Need health care, will travel

There’s a perception that if you live in a rural community, you have less access to health care.

But this assumption may not be entirely true, as a recent study by the Blue Cross Blue Shield of Tennessee Health Institute recently discovered.

The study, which was based on BCBS of Tennessee’s own claims data, found that nearly half of rural residents opted to go to an urban health center rather than the hospital closest to their home.

Dr. Steven Coulter, president of the Blue Cross and Blue of Tennessee Health Institute, told The (Nashville) Tennessean, “The conclusion that we came to is that we’re living in a very mobile society, and the distance is not necessarily a determinant factor in whether people get care or not.”

He added, “They drive farther to get the services, but they do get the services.”

The study makes some interesting observations but it opens the door to many more questions.

Why do rural residents travel for care? Is it to receive services that genuinely aren’t available at a smaller facility, or is it because they perceive, fairly or not, that their hometown hospital won’t have the care they need? The study didn’t look at this, and it would be enlightening to know.

What does the patient’s willingness to travel imply for rural hospitals? Perhaps they just need to do more marketing and community education about what they can offer. Then again, perhaps they’ve become out of touch with local needs and ought to reassess the services they’re providing.

This would be the simple answer. The reality is more complex and comes down to the fact that smaller rural hospitals operate with a different set of dynamics than urban centers: smaller population base, less revenue and less ability to be all things to all people.

The Tennessean considers what the impact of traveling patients might be:

The pattern isn’t new, but it raises questions about the viability of rural hospitals, some of which often don’t have the money for capital-intensive technology and services.

However, a recent increase in alliances between rural hospitals and larger hospitals and urban health systems does raise hopes that non-urban hospitals may be able to expand their menus of services.

The Tennessee Health Institute study contains another catch with some even larger implications: It only included consumers who were commercially insured through Blue Cross and Blue Shield  - in other words, those most likely to be employed and to have access to reliable transportation.

Do people covered by Medicaid or Medicare – mainly the poor and/or elderly – or who are uninsured also travel for care? Some studies suggest the average older American outlives his or her ability to drive by six years, making transportation a significant issue for older people who live in rural communities and need access to health care. And for the rural poor or uninsured, access to health care may not simply be a matter of choosing between local services and driving to an urban center; it might be the difference in whether they receive appropriate, timely care at all.

It argues for the importance of shoring up rural hospitals that frequently act as the community safety net. Although consumers are increasingly being urged to “shop” around for care, there are still many who can’t or won’t do this. Furthermore, there may also be times when care that’s close to home is as good as – or maybe even better than – care that’s delivered at a larger city hospital. When it comes to rural hospitals and rural health care consumers, it seems we shouldn’t make too many assumptions.

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