It is no secret that access to health care is a real challenge in rural parts of the world. While the urban landscape of the country now has the means to comfortably avail smooth access to public transportation, advanced medical care, and innovative preventive programs, the rural parts are lagging far behind in these aspects. As appalling as it sounds, the fact remains that 15% of Americans residing in rural parts do not have access to adequate health care. Narrowing down further we find that on average 46 million people living in the countryside are older, sicker, and have less access to medical care than those who live in urban areas, and the gap has widened in recent years.
What’s more, the rural parts of the country witnesses high rates of death, disease, and chronic illness. The patient-to-physician ratio in the countryside is only 39.8 physicians per 100,000 patients as compared to 53.3 in urban areas. The statistics become even more staggering when it comes to disease prevention.
Here are some stats from the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report:
- In the year 2014 many deaths among rural Americans were potentially preventable, including 25,000 from heart disease, 19,000 from cancer, 12,000 from unintentional injuries, 11,000 from chronic lower respiratory disease, and 4,000 from a stroke.
- The percentages of deaths that were potentially preventable were higher in rural areas than in urban areas.
Is it the sheer isolation of living in the countryside or their living standards that are causing severe disparities and standing in the way of access to good health care? Or does the challenge go way deeper than that?
Why is Rural Health Care still Stagnant?
There are multiple reasons for the poor availability of health care options in rural America. It is not that the rural population is large, but the population of doctors is small. It is not that there is more disease in rural areas, but that the diseases are either not prevented or treated in time. Let’s list some of these down here:
Distance & Disconnectivity: The geographical accessibility of health services is extremely poor in rural America. Bad logistics often come in the way of delivering access to care in these parts. Along with this, environmental barriers, lack of public transportation, and challenging roads can limit rural residents from accessing health care services.The distant location of hospitals, clinics, and pharmacies is a cause for alarm if care has to be made readily available to rural populations.
Shortage of Manpower: There is a severe shortage of physicians, dentists, and primary care physicians. Statistics show that about a fifth of Americans live in rural areas, but barely a tenth of physicians practice there. To be more precise, there are only 65 primary care physicians per 100,000 rural Americans as opposed to 105 per 100,000 urban and suburban Americans, a UnitedHealth paper found.
Improper Infrastructure: There is a lack of basic infrastructure. There are fewer roads available to get medicines out of urban centers into pharmacies in the rural areas. The same goes for ambulances if they have to transport patients. Many times small towns have don’t have enough hospitals.
Insufficient Funding: The key to achieving desired health outcomes is to ensure that the funds are targeted, allocated and used effectively, however, rural health care in America finds itself financially ill-equipped.
Lack of Services and Equipment: Physicians in small towns find it hard to maintain an appropriate level or scope of services of the population they serve.
Moving aside the aforementioned barriers, one major trouble with health care in rural areas in the underutilization of resources. There is a gap between the potential and the actual benefits that health care can reap by doing more with less.
Finding a Solution: Initiate, Intervene and Invest
Stopgap measures will only seek to solve the problem temporarily. It is pertinent to look for solutions that will tackle the problem of rural health care swiftly with long-term positive outcomes. We already know that the resources are low but how can we optimize their performance and improve the access as well as the quality of care? Enrolling more number of medical students and employing more PCPs will take years to happen but, we can start by bringing health care IT into the picture.
Increasing connectivity and ease of access to physicians is the first step. The physicians and patients may be geographically far in rural sites, but they can be brought closer virtually. Physicians need not be physically present to treat their patients. This can be done through sending personal updates, reports, or follow up details to their patients. Through this, value-based care can become a reality in rural America.
Detecting illnesses that can be prevented beforehand is one sureshot way of delivering better primary care while also eliminating the expenses of the treatments that come when the disease does strike. Preventive care can be undertaken by organizing immunization drives and also by equipping PCPs with tools that can help them identify patients with high risk of chronic illness.
Success Story of a Rural healthcare setting
One of the largest mid-west ACOs in America had over 20 rural sites on 22 Tier 2 & 3 EMRs. Furthermore, the disparate data streams from radiology, labs, billing, etc. lacked common standard and needed to be integrated for a streamlined care delivery operation and monitoring.
The legacy vendor did not commit to a cost-effective integration of these rural sites, and the ACO opted for a more technologically sound vendor. Within two months, they were able to integrate all the EMRs, enable real-time ADT feeds, enhance compliance by almost 25%, and most importantly save over 10 hours per week per health coach.
Creating the future of new age rural healthcare
Physicians have to take care of a lot of patients in a very short time. They need an ideal solution complementing to their acumen. The next-generation of IT solutions is here, and once we have them in all rural hospitals, possibilities are endless. We can overcome interoperability challenges, increase efficiencies, prevent physician burnout, and do all this is in real-time. I don’t believe that providing timely access to healthcare in rural areas is a dream; it is within our reach and that too with excellence. All of this is possible with the revolution of health IT.
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