Health Care in Rural America
Digg This!As we work on future podcasts, we think it is important to share some of the information we are looking at. In the next weeks we shall be doing a series of podcasts about Health Care Disparities. My co worker Sue Kettner shared this report with me, and I thought I would share it with you.
Introduction
Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Hard Times in the Heartland provides insight into the current state of health care in rural areas and the critical need for health care reform.
Health Care and the Rural Economy
High poverty rates and job loss in the current economic
recession highlight the challenges of accessing health care
and rising health care costs in rural areas.
Rates of poverty are higher, with 15% of people in rural areas
living below the poverty level compared to 12% of people in
urban areas.1
The rural economy is dominated by small businesses,
which are struggling as the cost of health care continues to skyrocket.
In the current recession, the rural economy is losing jobs
at a faster rate than the rest of the nation, and loss of jobs
can lead to loss of health coverage. In particular, rural
communities dependent on manufacturing have lost nearly
5% of their jobs since the recession began – and these are jobs
that offer some of the best benefits.3
Limited Coverage and Burdensome Costs
Many rural residents work part-time, seasonally, or for
themselves, making them less likely to have private,
employer-sponsored health care benefits.
A multi-state survey of farm and ranch operators found that
while 90% of farmers have insurance coverage, one-third
purchased it directly through an insurance agent (compared
to the national average of 8%).4
Nearly one in five of the uninsured – 8.5 million people –
live in rural areas. This problem is worse for rural minority
populations, the rural poor, and those with less than a high
school education.5
Rural residents spend more on health care out of pocket
than their urban counterparts. Indeed, one in five rural
residents spends more than $1,000 out of pocket in a year,6
and rural residents pay on average for 40% of their health
care costs out of their own pocket, compared with the urban
share of one-third.7
The high costs of health care hit farmers particularly hard.
In a multi-state survey, one in five insured farmers had
medical debt,8 and in one state, farmers who purchased an
individual health plan spent an average of $2,117 more than
their colleagues who were able to purchase through a group
plan.9
As a result, rural adults are more likely than urban adults
to report having deferred care because of cost (15%
versus 13%). This problem is worse among rural minority
populations, who are twice as likely to have deferred care in
the past year as rural whites.10
The Need for More Health Care Providers
Along with comprehensive and affordable coverage,
access to high quality providers is also a key component
of obtaining high quality care. Rural areas continue
to suffer from a lack of diverse providers for their
communities’ health care needs.
There were 55 primary care physicians per 100,000
residents in rural areas in 2005, compared with 72 per
100,000 in urban areas. This decreases to 36 per 100,000 in
isolated, small rural areas.11
There were half as many specialists per 100,000 residents in
rural areas compared with urban areas, and a third as many
psychiatrists.12
For persons of all ages who visited their usual care provider,
travel time was longer for rural than for urban patients.
Fourteen percent of rural patients traveled more than 30
minutes, while only 10% of urban patients did so.13
The problems of a thin provider workforce can be expected
to worsen if action is not taken. Rural areas have a higher
percent of physician generalists nearing retirement than
urban areas, and recruitment and retention continue to be a
challenge.14
Disparities in Health Need To Be Addressed
A scant provider network, lack of adequate and affordable
health coverage, and difficulty accessing high-quality care
can lead to worse health among rural populations.
The percentage of diabetes patients who received all three
recommended exams for diabetes is lower for patients in rural
areas than in metropolitan areas (32% versus 42%). Perhaps
as a result, rates of admissions for uncontrolled diabetes are
higher among residents of rural areas.15
Rural women are less likely than urban women to be in
compliance with mammogram screening guidelines (71%
versus 78%), and are less likely to have had a pap smear done
within the past three years (86% versus 91%).16
Rural residents are more likely to report fair to poor health
status than urban residents,17 and are more likely to have
experienced a limitation of activity caused by chronic
conditions than urban residents.18
Obesity is more common among rural residents (27%) than
urban residents (24%), as are diabetes,19 heart disease, and
high blood pressure.20
Comprehensive health reform is needed to bring affordable,
high quality health care to these populations that need it
most.
Sources
Report Prepared By
Meena Seshamani, MD, PhD
Joan Van Nostrand, PhD
Jenna Kennedy, BA
Carrie Cochran, MPA
Analysis and support provided by the Rural Health Research Centers
Report Production by the HHS Web Communications and New Media Division
1 DeNavas-Walt, C., Proctor, B. D., and Smith, J. C. (2008.) U.S. Census Bureau. “Current
Population Reports, P60-235, Income, Poverty, and Health Insurance Coverage in the United
States: 2007.” Washington, DC: U.S. Government Printing Office.
2 Ziller, E. C., Coburn, A. F., & Yousefian, A. E. “Out-of-pocket health spending and the rural
underinsured.” Health Affairs, Nov/Dec 2006; 25(6), 1688-1699. See also “Helping the Bottom
Line: Health Reform and Small Business” (2009). U.S. Department of Health and Human
Services. http://www.healthreform.gov/reports/helpbottomline/
3 Drabenstott, Mark and Moore, Sean. (March 2009). “Rural America in Deep Downturn: A RUPRI
Rural Economic Update.” RUPRI Center for Regional Competitiveness: Kansas City, MO.
4 The Access Project. (Sept. 2007). “Issue Brief: 2007 Health Insurance Survey of Farm and Ranch
Operators.” http://www.accessproject.org/adobe/issue_brief_no_1.pdf
5 Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality,
Medical Expenditure Panel Survey, 2006.
6 Ziller, E. C., Coburn, A. F., & Yousefian, A. E. “Out-of-pocket health spending and the rural
underinsured.” Health Affairs, Nov/Dec 2006; 25(6), 1688-1699.
7 Ziller, E. C., Coburn, A. F., & Yousefian, A. E. “Out-of-pocket health spending and the rural
underinsured.” Health Affairs, Nov/Dec 2006; 25(6), 1688-1699.
8 The Access Project. (Sept. 2007). “Issue Brief: 2007 Health Insurance Survey of Farm and Ranch
Operators.” http://www.accessproject.org/adobe/issue_brief_no_1.pdf
9 Dohogne, Aaron. (Sept. 2008). “Survey recommends remedies for farmers’ high insurance rates.”
The Missourian. http://www.columbiamissourian.com/stories/2008/09/26/missouri-farmers-
paying-more-individual-healthcare-insurance/
10 Bennett, K. J., Olatosi, B., & Probst, J.C. (2008). “Health Disparities: A Rural – Urban Chartbook.”
South Carolina Rural Health Research Center.
11 Fordyce MA, Chen FM, Doescher MP, Hart LG. (2007). 2005 physician supply and distribution in
rural areas of the United States. Final Report #116. Seattle, WA: WWAMI Rural Health Research
Center, University of Washington.
12 Fordyce MA, Chen FM, Doescher MP, Hart LG. (2007). 2005 physician supply and distribution in
rural areas of the United States. Final Report #116. Seattle, WA: WWAMI Rural Health Research
Center, University of Washington.
13 Agency for Healthcare Research and Quality, 2006 Medical Expenditure Panel Survey.
Calculations By Maine Rural Health Research Center.
14 WWAMI Rural Health Research Center. Aging of the rural generalist workforce. Seattle, WA:
WWAMI Rural Health Research Center, University of Washington; in press.
15 Health Care in Urban and Rural Areas, Combined Years 2004-2006. Update of Content in MEPS
Chartbook No. 13. Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.
gov/data/meps/chbook13up.htm
16 Bennett, K. J., Olatosi, B., & Probst, J.C. (2008). “Health Disparities: A Rural – Urban Chartbook.”
South Carolina Rural Health Research Center.
17 Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality,
Medical Expenditure Panel Survey, 2006.
18 Bennett, K. J., Olatosi, B., & Probst, J.C. (2008). “Health Disparities: A Rural – Urban Chartbook.”
South Carolina Rural Health Research Center.
19 Bennett, K. J., Olatosi, B., & Probst, J.C. (2008). “Health Disparities: A Rural – Urban Chartbook.”
South Carolina Rural Health Research Center.
20 Pleis JR, Lethbridge-Çejku M. Summary health statistics for U.S. adults: National Health Interview
Survey, 2006. National Center for Health Statistics. Vital Health Stat 10(235). 2007.
