When it comes to health care, people in rural areas face tougher odds that those in urban or suburban areas. The farther away you live from a big city, the more likely you are to be uninsured. Rural areas present unique health care challenges, described in a new issue brief from the Alliance for Health Reform, Rural Health and Health Reform.
Coverage. According to the issue brief, the average uninsurance rate in rural areas is 23 percent. (Nationally, it was about 15.3 percent in 2007, although that has probably risen during the recession.) Rural people are more likely to be unemployed, and more likely to work for a small business or be self-employed -- which means that on average, they make less money and have more difficulty getting insurance coverage. Almost one-third of all people living in rural areas are covered through public programs. Part of the reason for this is that people in rural areas experience higher rates of poverty (thus increasing the number eligible for Medicaid). Additionally, 27 percent of children in remote rural areas rely on Medicaid coverage.
Access. People living in rural areas are more likely to struggle to find a care provider -- and even those who have a reliable source of care often face higher out-of-pocket costs, so they’re more likely to defer needed care due to cost issues. A ‘health professional shortage area’ means there are not enough health professionals to meet the needs of the population, specifically in terms of primary, dental, and mental health care. According to the issue brief, 77 percent of rural areas are considered primary health professional shortage areas, and one in ten rural areas do not have any primary care doctors at all. The shortage of local care providers means that many rural patients must travel long distances to see their doctors -- even for emergency care.
Aging population. Rural people are more likely to be elderly (over 15 percent were over 65 in 2007, compared to 12.4 percent nationally). Many residents are disabled, and dually eligible in Medicare and Medicaid. The challenge of meeting the health needs of rural populations -- especially in primary care -- is exacerbated by the higher rates of chronic disease and disability present in the aging population.
So how can health reform help improve rural health? The issue brief touches on a few areas of improvement:
Coverage expansion. In rural areas, Medicaid is an important source of funding for care providers, accounting for about 20 percent of patient revenue for physicians. Health reform will expand Medicaid eligibility and reach more low-income Americans. Many small businesses in rural areas will be helped by the Senate bill’s sliding scale tax credit to help small firms purchase health insurance for their employees, or the House provision that firms with a payroll under $250,000 don’t have to pay for employee health care coverage. Health reform will make it easier for many rural residents to access preventative care, because it will eliminate cost sharing for certain preventative care services under Medicare and Medicaid.
Recruiting Health Professionals. Students growing up in rural areas who go into medicine are more likely to remain in rural locations -- but relatively few rural students pursue medical careers. Education and achievement levels are often lower in rural areas, and resources that could help rural students go into medical careers are scarce, reports the issue brief. Health reform will extend the health professional recruitment strategies started in the economic stimulus package (aka the American Recovery and Reinvestment Act of 2009), such as scholarships and loans targeted specifically at increasing the primary care workforce. Through the National Health Service Corps, students can get assistance in repaying their medical education debt by agreeing to spend time working in underserved areas. (The Alliance's Deanna Okrent writes more about expanding the primary care workforce, not just in rural areas, at the RWJF Users Guide to the Health Reform Galaxy blog.)
Health IT and Quality Care. Health reform will support the federal government’s commitment to encourage meaningful health IT adoption through loans and grants. Telehealth and health information technology will help rural people overcome the geographic barriers that make it more difficult for them to access care. Allowing doctors and patients to connect over long distances without travel will help rural health providers create and sustain the kind of infrastructures that make coordinated, high quality, low cost health care possible -- such as Accountable Care Organizations and medical homes.
Health reform will help many demographics across the nation, but as this Alliance brief demonstrates, reform will be a big help for rural populations. Many questions remain -- on everything from reimbursement levels to health care workforce capacity -- and we're sure policymakers will grapple with these questions in the coming years. But right now, current health reform legislation is an important step in the right direction.
This is CABL.com posting #295419. Tiny Link: cabl.co/mbo0Z
