To anyone who’s familiar with the rural health care scene, a newly issued report by the UnitedHealth Group’s Center for Health Reform and Modernization doesn’t contain many major surprises about the state of rural health.
According to the report, Americans who live outside urban areas have more chronic health conditions, are more likely to qualify for Medicaid or other subsidized health coverage, and have a harder time obtaining quality care than their city and suburban counterparts. These findings echo other statistics that shape what we currently know about rural health. And they sound an early, urgent alarm for the crunch that looms ahead as more Americans obtain health coverage as a result of the Affordable Care Act.
In reality, though, a gap has been silently widening for many years between rural Americans and the rest of the population.
It’s interesting, although probably coincidental, that the U.S. Census Bureau released new numbers this week showing that the rural population (defined as communities of 50,000 or fewer) has shrunk to an all-time low: just 16 percent of the American total. Jobs and services continue to vanish as the U.S. economy becomes ever more urban-centric.
What this all bodes for rural health care ought to be concerning for anyone who lives in a rural community, as well as to policymakers.
Some statistics for Minnesota and for the U.S. in general, gleaned from the UnitedHealth Group report:
Nearly three-fourths of Minnesota’s population is now considered urban or suburban; 1.41 million Minnesotans, or 27 percent, are rural. There are 76 primary care physicians per 100,000 rural Minnesotans vs. 122 per 100,000 urban and suburban Minnesota residents.
Nationally, rural patients have an average distance of 60 miles between their local primary care clinic and a specialist’s office. And rural doctors are more likely than their city counterparts to believe there will be a shortage of physicians and mid-level clinicians in coming years.
Perhaps one of the most eye-opening findings of the report is this: In a Harris Interactive survey of 2,000 consumers and 1,000 primary care doctors conducted for the report, both groups rated the quality of rural health care lower than urban and suburban respondents did. This could be due to perception and a potential bias in favor of bigger as better. But when UHG delved into some of its own data, the analysis confirmed that in most markets, rural care indeed is measurably lower when it comes to quality.
It’s not clear what to make of this. Is rural health care truly second-rate? After all, this is the second time this month that a group of researchers has studied rural health care and found it lacking; a study in the Journal of the American Medical Association recently gave failing marks to rural hospitals.
Current yardsticks for measuring quality of care might simply be inadequate or inappropriate for rural health. Moreover, rural America is more diverse than a generalized collection of data would indicate. Relatively well-populated rural counties lying just outside a metropolitan area do not have the same challenges as counties that are remote and isolated. Many rural communities have figured out how to deliver health care services that are every bit as good, although less specialized, than those in the suburbs. Others are struggling, though, and their performance may be skewing the data and creating misleading conclusions.
Still, it’s hard to ignore a solid body of evidence that patients who live in rural areas often are shortchanged when it comes to quality health care.
What’s the solution? The UnitedHealth Group report is pinning its hopes on telemedicine to help close the rural health care gap. The report calls for expanding the use of broadband in rural America, restructuring reimbursement to make greater use of telemedicine, and reducing the technological barriers for consumers and health care professionals.
Coincidentally, an organization known as the Internet Innovation Alliance released a report yesterday that outlines 10 benefits of information technology in health care. One of the projected benefits is allowing rural residents “to receive expert diagnosis and treatment from distant medical centers.”
While this all sounds promising, it will more than likely take multiple strategies to strengthen the fabric of rural health care – and one size is not going to fit all.
Furthermore, judging from the growing amount of data suggesting that rural health care doesn’t offer the quality it should, it begs the question: Have policymakers’ efforts to support rural health care focused too much on access, in the belief that available care – even if it’s second-rate – is better than no care at all? It would seem that rural health care deserves a renewed emphasis on quality and positive outcomes. This is a gap that can and ought to be narrowed.
– “Quality Through Collaboration: The Future of Rural Health,” by the Institute of Medicine
– University of Minnesota Rural Health Research Center
– Minnesota Department of Health Office of Rural Health and Primary Care
Photo: Wikimedia Commons