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Understanding the Health Challenges Facing Rural Communities

Jaime Rosenberg
Rural communities continue to face health challenges and disparities, with higher percentages of preventable deaths, higher rates of Medicare and Medicaid populations, and much fewer providers, according to a panel discussion at AcademyHealth National Health Policy Conference, being held February 4-5 in Washington, DC.
Rural communities continue to face health challenges and disparities, with higher percentages of preventable deaths, higher rates of Medicare and Medicaid populations, and much fewer providers, according to a panel discussion at AcademyHealth National Health Policy Conference, being held February 4-5 in Washington, DC.

In 1999, there was a 6% gap in mortality rates between rural and metropolitan areas, but by 2016, that rate tripled to 18%, explained Mark Holmes, PhD, professor of health policy and management at the University of North Carolina Gillings School of Global Public Health. From 1999 to 2010, there was a 50% quicker decrease in mortality rates compared with prior years for both metropolitan and nonmetropolitan areas. However, from 2010 to 2016, nonmetropolitan mortality remained flat while metropolitan mortality continued to decline, albeit at a slower rate.

The reasons behind this trend can largely be explained by higher deaths from motor vehicle accidents, heart attacks, other types of accidents, and suicide by firearms, according to Holmes.

At the same time, rural hospitals have been facing shrinking inpatient volume while outpatient volume increases, with 3 of 4 hospitals having more than 60% of their revenue coming from outpatient care. Other challenges facing these hospitals include having trouble recruiting and retaining providers; having greater Medicaid, Medicare, and self-pay populations; having smaller populations that are sicker, older, lower-income, and unemployed; and having less access to technology, such as electronic health records and telehealth.

These hospitals also face a lack of physician coverage, patient safety concerns, and poor management, as well as negative profit margins.

As a result, rural hospitals are closing across the country, with higher concentrations of closures in the South, said Holmes. While some convert to outpatient, primary, or urgent care centers, more than half are being abandoned.

And it’s not just closures of whole units that are an issue, explained Holmes. It’s also the closure of service lines. For example, 9% of rural counties lost their obstetrician services between 2004 and 2014.

As healthcare stakeholders continue to search for answers to the problem, Holmes explained that a possible solution could come from rural freestanding emergency departments that offer 24/7 care. However, he said, there is no current good mechanism for reimbursing them.

Rural health clinics (RHCs)—primary care clinics in underserved rural areas—are also facing significant shifts from these challenges, explained Bill Finerfrock, executive director for the National Association of Rural Health Clinics.


 
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