Health care is lagging in rural America

Hospital closures and a lack of primary and specialty health care providers are causing big problems in rural America.

The US Agency for Health Care Research and Quality (AHRQ) of the US Department of Health and Human Services has just released its 20th annual report on health care quality and disparities. Congress commissioned this study to demonstrate the disparities in care received by people from different socioeconomic and racial groups.

The report describes quality of care in six areas: patient safety, person-centred care, coordination of care, effective treatment, healthy living and affordability of care. It aims to answer the question, “How well does the nation ensure that people actually benefit from scientific advances and effective treatments available today?”

COVID-19 has had a dramatic effect on health measures in this report. It indicates that in 2020, the life expectancy of Americans decreased for the first time because of the pandemic. This decline was greater for the Hispanic and Black population.

Rural Americans disproportionately affected

The percentage of people covered by health insurance has increased significantly over the past decade, although Native American, Alaska Native and Hispanic groups are much less likely to have insurance than other groups. There are more people under the age of 65 with health insurance than ever before, but rural communities, as well as low-income households, minorities and inner-city populations are much less likely to have coverage .

Nearly 63% of all counties in the United States are experiencing a shortage of primary health care professionals to the point that access to services is at risk. Rural counties are disproportionately affected by this shortage compared to their urban counterparts. There are 28 million people living in non-metro counties designated as having a shortage of healthcare professionals.

This trend started before COVID-19. Between 2010 and the start of the pandemic, 135 rural hospitals closed, leaving a gap in services in these areas.

The Government Accountability Office has found that people living in areas where these hospitals have closed have lost access to more than critical, emergency and after-hours care. They also had to travel further afield to access dental, mental health, addictions and obstetrics services.

The report looked at the increase in travel needed for different services after these hospital closures. In 2012, before the shutdowns, the median distance patients had to travel for an emergency department, general hospital care, operating room, intensive care, obstetric care or emergency psychiatry was less than eight kilometers. After the closures in 2018, all of these services were more than 20 miles away. Dental care went from about three miles to nearly 40 miles, and alcohol and drug treatment went from just over five miles to over 40.

Maternal health

Maternal health is affected by location, with higher mortality and morbidity rates among rural patients. Only 6% of all OB-GYNs are located in rural areas, and the ratio of OB-GYNs to population is lower in rural areas than in metropolitan areas. Other factors contributing to maternal health include food insecurity, substance abuse, pollution, and COVID-19.

The report says the Ministry of Health and Human Services has identified maternal health as a national priority and is working to address the higher pregnancy-related mortality rate among rural women. It also says the White House Blueprint for Addressing the Maternal Health Care Crisis outlines the Biden administration’s intentions to address this issue by investing in rural maternal care.

Oral health

The study identified more than 7,000 geographic areas that are considered areas of shortage of dental health professionals, and almost three-quarters of them are rural.

It indicates that children and adults in rural areas are less likely to have had a visit to the dentist in the past year than those in metropolitan areas. This may be linked to data showing that metropolitan residents are consistently more likely year-over-year to have private dental insurance than those in rural areas, although the report shows that lack of local access is a even greater obstacle.

Strategies proposed by several experts to reduce dental workforce shortages in rural areas are shared in the report. These include prioritizing students from rural areas for admission to dental schools including rural dentistry in dental school curricula, recruiting rural dentists and oral care providers dental services through financial and tax incentives or loan forgiveness, to enable primary care providers to provide certain dental services and to enable other healthcare professionals such as dental therapists to provide care oral.

substance abuse

Drug overdose deaths involving synthetic opioids increased at a similar rate between 2018 and 2020, regardless of geographic location.

While opioids are definitely a problem in rural areas, they had the lowest per capita death rate of any geographic classification, regardless of race. In fact, the death rate among non-Hispanic blacks in large urban areas was four times higher than the same group in rural areas.

Best and worst states

When ranked nationally across all care segments, Maine, Massachusetts, New Hampshire, Pennsylvania, Rhode Island, Iowa, Minnesota, North Dakota, Wisconsin, Colorado and Utah had the highest overall scores.

The lowest ranked states were Alaska, Arizona, California, Montana, Nevada, New Mexico, Wyoming, Georgia, Mississippi, Oklahoma, Texas and New York. The District of Columbia also ranked last.

  • READ MORE: Download the full report here.

About Keneth T. Graves

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