National Rural Health Association

2015 Policy Institute

What's Different about Rural Health Care?

The obstacles faced by health care providers and patients in rural areas are vastly different than those in urban areas. Rural Americans face a unique combination of factors that create disparities in health care not found in urban areas. Economic factors, cultural and social differences, educational shortcomings, lack of recognition by legislators and the sheer isolation of living in remote rural areas all conspire to impede rural Americans in their struggle to lead a normal, healthy life. Some of these factors, and their effects, are listed below.

  • Only about ten percent of physicians practice in rural America despite the fact that nearly one-fourth of the population lives in these areas. **
  • Rural residents are less likely to have employer-provided health care coverage or prescription drug coverage, and the rural poor are less likely to be covered by Medicaid benefits than their urban counterparts.
  • Although only one-third of all motor vehicle accidents occur in rural areas, two-thirds of the deaths attributed to these accidents occur on rural roads.**
  • Rural residents are nearly twice as likely to die from unintentional injuries other than motor vehical accidents than are urban residents. Rural residents are also at a significantly higher risk of death by gunshot than urban residents.
  • Rural residents tend to be poorer. On the average, per capita income is $7,417 lower than in urban areas, and rural Americans are more likely to live below the poverty level. The disparity in incomes is even greater for minorities living in rural areas. Nearly 24% of rural children live in poverty.
  • People who live in rural America rely more heavily on the federal Food Stamp Program, according to The Carsey Institute at the University of New Hampshire. The Institute's analysis found that while 22 percent of Americans lived in rural areas in 2001, a full 31 percent of the nation's food stamp beneficiaries lived there. In all, 4.6 million rural residents received food stamp benefits in 2001, the analysis found.
  • There are 2,157 Health Professional Shortage Areas (HPSA’s) in rural and frontier areas of all states and US territories compared to 910 in urban areas.**
  • Abuse of alcohol and use of smokeless tobacco is a significant problem among rural youth. The rate of DUI arrests is significantly greater in non-urban counties. Forty percent of rural 12th graders reported using alcohol while driving compared to 25% of their urban counterparts. Rural eighth graders are twice as likely to smoke cigarettes (26.1% versus 12.7% in large metro areas.) **
  • Anywhere from 57 to 90 percent of first responders in rural areas are volunteers. **
  • There are 60 dentists per 100,000 population in urban areas versus 40 per 100,000 in rural areas**
  • Cerebrovascular disease was reportedly 1.45 higher in non-Metropolitan Statistical Areas (MSAs) than in MSAs.**
  • Hypertension was also higher in rural than urban areas (101.3 per 1,000 individuals in MSAs and 128.8 per 1,000 individuals in non-MSAs.)**
  • Twenty percent of nonmetropolitan counties lack mental health services versus five percent of metropolitan counties. In 1999, 87 percent of the 1,669 Mental Health Professional Shortage Areas in theUnited States were in non-metropolitan counties and home to over 30 million people **
  • The suicide rate among rural men is significantly higher than in urban areas, particularly among adult men and children. The suicide rate among rural women is escalating rapidly and is approaching that of men.**
  • Medicare payments to rural hospitals and physicians are dramatically less than those to their urban counterparts for equivalent services. This correlates closely with the fact that more than 470 rural hospitals have closed in the past 25 years.
  • Medicare patients with acute myocardial infarction (AMI) who were treated in rural hospitals were less likely than those treated in urban hospitals to receive recommended treatments and had significantly higher adjusted 30-day post AMI death rates from all causes than those in urban hospitals. ***
  • Rural residents have greater transportation difficulties reaching health care providers, often travelling great distances to reach a doctor or hospital.
  • Death and serious injury accidents account for 60 percent of total rural accidents versus only 48 percent of urban. One reason for this increased rate of morbidity and mortality is that in rural areas, prolonged delays can occur between a crash, the call for EMS, and the arrival of an EMS provider. Many of these delays are related to increased travel distances in rural areas and personnel distribution across the response area. National average response times from motor vehicle accident to EMS arrival in rural areas was 18 minutes, or eight minutes greater than in urban areas.**

A National Rural Health Snapshot

Rural

Urban

Percentage of USA Population**

nearly 25%

75% +

Percentage of USA Physicians**

10%

90%

Num. of Specialists per 100,000 population**

40.1

134.1

Population aged 65 and older

18%

15%

Population below the poverty level

14%

11%

Average per capita income

$19K

$26K

Population who are non-Hispanic Whites

83%

69%

Adults who describe health status as fair/poor

28%

21%

Adolescents (Aged 12-17) who smoke

19%

11%

Male death rate per 100,000 (Ages 1-24)

80

60

Female death rate per 100,000 (Ages 1-24)

40

30

Population covered by private insurance

64%

69%

Population who are Medicare beneficiaries

23%

20%

Medicare beneficiaries without drug coverage

45%

31%

Medicare spends per capita compared to USA average

85%

106%

Medicare hospital payment-to-cost ratio

90%

100%

Percentage of poor covered by Medicaid

45%

49%

Statistics used with permission from "Eye on Health" by the Rural Wisconsin Health Cooperative, from an article entitled "Rural Health Can Lead the Way," by former NRHA President, Tim Size; Executive Director of the Rural Wisconsin Health Cooperative


Sources:

**Rural Healthy People 2010—"Healthy People 2010: A Companion Document for Rural Areas," is a project funded with grant support from the federal Office of Rural Health Policy. The full document is available for download at the following site:
http://srph.tamhsc.edu/centers/rhp2010/Volume1.pdf
***WWAMI Rural Health Research Center study, funded by the Federal Office of Rural Health Policy, described in:
Baldwin L-M, MacLehouse RF, Hart LG, Beaver SK, Every N, Chan L: Quality of care for acute myocardial infarction in rural and urban U.S. hospitals. Journal of Rural Health 2004;20(2):99-108.

For more information on WWAMI projects and publications, visit
http://depts.washington.edu/uwrhrc/index.php

Rural Health in the United States - 1999
Thomas C. Ricketts III, Editor
Oxford University Press

Health, United States, 2001 Urban and Rural Chartbook..., - 2001 Centers For Disease Control

Rural Information Center Health Service (RICHS) Web site
http://www.nal.usda.gov/ric/

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