the Public Health Security and Bioterrorism Preparedness and Response Act of 2002—aimed at improving bioterrorism preparedness will help strengthen the public health infrastructure.

Following the expression of concern (NACRHHS, 1999) about the need to repair or replace aging rural hospitals, the Walsh Center for Rural Health Analysis, University of Chicago, carried out a survey of 950 rural hospitals with under 50 beds to identify their capital needs and their ability to borrow funds (Stensland et al., 2002). As part of this survey, funded by the Health Resources and Services Administration, respondents were asked to estimate for their hospital the annual charges for borrowing $1 million. Of 221 respondents, 81 percent (178) were able to estimate their cost of capital, while the remainder (43) stated they would not qualify for a $1 million loan. The latter hospitals tended to be older, lower-volume facilities with operating losses. Likewise, a more recent survey, undertaken by the Rural Health Research Center, University of Minnesota, indicated that a significant proportion of critical access hospitals has difficulty raising capital. Of the critical access hospitals surveyed (95 percent response rate) 39 percent indicated that they had experienced an important capital need of at least $250,000 and had not tried to borrow the money because they had no chance of obtaining it (Gregg, 2004).