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Healthcare lags in rural America

Hospital closings and a lack of primary and specialty healthcare providers are causing big problems in rural America.

The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ) has just published its 20th annual National Healthcare Quality and Disparities Report. Congress mandates this study to demonstrate disparities in care received by those in different socioeconomic and racial groups.

The report outlines quality of care in six areas: patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. It aims to answer the question, "How successfully does the nation ensure that people actually benefit from the scientific advancements and effective treatments available today?"

COVID-19 had a dramatic effect on health measures in this report. It says that in 2020, life expectancy for Americans decreased for the first time ever because of the pandemic. That decline was greater for  the Hispanic and Black population.

Rural Americans disproportionately affected

The percentage of those covered by health insurance has increased greatly over the past decade, although American Indian, Alaska Native, and Hispanic groups are much less likely to have insurance than other groups. There are more people under age 65 with health insurance than ever before, but rural communities, along with low-income households, minorities, and inner-city populations are significantly less likely to have coverage.

Nearly 63% of all counties in the U.S. are seeing a shortage in primary healthcare professionals to the extent that access to services is threatened. Rural counties are disproportionately affected by this shortage compared with their urban counterparts. There are 28 million people living in non-metropolitan counties designated as having a shortage of healthcare professionals.

This trend started before COVID-19. Between 2010 and the start of the pandemic, 135 rural hospitals closed, leaving a gap in services in those areas.

The Government Accountability Office found people living in areas where these hospitals closed lost access to more than just critical, emergency, and after-hours care. They also had to travel farther to access dental, mental health, substance abuse, and obstetric services.

The report examined the increased travel required for different services after these hospital closures. In 2012, before the closures, the median distance patients had to travel for an emergency department, general inpatient care, operating room, intensive care, obstetric care, or emergency psychiatry was under five miles. After the closures in 2018, all of those services were more than 20 miles away. Dental care went from around three miles to nearly 40 miles, and alcohol and drug treatment went from just over five miles to more than 40. 

Maternal health

Maternal health is affected by location, with higher mortality and morbidity rates among rural patients. Only 6% of all OB-GYNs are located in rural areas, and the ratio of OB-GYNs to the population is lower in rural than metropolitan areas. Other factors contributing to maternal health include food insecurity, substance abuse, pollution, and COVID-19. 

The report says the Department of Health and Human Services has identified maternal health as a national priority, and is working to address the higher pregnancy-related mortality rate among rural women. It also states the White House Blueprint for Addressing the Maternal Health Care Crisis outlines the Biden administration's intentions to address this issue through investments in rural maternal care.

Oral health

The study has identified more than 7,000 geographic areas that are considered dental health professional shortage areas, and nearly three-quarters of those are rural.

It says children and adults in rural areas are less likely to have had a dental visit in the past year than those in metropolitan areas. This may be related to the data showing metropolitan residents are consistently more likely year-over-year to have private dental insurance than those in rural areas, although the report shows a lack of local access is an even greater barrier.

Strategies proposed by several experts for reducing dental workforce shortages in rural areas are shared in the report. They include prioritizing students from rural areas for admission to dental schools, including rural dentistry in dental school curricula, recruiting rural dentists and oral healthcare providers through financial and tax incentives or loan forgiveness, enabling primary care providers to offer some dental services, and enabling other health professionals like dental therapists to provide oral healthcare.

Substance abuse

Drug overdose deaths involving synthetic opioids grew at a similar rate between 2018 and 2020 regardless of geographic location. 

While opioids are definitely a problem in rural areas, they had the lowest death rate per capita of all geographic classifications, regardless of race. In fact, the death rate among non-Hispanic Black people in large urban areas was four times as high as the same group in rural areas.

Best and worst states

When ranked nationally across all care segments, Maine, Massachusetts, New Hampshire, Pennsylvania, Rhode Island, Iowa, Minnesota, North Dakota, Wisconsin, Colorado, and Utah had the highest overall scores.

The lowest ranked states were Alaska, Arizona, California, Montana, Nevada, New Mexico, Wyoming, Georgia, Mississippi, Oklahoma, Texas, and New York. The District of Columbia also ranked in the bottom tier.

  • READ MORE: Download the full report here.
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