Of the many issues in healthcare, 1 of the most problematic is access.

For both men and women, rural healthcare continues to be lacking in both quantity and quality. Many people in rural areas find that locating a qualified physician for even their most basic needs is nearly impossible, and specialists are even scarcer.

Rural areas face unique issues that are driving this scarcity of healthcare. In 2009, a paper published by the Center for Rural Affairs listed the following as the top 10 unique issues facing rural healthcare.

1. An economy based on self-employment and small business

These types of employment offer less stable income and less affordable access to quality rural healthcare. Often employees are forced to make difficult decisions regarding insurance and may not be able to cover premiums. Because towns are small, any ripple in the daily economic pond can quickly turn into a tidal wave, and insurance is often the 1st thing eliminated when times get tough.

2. Large population dependent on public health insurance

More people in rural areas are in need of public assistance programs such as Children’s Health Insurance Programs (CHIP), Medicare, and Medicaid. The number of rural residents in need of these programs has increased by 122% since 1987, and 33% more people are covered in rural settings when compared to the number of urban recipients of aid. There are more people taking a slice of the same pie, and revenue may not keep pace with demand.

3. Not enough physical space and supplies

There are often not enough facilities to support the number of patients in rural areas, and hospitals and small physicians struggle to keep equipment up to date. A single facility may serve a large area, and lack of transportation may be an issue when seeking healthcare.

4. Shortage of doctors, nurses, and other rural healthcare providers

Close to 82% of counties in rural areas are considered medically underserved, with only 9% of the nation’s doctors choosing to practice in rural areas. Even fewer medical school grads go rural; only 3% practice in areas outside of the city and suburbs.

5. Aging rural population

Due to migration of young people back to the cities and the suburbs, the rural population is getting older. These older patients present complicated medical needs to the doctors who serve them, taxing both doctors and facilities.

6. A generally sick population, amplified

The health of the nation is fading in general, but in rural populations, the decline is pronounced. Diabetes, arthritis, hypertension, asthma: these conditions affect rural populations in greater numbers than their urban and suburban counterparts. The rate of disability due to these conditions is also higher because rural citizens are less likely to receive regular check-ups and health monitoring.

7. Lack of preventative medical care

New reforms brought about by the Affordable Care Act make preventative check-ups and treatments free, but with the lack of facilities or doctors to provide them, many rural residents pass them up. Additionally, the lack of education about the importance of nutritious eating and healthy exercise results in a population that is overweight and suffering from malnutrition at the same time.

8. Few, if any, mental health services

There is a vast difference in the amount of services available for rural people suffering from mental illness. Over half of all counties in the U.S. don’t have even 1 mental health specialist. The link between mental and physical health is well-established: those suffering from mental illness tend to also suffer from other physical conditions, such as chronic pain or obesity.

9. Reliance of medicine on technology

As hospitals and clinics move to electronic medical records and access to second opinions via Skype and other online services, rural areas struggle to maintain fast internet connectivity to utilize these tools. Any technology that is utilized needs to be maintained, and the lack of financial resources in rural areas forces doctors to choose between updating medical equipment and staff or maintaining computers. Often, technology is the last thing to be funded.

10. Need for more effective emergency medicine

Lack of funds and people play a critical role in the quality of emergency medical services (EMS). EMS workers must now have more knowledge than ever for rural healthcare, providing a wider range of services for less money. The lack of technology in rural areas cuts EMS workers off from medical records and doctors—2 crucial pieces of the puzzle when responding to emergencies.

Some studies have found that the lack of rural healthcare is especially hard on women, who are more likely than their urban counterparts to suffer from depression and anxiety. An article published by researchers in Penn State reported findings that many primary care physicians in rural areas were taxed with providing mental health services to their patients, and they were not comfortable in that role. 1 of the primary care physicians in the article noted that “

[they] do a lot of psychiatry in [their] practice that [they] really wish [they] didn’t have to do, but [they] do it because someone’s got to do it.”

So where can you go to find good rural healthcare?

The solution may be to re-evaluate what healthcare means. Patients are spending less time in the hospital than they used to, so continuing to focus on maintaining outdated hospital infrastructures may not be the answer.

Rural areas are getting creative with what they have, focusing more on education of residents to improve overall health and creating smaller outpatient clinics to treat illness when it arises.  Some communities are focusing on improving their emergency medical services instead of expanding little-used emergency rooms, taking the medical services into the field. Advocates for laws that expand subsidized healthcare have been very vocal to ensure that the particular concerns of rural healthcare are heard.

Videoconferencing is 1 way for rural doctors to consult with specialists all over the country. With a clear internet connection, this technology invites a 2nd opinion into the examination (or operating) room and broadens the scope of services a rural physician can offer.

Tell us what you think about this videoconferencing option as a way to provide more comprehensive rural healthcare!

Image by Orin Zebest via Flickr


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