The Challenges of Rural Healthcare

Access to healthcare is important to all Ohioans, but rural counties have some challenges that urban areas don’t. One of these issues is availability of hospitals and other health facilities. Fewer health facilities means greater distances to travel to get help.

Rural residents are more likely to die from some diseases than urban residents, and many of these deaths are preventable

A 2017 Centers for Disease Control (CDC) study reported that Americans in rural areas are more likely to die from five leading causes than their urban counterparts: heart disease, cancer, unintentional injuries (which includes vehicle accidents and drug overdoses), chronic lower respiratory disease, and stroke. See charts comparing urban versus rural deaths in Ohio (2006 to 2015) from these causes.

For instance, in 2006, there were 82 deaths in 100,000 from heart disease in rural communities, compared with 77 per 100,000 in urban areas in Ohio. In 2015, that number increased in rural areas to 85 per 100,000, whereas in urban communities, it decreased to 72 in 100,000—a 4% increase in heart disease deaths in rural areas and a 6% decrease in urban areas.

Preventable rural deaths are partly due to lack of access to health care or distance from a health care facility, which is made worse when hospitals close 

Rural areas also have more people without health insurance than urban areas. This places a burden on hospitals, which are required to provide emergency services even to people who cannot pay. Fortunately, Ohio is one of the states that expanded the Medicaid rolls under the Affordable Care Act (ACA), reducing the level of uncompensated emergency room and chronic illness care. In states that accepted the Medicaid expansion under the ACA, rural hospitals are financially healthier than in states that did not. A smaller proportion of hospitals and other facilities have closed in Medicaid expansion states than in states that rejected Medicaid expansion. This may change under the Trump administration. Naturally, when hospitals or clinics close, many people have to travel farther to get treatment. In some cases, they may also lose their employment.

Hospitals and other health facilities are often major employers in rural counties

In many counties a hospital or other health care facility is one of the top ten employers—and sometimes one of the better paying ones. The loss of a hospital or health facility could lead to a significant increase in unemployment. In Ohio Congressional District 15 as of 2016, rural county health providers employed more than 20,000 people:

County* Health Care/Social Assistance Employment Total Employment Health Care/Social Assistance Employment as a Percentage of Total Employment
Athens 3,562 32,166 11.07%
Fairfield 8,159 62,608 13.03%
Hocking 912 10,319 8.84%
Morgan 459 4,632 9.91%
Pickaway 1,814 20,305 8.93%
Ross 5,583 36,609 15.25%
Vinton 418 3,460 12.08%

*Clinton, Fayette, Madison, and Perry did not report county specific totals for Health Care/Social Assistance Employment

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