Rural State Residents Deserve Equal Care
As health care reform begins, and we struggle to get a state budget passed, we have an opportunity to ensure that all Pennsylvanians have access to quality health care. The health and welfare of rural Pennsylvania affects the entire commonwealth. All but two of our 67 counties have rural residents, 48 are predominantly rural and five are completely rural. But the bulk of our resources go to urban areas, organizations, communities and residents. This includes health care.
Rural Pennsylvanians face multiple barriers when accessing health care services. Four key areas are:
The struggle to build and keep a rural health care work force.
Deficiencies in rural health care infrastructure.
Lower insurance reimbursement for health care services.
Rural citizens are increasingly underinsured and uninsured.
The numbers show it, rural residents live it, and rural advocates continue to tell the story. An adequate supply of providers and practitioners is essential to quality health care for all residents of the state. Rural residents require the same spectrum of skilled providers across the health care continuum — including primary care, pre-hospital emergency medical services, acute care, home health, rehabilitation, long-term care and hospice — as their urban and suburban counterparts.
Rural residents generally must travel beyond their communities to meet tertiary health care needs. Local access to primary and secondary health care is essential to ensure that health problems are addressed before they become emergencies too serious or expensive to treat.
This also means that access to preventive care and effective management of chronic conditions must be provided locally. Too often, the primary and preventive care available is too scarce to serve all those in need.
Health profession work force shortages are among the most pressing issues facing hospitals, health systems and their communities today. For rural communities, the challenge is even greater, since there is not the health care infrastructure for clinical training or health care delivery.
Travel and financial barriers pose increased challenges for those rural residents interested in becoming a health care professional.
Pennsylvania is training the nation’s health care work force. However, a lack of rural resources and infrastructure precludes the many Pennsylvania-trained professionals from choosing to practice in our rural communities. This includes physicians, nurses and other health care technicians, as well as nonclinical workers trained in social services, housekeeping, maintenance and food service.
Maintaining a strong health care industry has important ramifications for the economic vitality of rural communities. Rural hospitals and primary care clinics, such as Federally Qualified Health Centers and Rural Health Clinics, provide quality health care services to rural residents. Hospitals are key providers of health care in rural areas and often serve as the anchor for the entire continuum of services.
The closure of a hospital can significantly impact the local economy. Rural communities across the nation that have lost their local hospital have often experienced a domino effect, with a subsequent departure of primary care physicians, deterioration of home health services, decreased medical oversight and access to health care in general. Rural communities that lose their hospital lose a major employer. They lose the direct and “roll-over” dollars from having that major employer in their community and often lose other health care services across the continuum. Also, they have diminished ability to attract new employers.
Rural Pennsylvanians play a vital role in delivering the agricultural, timber, mining and other business services to the commonwealth’s economy, however, 78 percent of rural businesses employ fewer than nine people. This makes it extremely costly to provide health insurance. When rural residents enter the private insurance market, they are likely to pay higher administrative fees, find fewer health insurance choices and be underinsured.
Rural residents pay a higher proportion of their income for health insurance because premium rates in rural America are comparable to or even higher than those in urban areas. The average wage disparity between urban and rural is more than $12,000. Because rural populations tend to be older and poorer, they rely heavily on public sources of coverage. For this reason, rural residents and health care providers are more heavily impacted by coverage changes and inadequate provider payment rates in Medicare, Medicaid and the state Children’s Health Insurance Program.
Rural Pennsylvanians are less likely to seek primary and preventive care and are more likely to be in poor health. This is the result of many factors, including lower coverage rates, lower incomes, less comprehensive coverage and less access to health care providers. Strong and reliable sources of health care financing and insurance, as well as local access to health care, are critical for improving health status and outcomes of rural citizens.
We have an opportunity, as health care reform gets under way, to make a difference for the better in our rural communities to improve the overall health and quality of life. Indeed, rural should not mean less when it comes to health care.
Walt Eisenhauer is immediate past president of the Pennsylvania Rural Health Association