorer economics

  4. Less population

  5. Young professionals not there to support each other and help lead community 



Hope: Students From the Underserved, For the Underserved


Longer version at Centralization of State Educational Resources and Impact on the Location of Young Professionals


Selection vs Socialization


Admissions and Social Status


Rich Colleges Receiving Richest Share of U.S. Aid    November 9, 2003   By GREG WINTER
The federal government typically gives the wealthiest private universities significantly more financial aid money than schools with much greater shares of poor students. also private file copy for backup

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