Imagine not being able to have a reliable way to contact a doctor or other health professional when you need their services. This is the reality for many people living in rural areas, areas which consist of almost 16% of the US population, or roughly 50 million people. Compared to their urban counterparts, rural patients are faced with a significant number of barriers when it comes to receiving healthcare attention, and are subsequently disproportionately affected by disability, disease, and chronic conditions such as diabetes, cancer, heart disease, and stroke. Below are some of the most significant barriers that hinder the ability of rural residents to receive adequate healthcare services.
Location
Geographic isolation is arguably the more significant barrier that limits access to healthcare providers and specialty care services in particular. The travel time to the nearest healthcare facility for rural residents (over 30 minutes for those living farthest, 6 minutes for those living closest) have greater discrepancies than those living in urban areas (19 minutes vs 5 minutes). Those living on farms, ranches, etc. that require large, open spaces are confronted with the issue of traveling greater distances to receive the help they need, which further endangers patients requiring emergency medical attention. Moreover, this issue is exacerbated by limited public transportation options, poor road conditions, and exposure to environmental hazards.
Socio-Economic Status
Rural individuals also face daunting socio-economic barriers that make it difficult to travel to a location where health professionals are available. In fact, the Kaiser Family Foundation reports that a fourth of the non-elderly rural population earn a median household income that is below the federal poverty level, compared to roughly one fifth in metro areas, and are less likely to be covered by employer-based insurance. The Affordable Care Act, which was passed in 2010, presented an opportunity to expand health coverage through Medicaid among individuals below 138% of the federal poverty level, which included the vast majority of the uninsured rural population. However, 24 states chose not to expand their Medicaid programs. With roughly two-thirds of uninsured individuals living in these states, rural residents face even greater health disparities as a result.
Some of the most affected individuals are African Americans, who make up the largest minority group in the South. According to the Association of American Medical Colleges (AAMC), they have “higher rates of cancer morbidity and mortality than other rural residents and have higher rates of co-morbid conditions,” meaning African Americans are more susceptible to more than one disease or illness. In recent decades, the rise of immigration has increased rural diversity, with the Hispanic and Asian populations being the fastest growing groups. These ethnic and racial variations each have their own distinct health issues.
Physician Shortage
Another major issue is the maldistribution of healthcare workers in rural areas. Primary care doctors are stretched thin and accessing subspecialty care is challenging due to geographic isolation. This lack of specialists, including mental health and substance abuse providers, contributes to the mental health disparities that rural individuals experience.
In order to bridge the gap in rural healthcare access, greater awareness of the issue must be spread and action must be taken. One potential solution is the expansion of telemedicine, which uses electronic information and communication technology. Its aim is to improve access and quality of care for those with limited access to healthcare specialists. Through videoconferencing, remote patient monitoring, and the transmission of medical information and images, pediatric subspecialty expertise can be implemented in even the most remote rural locations as well as nontraditional settings, such as schools and homes. Telemedicine presents an effective solution to increasing access to high-quality care, but of course it can’t solve the health disparity issues alone. By investing in rural communities and providing them with the resources and technical assistance needed--including establishing more public health facilities like hospitals--we can make steps to eliminating healthcare disparities associated with geographic location.
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More information:
Mental health disparities in rural communities:
How telehealth can improve healthcare quality:
Racial and ethnic diversity in rural areas: