Rural Americans experience different healthcare challenges than those who live in other areas of the country. Read on to explore the issues that rural Americans experience and what can be done to combat these obstacles.
The U.S. Government Accountability Office says over 60 million Americans live in rural areas. Many of those Americans are elderly adults who tend to have more or worse chronic health conditions than those who live in more urban areas. However, those who live in far-flung places also have much more limited access to healthcare, which makes taking care of those conditions even more difficult.
There are many reasons why healthcare is more difficult to obtain in rural areas. One of the biggest hindrances is the lack of transportation; rural areas are known for having sparse or even non-existent public transportation options. Other factors include the lack of a reliable internet connection, a dearth of healthcare workers, and difficulty finding and affording health insurance.
November 21st brings National Rural Health Day, a great time to learn about the potential solutions to the healthcare problems that plague rural communities and the rural healthcare workers who go above and beyond to meet the challenges head-on. Continue reading to dive into the reasons why healthcare is such an issue in rural areas and what can be done about it.
Access to Healthcare Services is Limited
Rural communities are often rather isolated from the rest of the world. While this can create a peaceful atmosphere, it can also create serious barriers to getting the help a person needs. Access to healthcare can be scarce, requiring those who live in rural areas to travel long distances to see a primary care physician and even further to see a specialist.
Emergency care is even more fraught with concern, as the nearest full-time emergency department can be many miles from more rural areas. That’s especially true since over 100 rural hospitals closed between 2013 and 2020. Residents in those areas now travel at least 20 miles further to find basic care and 40 miles further to find specialty care.
Bring in More Healthcare Options
When access is limited, healthcare must go to where the people are. That might mean school-based services that provide immunizations for students or healthcare clinics set up in supermarkets or town squares on busy weekends. Screening tests for everything from low vision to diabetes to high cholesterol can be easily performed at libraries, community centers, and churches.
Improving telehealth access is a boon for rural communities, as this allows those who can’t travel to get the help they need from the comfort of home. For areas where internet connections are scarce in homes, a central location such as a dedicated area of a community center with computers set up for use and privacy screens in place to protect private information could work well.
Barriers to Mental Health Services
Obtaining mental health services is difficult across the nation, thanks to the lack of providers versus the high number of those seeking services. The problem is much more pronounced in rural areas where the number of mental health providers is even lower than in other parts of the country. In fact, 65% of rural counties don’t have a psychiatrist.
This matters even more because the occupations that historically lead to higher rates of suicide are often found in rural areas. The industry group with the highest suicide rate is mining and quarrying, both of which are more commonly found in less-populated areas. High rates of suicide are also found among construction, agriculture, forestry, fishing and hunting, and automotive repair workers, also common occupations for those living in rural areas.
Some insurance companies don’t cover mental health services, requiring patients to pay out of pocket when they see a therapist. This is something many in economically disadvantaged areas simply can’t afford. All these factors combine to create a perfect storm that leaves struggling individuals at risk.
Turn to Telehealth or Sliding Scale Options
Telehealth services for mental health have exploded in recent years, allowing those with a reliable internet connection – or even those who simply have reliable phone service – to access the care they need. Those who don’t have reliable internet at home can use it in public areas such as libraries, but they also need a dedicated space to have privacy during therapy sessions.
Getting therapy begins with reaching out, so it’s important to make resources available everywhere people congregate. Government offices, libraries, and grocery stores can display information on mental health services, particularly through telehealth, with instructions on how to obtain assistance.
When it comes to insurance not covering mental health services, there are many clinics (including those that work via telehealth) that provide assistance on a sliding fee scale. Some therapists might even offer group sessions in the community for a token cost or for free.
Difficulty of Chronic Disease Management
A wealth of problems – including a lack of providers willing to work in the area or difficulty with travel on rural roads in inclement weather – can make healthcare access even tougher. If someone has ongoing medical conditions that require regular care, the costs of making the trek to a more urban area, and thus more doctors, can quickly add up.
This lack of access to help with chronic disease, according to the CDC, can have deadly consequences. Those living in rural areas are much more likely to die early from the leading causes of death in the nation than those who live in more populated areas. Cancer, heart disease, strokes, and chronic lower respiratory diseases are among the killers more likely to strike those in rural areas.
Get the Word Out
Preventative care and screenings become much more important in areas where access to healthcare is so limited. Patient education programs through local health departments, partnered with local agencies and organizations, can help get the word out about symptoms to watch for and how to know chronic conditions are worsening. Educating about the advantages of lifestyle changes can help as well.
Telehealth again rises to the top as a potential solution for those who have difficulty getting to the doctor regularly. Community organizations can help with this by ensuring a strong internet connection and a place where patients can go to access telehealth.
For those who need more attention and hands-on assistance, traveling nurses might be the answer. These healthcare workers move from one location to another to bolster current healthcare facilities or venture to rural areas to provide health clinics, immunizations, and more.
High Cost of Health Insurance
Health insurance rates are high enough to price many people out of even the more “affordable” options, and that is especially true in economically depressed areas of the country. Though elderly residents across the nation often qualify for Medicare, finding providers in those rural areas can be a challenge. The effects of continued inflation put the squeeze on all of America, with the rural areas feeling it the most, and that can lead to dropping health insurance for the sake of necessities like food and clothing.
Even affordable premiums don’t help much when deductibles are in the thousands and co-pays tend to be rather high. Insurance becomes a matter of covering a person for emergencies, not necessarily for making the management of chronic health conditions more affordable.
Provide Sliding Scale Clinics and Government Assistance
Clinics that provide care on a sliding fee scale can be a good boost to health in rural areas. They can partner with community outreach organizations to provide basic healthcare necessities, such as screening for diabetes or providing flu shots, for free or at no cost. Cutting down on the costs of healthcare services helps more people obtain them without having to pay the hefty co-pays required by most insurance companies.
Health insurance incentives, such as rebates and tax credits, are potential solutions that are implemented by the government and then trickle down to help residents. In some cases, insurance through the Health Insurance Marketplace costs very little for those who make below a certain income. Some of those individuals might also be eligible for Medicaid coverage. Regularly evaluating residents for their eligibility can be a huge help to those who do qualify.
Lack of Transportation
Many rural areas don’t have public transportation, and if they do, it runs on a skeleton schedule that makes it almost impossible to find a way to get to the doctor for an appointment that isn’t on that particular schedule. Some rural areas can be difficult to leave even if you have a vehicle, especially during times of inclement weather. For instance, some mountain roads might be impassable during winter storms, a problem can persist for weeks or even months.
There is also the unique problem of not having enough hospitals in the area, and this means no emergency departments. That’s one reason why those in rural areas are much more likely to die of unintentional accidents than those who are in more populated places.
Provide Government Improvements to Infrastructure
Though rural areas might see some assistance in the form of ride shares like Uber or Lyft, these options can be rather expensive, especially if someone must travel a long distance to get the care they need. Those who are disabled or have mobility challenges might find that there are no vehicles that meet their unique needs available in rideshare apps.
Government help is crucial in expanding bus routes and other transit systems. Local organizations can provide volunteer drivers, but they are often beholden to tight budgets and navigating inclement weather. Investments in infrastructure are also a must, as many rural roads suffer the consequences of too little tax money and too many harsh elements. While residents turn to neighbors, family members, and volunteers for rides, it’s important to make their voices heard and push their representatives to advocate for more transportation initiatives to benefit local areas.
Little to No Infrastructure for Telehealth
Telehealth seems like an obvious solution for those who can’t get to the doctor in person. While telehealth can provide excellent care for those suffering from acute conditions or those who need simple ongoing care for chronic conditions, the problem lies in actually obtaining the services.
An internet connection that is too slow (or non-existent) can mean that those who want to use telehealth simply cannot. Pew Research says that three in ten rural residents don’t have an internet connection at home. Those that do are often plagued with outages, especially during times of inclement weather. The pricing for internet service can be steep, and those who don’t qualify for assistance might find that the financial burden of keeping the service is just too much.
Expand and Improve Internet Access
Improving internet access in rural areas should be a top priority, one that is taken up by local and state governments. Even those who do have access to the internet must have access to a device on which to use it, and that often stretches the already strapped incomes of many in rural areas. Offering low-cost devices and teaching individuals how to use them can boost access to telehealth.
Another option is to partner with community organizations to create access points for internet use. Libraries across the nation do this already but preparing for telehealth options means providing a private space where individuals can meet with their doctors without any interruption or distractions. These access points must also offer set hours so residents can confidently make appointments with their healthcare providers.
Shortage of Healthcare Workers
Getting healthcare workers to rural areas has been a problem for many decades. With a nursing shortage across most of the nation and other healthcare workers moving into new lines of work since the COVID epidemic ravaged the nation, finding healthcare workers for rural areas has become even more challenging.
While some workers come back home to their rural communities to be close to family and friends and to give back to the place that raised them, there simply aren’t enough of these individuals to go around. Therefore, enticing healthcare workers into rural areas is the key to ensuring better health for residents.
Provide More Incentives and Expand What Healthcare Workers Can Do
Local and state governments can provide more incentives for healthcare workers to come to rural areas. Forgiving student loan debt is a powerful way to ensure that workers come to designated rural areas and work for a set number of years. Hospital systems can also provide incentives like offering to pay for a higher degree or providing a living stipend, but cash-strapped systems might find this challenging.
One exciting solution is to allow healthcare workers already in the area to expand the scope of their practice. For instance, allow some certified nurse aides to administer medications. Give nurse practitioners the ability to do what a doctor does, including order tests, write prescriptions, and serve as a primary care physician. This expansion is becoming especially common in rural areas where physicians can sometimes be very difficult to find.
Healthcare Resources for Rural Americans
Advancing Health Podcast
This podcast from the American Hospital Association covers topics of interest to those in specific areas, including those in rural parts of the country.
FindHelp
Start with your zip code to find low-cost and free programs, including resources for healthcare. You might also be able to find help with prescriptions and other financial assistance.
Rural Health Information Hub
Find lists of state resources in this hub as well as an online library with thousands of articles and informative guides and a call center to help with whatever you can’t find online.
National Rural Health Association
Learn more about the various opportunities and initiatives happening in rural areas, including information on programs and advocacy.
USDA Rural Development
The U.S. Department of Agriculture allows you to search by state or program to find anything that you or your community might qualify for, and many programs focus on healthcare.
Affordable Connectivity Program
The Federal Communications Commission offers broadband internet for those who are of low income and live in disadvantaged areas. This is paused while waiting on new funding from Congress, so keep checking back to see when it goes live again.
National Association of City and County Health Officials
This directory of local health departments can guide you to local services like immunizations, screenings, traveling healthcare providers, and much more.
Rural Minds
Intending to close the devastating gap between rural areas and mental health services, Rural Minds provides fact sheets and other information on mental health.
Health Insurance Marketplace
The Affordable Care Act provides a Marketplace where Americans can find affordable health coverage and see if they qualify for tax credits that make the coverage even more accessible.
Rural Partners Network
Browse this site to discover funding specifically for those in rural areas. Healthcare is included, but you can also find assistance with other things (e.g., home modifications for the disabled or elderly) that can improve your health and safety.
