Rural health

Poll: Many rural Americans struggle to pay medical bills, access health care

A new national poll finds that while rural Americans are mostly satisfied with life, there is a strong undercurrent of financial insecurity that can create very serious problems for many people living in rural communities (Source: “Poll: Many Rural Americans Struggle With Financial Insecurity, Access To Health Care,” National Public Radio, May 21, 2019).

The findings come from two surveys National Public Radio conducted with the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health on day-to-day life and health in rural America.

Several findings stand out: A substantial number (40%) of rural Americans struggle with routine medical bills, food and housing. And about half (49%) say they could not afford to pay an unexpected $1,000 expense of any type.

One-quarter of respondents (26%) said they have not been able to get health care when they needed it at some point in recent years. That's despite the fact that nearly 9 in 10 (87%) have health insurance of some sort — a level of coverage that is higher now than a decade ago, in large part owing to the Affordable Care Act and the expansion of Medicaid in many states.


County Health Rankings spotlight link between health and wealth in Ohio

The University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation released the latest edition of the County Health Rankings & Roadmaps this week (Source: “Wealth means health in Ohio rankings,” Columbus Dispatch via Canton Repository, March 15, 2018).  

Once again the counties rated the healthiest in Ohio were also among the state’s most affluent. Delaware County was the healthiest county in Ohio in 2017, a title it has held for eight of the nine years that the rankings have been issued.

Four of the five healthiest counties are affluent suburban areas. The bottom five, with Adams ranked the lowest at No. 88, are among Ohio’s most impoverished Appalachian counties. In a statement accompanying the release of the national report Wednesday, RWJF’s president acknowledged the clear link between poverty, other social factors and poor health outcomes.

“We can’t be a healthy, thriving nation if we continue to leave entire communities and populations behind,” said Dr. Richard Besser, the foundation’s president and CEO.

This year’s report also shows that gaps in health persist not only based on geography, but also by race and ethnicity. HPIO recently launched a new resource page on health equity. The web page is the first in a series of health equity products that HPIO, through support from County Health Rankings and Roadmaps, will be releasing throughout 2018 to bridge the gap in knowledge and understanding of the issue.


Research finds dementia more common in rural areas

U.S. rates of mental decline and dementia decreased from 2000 to 2010, but the prevalence of both conditions was higher in rural areas than in cities, according to a new study (Source: “Dementia May Be More Common in Rural Areas,” HealthDay News, Dec. 18, 2017)

The Rand Corporation study, which was published in the American Journal of Preventive Medicine, also found that education level was a risk factor for both conditions.  The rural-urban differences in rates of mental decline and dementia would likely be worse if there hadn't been early 20th century investments nationwide in secondary education, the researchers said.


VA to prioritize rural areas for nursing home funding

Veterans Affairs Secretary David Shulkin said Monday during a visit to Montana that his agency will propose changes to make it easier for rural areas to receive funding to build nursing homes for veterans (Source: “VA seeks to funnel more nursing home money to rural areas,” Washington Post, Aug. 21, 2017).

Rural areas are often bypassed under the agency’s existing guidelines for awarding grants for veterans’ homes, Shulkin told reporters.

The VA now sets its priority list by looking at veteran demographics and the need for beds, making it difficult for some rural areas to compete, VA officials said. The agency plans to propose regulation changes by year’s end to ensure some of the money goes specifically to rural areas. Whatever proposal emerges must go through a public comment period, so it’s unclear when any changes may take effect.


Infant drug withdrawal spikes in rural counties, study finds

A surge in U.S infants born with symptoms of withdrawal from heroin or strong prescription painkillers is driven largely by rising drug use among women in rural areas, a new study found (Source: “Newborns pay price for rural drug woes,” Associated Press via Columbus Dispatch, Dec. 22, 2016).

The University of Michigan study, which was published in JAMA Pediatrics, estimates that about 21 percent of newborns in rural counties had withdrawal symptoms in 2013, up from 13 percent in 2004. The study shows the rate for affected rural newborns climbed six-fold — from about 1 per 1,000 births in 2004 to almost 8 per 1,000 births in 2013. By contrast, in urban areas the rate climbed from 1 per 1,000 to 5 per 1,000 births. The rates correspond with women’s use of opioid drugs during pregnancy. This includes use or misuse of oxycodone and other prescription opioid painkillers, and use of illegal narcotics.


Rural hospital closures accelerating nationwide

More than 50 rural hospitals have closed in the U.S. over the last six years, and another 283 are in fragile financial condition, according to the National Rural Health Association (Source: “Hospital Closures Rattle Small Towns,” Kaiser Health News, March 10, 2016).

With rural populations long in decline in the United States, small-town hospitals have lost customers and struggled to keep pace with the striking advancements in medical technology. But the pace of closures has escalated in recent years, hastened by a series of budget control measures passed by Congress that reduced Medicare payments and by the Affordable Care Act, which is slowly restructuring the health care industry.

Compounding financial troubles at rural hospitals, 19 states have not taken advantage of a key provision in the health law to expand their Medicaid programs. That’s left many rural hospitals with uninsured patients just as federal subsidies for taking care of the uninsured are being reduced.


More rural hospitals closing labor and delivery units

Faced with financial challenges, a growing number of rural hospitals have shuttered their labor and delivery units, forcing pregnant women to travel farther for care (Source: “As Rural Hospitals Struggle, Some Opt To Close Labor And Delivery Units,” Kaiser Health News, Feb. 23, 2016).

About 500,000 women give birth each year in rural hospitals, yet access to labor and delivery units has been declining. Comprehensive figures are spotty, but an analysis of 306 rural hospitals in nine states with large rural populations found that 7.2 percent closed their obstetrics units between 2010 and 2014.

There are many factors that contribute to the decline in rural hospital obstetrics services. For one thing, obstetrics units are expensive to operate, and a small rural hospital may deliver fewer than 100 babies a year.

It can be difficult to staff the units as well. Small rural hospitals may not have obstetricians on staff and rely instead on local family physicians, but it can be difficult to get enough to fully provide services for a hospital, too. Nurses with obstetrics experience also can be scarce.


Agriculture contractors concerned with ACA coverage requirements

Many contractors who provide farm labor and must now offer workers health insurance are complaining loudly about the cost in their already low-margin business (Source: “Farm Contractors Balk At Obamacare Requirements,” Kaiser Health News, Feb. 11, 2016).

Some are also concerned that the forms they must file with the federal government under the Affordable Care Act will bring immigration problems to the fore. About half of the farm labor workforce in the U.S. is undocumented, according to U.S. Department of Agriculture estimates.

“There’s definitely going to be some repercussions to it,” said Jesse Sandoval, a farm labor contractor based in Stockton, California. “I think there’s going to be some things that cannot be ignored.”

Last year, employers with 100 or more full-time employees had to offer health insurance to their workers or pay a stiff penalty. This year, employers with 50 to 99 full-time employees must comply.


Senate budget bill includes PASSPORT expansion into rural areas

The budget plan approved this week by the Ohio Senate includes a provision that would extend a pilot program into some rural regions of the state to allow family members to provide home- and community-based care under the PASSPORT program (Source: “At-home senior care program could expand to rural Ohio,” Newark Advocate, June 11, 2013).

The approved senate budget included a section to extend a pilot program in a few rural regions of the state to allow family members to provide home- and community-based care under the PASSPORT program. PASSPORT provides home-based services to elderly Ohioans eligible for Medicaid.

The state has 12 PASSPORT regions, and the legislation would extend the service to three of the rural areas. Those specific areas have not yet been selected.


Study: Rural residents have more surgeries than city dwellers

A new national study of nearly 46 million Medicare patients found that residents of rural areas are more likely to undergo any of nine common surgeries than residents in cities, a notion that seems to challenge a long-standing belief that rural areas lack access to care (Source: “Study challenges rural lack of access to surgery,” Associated Press via Seattle Times, May 16, 2011).

According to the Texas Tech University study, which appeared in the journal Archives of Surgery, back surgery, hip and knee replacements, and prostate removal were all more common among rural Medicare patients, using data from 2006.

The study’s authors caution against reading too much into their findings, however. They note that the results could mean that rural residents are sicker, getting treatment they don't need, or more likely to delay treatment for aches and pains until they worsen and require surgery.