Susan Hensler
Health care, health insurance, and accessibility to medical services are top conversations
in the news today, and with good reason: a patient seeking health care requires not only
insurance or the financial means to pay for a providers services, but also easy access to a
healthcare facility or provider. In 2004, Hartley related that rural health research and healthcare
policy was a bourgeoning field of study aimed at creating an awareness of the health disparities
between the 80% of urban/suburban America and roughly 20% of the population comprising
rural America. Hartley (2004) also discussed the need for federal funding aimed at the shortage
of providers in rural populations and the need for increased Medicaid/Medicare reimbursement.
The Federal Office of Rural Health Policys preservation of rural hospitals and the creation of
policy interventions directed toward closing the healthcare disparity gap rural Americans face
Data Review
Fast forward from 2004 to 2015 and Rural Healthy People 2020, a companion document
to Healthy People 2020, and the goals for rural America remain the same: increase the number of
rural providers, mitigate Medicaid and Medicare cutbacks, and reduce the number of rural
hospital closings (Texas A&M University, n.d.). Sadly, the goal target of 83.9% of Americans
with a PCP missed the mark with only 77.3% in 2011 (Office of Disease Prevention and Health
Much of rural America faces a critical shortage of health care providers and facilities.
Bolin (2015) asserts that while rural America constitutes 17% of the nations population, only
HEALTH CARE DISPARITIES IN RURAL AMERICA 3
9% of doctors and 16% of registered nurses practice in rural areas. The Office of Disease
Prevention and Health Promotion (ODPHP) (2014) found that having a regular Primary Care
Physician (PCP) increases the likelihood of appropriate care through better communication and
trust, reduces the likelihood of premature death, and increases the quality of life. Furthermore,
the ODPHP asserts that access to health services profoundly affects every aspect of an
individuals health, yet roughly 25% of Americans do not have a primary care provider.
According to County Health Ranking (2017), finding a healthcare provider can be a challenge
for those in rural Sussex County, Delaware, which has a ratio of 1,520 persons to each physician,
significantly below the national top performer of 1,040 patients per physician, a comparison
Inability to Pay
With up to 22.5% of rural Americans relying on Medicaid and with further budget cuts
expected, Families USA (2017), suggests the issue does not seem to have an easy resolution. The
Office of Disease Prevention and Health Promotion (2014) maintains that 20% of Americans
lack health insurance and County Health Rankings (2017) reported 11% of Sussex County
residents do not have health insurance. Sadly, the Office of Disease Prevention and Health
Promotion (2014) cites the Leading Health Indicator goal set forth by Healthy People 2020 of
100% of Americans having medical insurance falls short with only 83.1% insured in 2012, the
Accessibility
According to a 2014 Rural Health Information Hub (2017) report, rural residents face
barriers in accessing healthcare. Even when primary health care is available, access is often
limited due to transportation issues, patient health literacy, financial constraints, or lack of
HEALTH CARE DISPARITIES IN RURAL AMERICA 4
awareness of health care resources available. If basic primary care is difficult to find, imagine the
struggle for special populations. For women, the challenges to finding health care can be even
greater. Not only do many rural counties lack hospitals that provide obstetric care, but from 2004
to 2014, the rate of areas without facilities increased from 45% to 54% due to closures of
existing obstetrical units. While 77.9% of micropolitan counties offered obstetrical services,
only 40.2% of rural counties offer these services (Hung, Kozhimannil, Henning-Smith, & Casey,
2017). And with the nationwide opiate crisis at an all-time high, it is important to consider the
statistics surrounding rural America and detoxification services. Most rural residents must drive
upwards of 100 miles to find a rehabilitation facility, and 82% of rural residents live in a county
How can these vital issues facing rural Americans be resolved? Fortunately, several
agencies are working to improve healthcare policy in rural America. The Rural Health
Information Hub (2014) reports that a major goal of the Federal Office of Rural Health Policy is
the dissemination of research findings to federal, state and local legislators toward rural
healthcare promotion policy. The Agency for Healthcare Research and Quality is mentioned by
the U.S. Department of Health & Human Services (2017) as an organization that conducts
research on rural healthcare and provides information and evidence-based outcomes. The
National Rural Health Association focuses on reduction of health disparities for rural Americans.
Offering financial incentives may be one option for maintaining or increasing rural providers
(Rural Health Information Hub, 2014). A recent article by The Kaiser Health News (2017)
reported that the Affordable Care Act is under scrutiny by the United States legislature and faces
potential insurance cost hikes. While goals for an increase in providers, affordability, and
HEALTH CARE DISPARITIES IN RURAL AMERICA 5
accessibility should be evaluated at least yearly, there is hope that by 2020 some of the goals of
Recommended Resources
There are hundreds of national, state, and local agencies both public and private that are
geared toward assisting rural Americans with a wide range of human service needs. Some
agencies focus on healthcare, dental, or behavioral health, while others steer consumers through
the complex maze of insurance and Medicaid / Medicare options best suited to their individual
needs. A resource for public transportation availability and schedules is available for those in
need of transportation to and from healthcare services (see Appendix A for resource information
and links).
HEALTH CARE DISPARITIES IN RURAL AMERICA 6
References
Bolin, J. (2015). Rural Healthy People 2020: New Decade, Same Challenges. The Journal of
County Health Rankings. (2017). Delaware: Primary Care Physicians. Retrieved from County
http://www.countyhealthrankings.org/app/delaware/2017/measure/factors/4/description
Families USA. (2017, March). Cutting Medicaid Would Hurt Rural America. Retrieved from
Hartley, D. (2004). Rural Health Disparities, Population Health, and Rural Culture. American
Hung, P., Kozhimannil, K., Henning-Smith, C., & Casey, M. (2017, April). Closure of Hospital
content/files_mf/1491501904UMRHRCOBclosuresPolicyBrief.pdf
Kaiser Health News. (2017, August 2). 30 Percent Rate Hikes Reflect Uncertainty In Affordable
breakout/30-percent-rate-hikes-reflect-uncertainty-in-affordable-care-act-marketplaces/
Office of Disease Prevention and Health Promotion. (2014). Healthy People 2020: Access to
https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Access-
to-Health-Services
Rural Health Information Hub. (2014, October 31). Rural Health Disparities. Retrieved from
RHIhub: https://www.ruralhealthinfo.org/topics/rural-health-disparities#organizations
HEALTH CARE DISPARITIES IN RURAL AMERICA 7
Rural Health Research Center. (2017, May). Changes in the Supply of Physicians with a DEA
DATA Waiver to Prescribe Buprenorphine for Opioid Use Disorder. Retrieved from
content/uploads/sites/4/2017/05/RHRC_DB162_Andrilla.pdf
Texas A&M University. (n.d.). Rural Healthy People 2020. Retrieved from Southwest Rural
U.S. Department of Health & Human Services. (2017). HRQ: Agency for Healthcare Research
and Quality. Retrieved from Agency for Healthcare Research and Quality:
https://www.ahrq.gov/
HEALTH CARE DISPARITIES IN RURAL AMERICA 8
Appendix A
Resources listed below are a sample of those available to assist rural Americans with
finding providers and health care facilities, locating services, obtaining insurance, and
determining qualification of free services. A resource is also provided for those in need of public
transportation.
Delaware Family Voices: Supporting families and children with special needs. Website:
numerous sources for free or low-cost healthcare, dental, public health and insurance
information.
website offers access to free or low-cost screenings, healthcare, behavioral, and social services to
Delaware residents.
Centers for Medicare and Medicaid Services: Website: https://www.cms.gov This site has a
wealth of information that ranges from public health emergencies to affordable healthcare
options.