Americans living in rural areas tend to have worse health than people in cities. Why is this, and what can providers and policymakers do to improve rural healthcare access?
Rural health disparities
The 20% of Americans living in rural areas face higher risks for poor health outcomes. Rural populations experience higher death rates from heart disease, cancer, chronic respiratory disease, stroke, and unintentional injuries. As just one example, diabetes is 17% more prevalent in rural areas than in urban ones.
But why are health outcomes worse in rural communities?
Healthcare professional shortage
Health is influenced by factors beyond medical care—such as socioeconomic conditions, behaviors, and the environment— but access to quality healthcare is still crucial. One of the primary challenges facing rural areas is the shortage of healthcare professionals.
While 20% of Americans live in rural counties, just 10% of doctors practice in those areas. Fewer family physicians, specialists, and mental health providers make it more difficult to receive timely care.
Hospital closures are a related factor that limits physician employment options. Over the past 17 years, 124 rural hospitals across the U.S. have closed, and many more have reduced their services.
Social determinants of health
A shortage of healthcare professionals and facilities is compounded by more challenging social determinants of health in rural areas. For example, U.S. poverty rates are higher in rural areas (15%) than in urban areas (12%), and more rural adults (12%) lack health insurance than urban adults (10%).
Additional structural challenges include lower education levels, lower health literacy, longer physical distances to access health care, and a lack of reliable transportation. Add these variables together, and the rural-urban health disparity begins to make sense.
Improving rural healthcare access
Improving rural healthcare access requires policy solutions that address structural barriers. While policies will come from states and the federal government, physicians working in rural areas have essential perspectives on the challenge and potential solutions.
A recent qualitative study asked providers in Pennsylvania what strategies they thought would help overcome barriers for rural patients in need of care. Here are some of some of the solutions they identified.
1. Subsidized services
Government subsidies can reduce the economic burden for rural residents, making healthcare more affordable by covering costs such as insurance premiums and transportation.
Medicaid plays a central role in filling insurance coverage gaps for rural residents. The Health Resources and Services Administration also funds community-based grants to address rural healthcare challenges.
2. Mobile and satellite clinics
Mobile health clinics can bring essential services, such as preventive care and chronic disease management, directly to underserved areas. Satellite clinics provide a similar benefit by offering specialized care on a rotating basis.
Here’s how one provider described a mobile clinic program in their community:
Our community health center recently invested in a mobile clinic they’re taking to certain schools and different places. They bring their vehicle out there and do some visits trying to address those needs for primary care.
3. Telehealth expansion
Telemedicine allows rural patients to access care without traveling long distances. However, expanding internet access is critical to making telehealth more widely available in rural communities.
Given the significant correlation between increasing broadband access and positive health outcomes, the federal government is piloting programs to improve broadband access in rural America.
4. Advanced practice providers
Nurse practitioners and physician assistants can help fill the gap left by the shortage of doctors. Expanding their role and scope of practice in rural areas can significantly increase access to care.
5. Improved ancillary services
Providers simply can’t do it alone. Local areas need investment in ancillary services like medical education, mental health services, and social support. Healthy patients need a suite of services beyond those provided by physicians.
Recommendations for rural providers
If you’re a rural healthcare provider, consider the steps you can take to address your patients’ challenges.
Incorporating telehealth into your practices can help reach more patients, especially for follow-ups or chronic condition management. Focusing on preventive care, such as screenings and health education, can also reduce the need for more intensive treatments later.
Finally, providers can collaborate with local organizations and community resources to address social determinants of health. Like all citizens, doctors can also support policy changes that improve health insurance coverage, expand broadband access, and increase funding for rural health centers.