The roughly 60 million people who make their homes in rural communities across the United States are often faced with a unique set of challenges to the goal of achieving and maintaining good health. For example, rural Americans are statistically more likely to have a chronic illness than the general population, while simultaneously being less likely to have adequate insurance coverage. Rural Americans are also more likely to be living under the federal poverty line, which impacts their health outcomes in a variety of ways.
In addition to social determinants of health such as chronic illness and poverty, individuals in rural communities often face challenges to simply access adequate healthcare. Because of the widespread nature of rural communities, many individuals face challenges getting to the doctor. This barrier is compounded by the fact that few rural communities have public transportation. If a rural patient is in need of a specialty care, the distances become even greater as few specialists practice outside of metropolitan areas with large patient bases.
Where Are All the Doctors?
Not only are travel distances a problem, there are simply fewer doctors in rural areas. According to the National Rural Health Association, there are 39.8 physicians for every 100,000 people in rural areas, as compared to 55.3 physicians per 100,000 people living in urban areas. As serious as the physician shortage is now, it is actually getting worse. Since 2010, 83 hospitals have closed in rural areas with hundreds more at risk because of the challenges of managing costs and maintaining steady revenue in a lower population area.
The doctor shortage and shrinking hospital count are having serious impacts on rural communities. For instance, fewer hospitals means less available emergency care, in some areas it may take 30 minutes or more for an ambulance to arrive at the scene of an emergency. The impact of this shortage can perhaps best be seen in the cases of substance abuse. Residents in rural communities are less likely to abuse opioids than individuals living in urban areas, but they are more likely to die from an overdose. There are a number of reasons for this, but one of them is a lack of immediate access to emergency services.
Along with emergency care, shortages of behavioral health resources are impacting communities. For example, in Mississippi there are a limited number of state-funded community mental health clinics in rural areas and so adolescents with mental health needs must either wait for months for the opportunity to meet with a provider or be admitted to a psychiatric institution that is most likely far from their home.
So What Is Being Done?
One step towards helping rural Americans achieve better health outcomes is a shift in focus. As part of that shift, the Centers for Medicare and Medicaid (CMS) recently announced a new agency-wide Rural Health Strategy. This new strategy was designed with the cooperation of rural healthcare providers and patients and is designed to “apply a rural lens to CMS programs and policies.” By keeping rural residents in mind when creating policies and programs, CMS hopes to improve access to quality healthcare, while also proactively preventing the types of unintended consequences that rural health providers have often faced in the past.
Strategy shifts are also taking place among providers and healthcare networks as they look to address rural health challenges through technology. Telehealth software allows for patients to consult with doctors, often specialists, remotely from a local clinic, community hospital, or even occasionally from their own home. This ability for patients to work with doctors without having to leave their communities is opening up new opportunities for rural residents to access a wide variety of specialists, while also lowering costs through avoiding expensive patient transfer procedures or other travel related costs.
Telehealth is even being utilized by school districts, particularly in the field of behavioral health. Many rural schools across the country face a severe shortage of qualified school counselors, leaving students who would benefit from counseling services without an available option. To address this trend, Utah recently passed a law to open up more options for rural schools to provide counseling resources on site by implementing telehealth technology.
As promising as telehealth is, so far it is not the perfect solution for rural communities. For instance, telehealth communication relies on having a dependable high-speed internet connection that is simply not available yet in many rural communities. Until the infrastructure to provide broadband access reaches the most remote areas of the country, there will still be thousands of patients outside of the reach of telehealth.
Another barrier to implementing telehealth in many rural communities is cost. Though there are tangible cost savings available when using a telehealth program, the initial investment to purchase and implement telehealth software can be prohibitive for all but the largest healthcare networks. One non-profit in Georgia hopes they have found a solution to this barrier. Global Partnership for Telehealth has actually developed their own telehealth software that is designed to be affordable to rural communities. The developers themselves admit that their software will probably never compete with the telehealth suites developed by large software companies, but their goal was simply to provide an affordable option for community health clinics, schools, and small practices that are looking for a way to expand healthcare access on a limited budget.
The challenges that face rural communities and rural healthcare networks are not going anywhere. But by focusing on their unique needs and utilizing solutions such as new technologies, the one fifth of Americans who call rural communities home can have the opportunity to have access to quality healthcare resources.