We’ve known for a long time that delivering and accessing healthcare presents certain challenges for both patients and providers in rural areas. This results in health disparities, which the NIH defines as “differences in the incidence, prevalence, morbidity, mortality and burden of diseases and other adverse health conditions that exist among specific population groups.”
The American Hospital Association (AHA) has renewed its commitment to ending healthcare disparities through its #123forEquity Pledge to Act Campaign. More than 700 hospitals to date have signed on, pledging to take action by implementing at least one quality measure that is based on race or some other social determinant of health. Yet rural hospitals are fighting health disparities against very high odds.
The Washington Post recently ran a lengthy report, titled “A New Divide in American Death,” which analyzes rural health disparities in depth. The article states:
The Post’s analysis, which builds on academic research published last year, shows a clear divide in the health of urban and rural Americans, with the gap widening most dramatically among whites. The statistics reveal two Americas diverging, neither as healthy as it should be but one much sicker than the other… Progress for middle-aged white Americans is lagging in many places — and has stopped entirely in smaller cities and towns and the vast open reaches of the country.
For those who live in rural counties, there are major barriers to accessing healthcare. These include:
- Too few healthcare providers. While between 20 and 25 percent of the U.S. population lives in rural areas, only ten percent of physicians choose to live and practice there, presumably because they can make more money in cities. There are fewer dentists as well, and some rural counties lack mental health services completely.
- Reduced access to emergency care. Response times are longer and many first responders, like firefighters and paramedics, are volunteers only. Perhaps because of this, two-thirds of motor vehicle deaths occur on rural roads, and rural populations are also twice as likely as their urban counterparts to die of other types of accidental injuries.
- Reduced insurance coverage. Rural people, particularly those who farm, are far less likely to have employer-sponsored health benefits or be covered by Medicaid. Coupled with the fact that rural residents tend to have lower incomes, many of them simply cannot afford healthcare, even if services are available.
- Geographic barriers. Wide open spaces and lack of public transit meant that rural residents may have to drive great distances to access any point of the care delivery system. Since rural clinics are small and offer limited services, rural people often have to travel to the closest city for specialized services like cancer treatment.
- Chronic disease is common. Rural residents suffer from higher rates of obesity, hypertension, diabetes, and cardiovascular disease. Alcohol abuse and tobacco use rates are higher, particularly among youth. And Medicare patients who are treated for heart attacks in rural hospitals are less likely to receive recommended treatments than those treated in urban hospitals, and are more likely to die within 30 days.
Perhaps the most promising tool we have to eliminate health disparities and bring much needed services to rural areas is telemedicine. According to a 2014 article from Modern Healthcare, titled “Wiring in Rural Patients,” there are now over 200 telemedicine networks that connect large regional health centers to about 3,000 rural health centers for specialized services—including stroke treatment by neurologists and ICU care by intensivists. Telemedicine is expanding and health policy is evolving to remove regulatory barriers—for example, Medicare and Medicaid just started covering telehealth treatments for chronic diseases in January, 2015. As private insurers follow suit, there will likely be increased demand for nurses with telehealth experience. If you’re interested in moving into telenursing, you’ll need a strong clinical background, coupled with the ability to communicate with and assess patients without seeing them in person. An online RN-to-BSN degree is the perfect way to build critical thinking skills. American Sentinel University is an innovative, accredited provider of online nursing degrees.