Healthcare Access in Rural Communities

Healthcare Access in Rural Communities
• Access to healthcare services is critical to good health, yet rural residents face a variety of access barriers. A 1993 National Academies report, Access to Healthcare in America, defined access as the timely use of personal health services to achieve the best possible health outcomes. A 2014 RUPRI Health Panel report on rural healthcare access collects additional definitions of access, along with measures that can be used to determine access.
• Ideally, residents should be able to conveniently and confidently access services such as primary care, dental care, behavioral health, emergency care, and public health services. According to Healthy People 2020, access to healthcare is important for:
1. Overall physical, social, and mental health status
2. Prevention of disease
3. Detection and treatment of illnesses
4. Quality of life
5. Preventable death
6. Life expectancy
• Rural residents often experience barriers to healthcare that limit their ability to obtain the care they need. In order for rural residents to have sufficient healthcare access, necessary and appropriate services must be available and obtainable in a timely manner. Even when an adequate supply of healthcare services exists in the community, there are other factors to consider in terms of healthcare access. For instance, to have good healthcare access, a rural resident must also have:
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• Financial means to pay for services, such as health insurance coverage that is accepted by the provider.
• Means to reach and use services, such as transportation to services which may be located at a distance, and the ability to take paid time off of work to use such services.
• Confidence in their ability to communicate with healthcare providers, particularly if the patient is not fluent in English or has poor health literacy.
• Confidence in their ability to use services without compromising privacy.
• Confidence in the quality of the care that they will receive.
• What are barriers to healthcare access in rural areas?
? Health Insurance Coverage
Individuals who do not have health insurance have reduced access to healthcare services.
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? Workforce Shortages
Healthcare workforce shortages have an impact on access to care in rural communities. One measure of healthcare access is having a usual source of care. Having an adequate health workforce is necessary to providing that usual source of care.
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? Distance and Transportation
People in rural areas are more likely to have to travel long distances to access healthcare services, particularly specialist services. This can be a significant burden in terms of both time and money.
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? Social Stigma and Privacy Issues
In rural areas, where there is little anonymity, social stigma and privacy concerns are more likely to act as barriers to healthcare access.
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? Poor Health Literacy
Health literacy, which impacts a patient s ability to understand health information and instructions from their healthcare providers, is also a barrier to accessing healthcare.
• Why is primary care access important for rural residents?
1. Some benefits of primary care access are:
2. Preventive services, including early disease detection
3. Coordination of care
4. Lower all-cause, cancer, and heart disease mortality rates
5. Reduction in low birth weight
6. Improved health behaviors
• What types of healthcare services are frequently difficult to access in rural areas?
1. Obstetric Services
2. Mental Health Services
3. Oral Health Services
4. Substance Abuse Services
• What are some strategies to improve access to care in rural communities?
Many strategies are being used to improve access to healthcare in rural areas:
? Delivery Models
Two rural healthcare models that have been supported by the Federal Office of Rural Health Policy (FORHP) include:
1. Frontier Extended Stay Clinics (FESC)
Clinics in frontier communities which help seriously ill patients or injured patients who cannot be immediately transferred to a hospital due to adverse weather conditions or other concerns.
2. Frontier Community Health Integration Program (FCHIP)
A program to develop and test new models to improve access to quality healthcare services in frontier areas.
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? Affiliation with Larger Systems or Networks:
Local rural healthcare facilities may choose to join healthcare networks or affiliate themselves with larger healthcare systems as a strategy to maintain or improve healthcare access in their communities.
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? Efforts to Improve the Workforce
Having an adequate workforce is necessary to maintain access to healthcare in a community. In order to increase access to care, rural communities can make sure that they are making the best use of all healthcare professionals.
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? Telehealth
Telehealth is increasingly seen as a key solution to help address rural health access issues. Through telehealth, rural patients can see specialists in a timely manner while staying in their home communities. Local healthcare providers can also benefit from specialists expertise provided via telehealth.
An isolated community may be unable to afford key inputs to expand coverage, which includes infrastructure, technologies and human resources (particularly the training of personnel). However, when communities join forces, they can secure such inputs at manageable costs.
A second strategic focus is on “mobile resources” or those that can overcome distance and geographical obstacles efficiently and affordably. Depending on the setting, this strategic focus may include transportation, radio communications, and other information and communications technologies. Telecommunications can enable less skilled frontline health-center staff to be advised and guided by experts at a distance in real time. Finally, the financing of health care for dispersed populations poses specific challenges, which often require larger per capita expenditure compared to more clustered populations. In countries whose territories include both high-density and low-density populations, it is expected that dispersed populations will receive some subsidy of care.

it is necessary to embed universal coverage in wider social protection schemes and to complement it with specially designed, targeted forms of outreach to vulnerable and excluded groups. Established health-care networks often do not make all possible efforts to ensure that everyone in their target population has access to the full range of health benefits they need, as this requires extra efforts, such as home visits, outreach services, specialized language and cultural facilitation, evening consultations, etc.

These may, however, mitigate the effect of social stratification and inequalities in the uptake of services. They may also offer the opportunity to construct comprehensive support packages to foster social inclusion of historically marginalized populations, in collaboration with other government sectors and with affected communities.