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Access and Other Rural Health Problems

An Office of Technology Assessment report (1990) summarizes the dilemma faced in rural communities: "The 1980s witnessed rural economic decline and instability, major changes in Federal health programs, and increasing concern about the long-term viability of the rural health care system." The report went on to document some of the problems unique to rural areas, with access to health care being a central issue:

• The lack of public transportation and the lack of health care providers create significant barriers to obtaining health care. Low density "frontier" counties with six or fewer persons per square mile "can have geographic access problems of immense proportions."
• Economic barriers often outweigh the physical barriers in preventing rural residents from obtaining adequate health care. Rural residents have lower average incomes and higher poverty rates than urban residents, with one out of every six rural families living in poverty. In the south, where nearly 44% of the nation's rural residents live, 4 out of 10 rural residents are poor, elderly, or both.
• Rural residents are much more likely than urban residents to have no health insurance coverage (18.2% vs. 14.5%). In addition, rural residents are much less likely to be covered by Medicaid than urban residents (35.5% vs. 44.4%).
• Rural areas are finding it increasingly difficult to recruit and retain the variety of qualified health personnel they need. In some isolated areas, there is an absolute lack of health care providers: in 1988, 111 counties in the U.S., with a total population of 325,100, had no physicians at all.
• Rural hospitals have high expenses and low revenues compounded by low occupancy rates and a high proportion of patients who cannot pay the full costs of their care, and many are going broke. Hospitals faced with continuing financial difficulties will continue to close, including facilities that are the only source of care in their communities.
• Rural residents are characterized by higher rates of chronic illness and disability (14% vs. 12%) and by lower rates of mortality (4% lower). While mortality rates are lower, there are two notable exceptions: infant mortality is slightly higher (10.8 vs. 10.4 per 1000 infants) and injury-related mortality is dramatically higher (0.6 vs. 0.4 per 1000).