Rural communities face many obstacles to accessing quality healthcare. Economic factors, cultural and social differences, educational shortcomings, and the isolation of living in remote areas all conspire to create health care disparities and struggles for rural Americans to lead normal, healthy lives.
According to the National Rural Health Association, rural Americans make up at least 15 to 20% of the U.S. population.
“When you don’t get your health care taken care of, you wind up with disease presentations that are much farther along. People with cancer show up with metastatic cancer, people with diabetes show up with end-organ damage,” said Joseph Florence, MD, professor of family medicine and director of rural programs at Eastern Tennessee State University Quillen College of Medicine.
The National Organization of State Offices of Rural Health, discusses four social determinants of health in rural areas below.
Rural Americans travel farther for access to healthcare than their urban counterparts and are more likely to lack access to public transportation to meet their needs. Lack of transportation can have a significant impact on health and on the ability to make healthy lifestyle choices, such as regular physical activity, access to healthcare, access to steady, well-paying jobs, and ability to purchase healthy foods.
A growing body of scientific evidence shows that low-quality or inadequate housing can harm the health of individuals. Health risks associated with poor housing include: respiratory and cardiovascular diseases from indoor air pollution, illness and deaths from temperature extremes, accelerated spread of communicable diseases, and risks of at-home injuries.
Educational attainment has a direct impact on an individual’s health, as those with lower education levels are less likely to receive health screenings and prevention services, have higher risks of hospitalization, and have an overall poorer health status.
There are many difficulties in achieving access to healthy foods in rural areas either due to availability or cost. Rural American households are more likely than other areas to be food insecure, with households including children being even more food insecure.
When it comes to transportation solutions, WellCare has contracts with non-emergency medical transportation (NEMT) services and help Medicaid members get to, and keep, their medical appointments. They also help reimburse some family members who help address transportation shortages by taking their loved ones to medical appointments.
Telehealth is a useful tool for reaching rural populations on Medicaid and increasing access to urgent care and specialty services. From blood pressure monitoring to medication management to behavioral health treatment, connecting via a computer or tablet allows us to be more efficient, overcome issues of distance and address physician shortages.
Freestanding Emergency Departments (FSEDs) are a new and growing solution for providing medical care to rural populations. FSEDs are defined by the American College of Emergency Physicians (ACEP) as a “facility that is structurally separate and distinct from a hospital and provides emergency care. FSEDs remain open 24/7 and include an emergency department, imaging, and on-site lab.
Community paramedicine is another relatively new and evolving healthcare model. It allows paramedics and emergency medical technicians (EMTs) to operate in expanded roles by assisting with public health and primary healthcare and preventive services to underserved populations in the community.
There have been strides made toward improving rural healthcare, but there is still much work to be done.