Nearly one in four rural Americans rate the health care in their communities either fair or poor, according to a poll commissioned by United Health Care. That is twice the rate that urban residents rate the health care in their communities in either of those categories. This poll corroborates a recent Harvard study published in the Journal of the American Medical Association indicating urban hospitals are better able to handle heart attacks, congestive heart failure and pneumonia compared to rural hospitals.
In the Harvard study, researchers also looked at 300 hospital referral areas, which are geographic regions that tend to use the same hospitals. Researchers compared how often rural and urban doctors adhered to accepted ways of handling patient conditions. Of the 256 referral areas with sufficient data, 75 percent showed better performance by urban doctors, 20 percent showed no difference, and rural doctors performed better in five percent of the referral areas.
Rural doctors were three percent less likely than urban doctors to provide “high-quality” care. Rural doctors in the upper Midwest and Northeast did the best in this comparison. In addition, rural doctors performed comparably to urban doctors in handling cholesterol and blood pressure issues, but ranked lower on cervical and breast cancer screenings.
It is difficult to determine why rural hospitals perform more poorly. Some possible reasons include that patients in rural areas may be sicker, or that physicians in rural areas are older and have not kept up with current technology. Isolation from other hospitals and universities may also play a role in the relatively poor performance of rural hospitals.
The same report also estimates that the national health care reform law, the Affordable Care Act, will result in a greater increase in insured patients in rural areas than urban areas. While this is one of the law’s positive outcomes, the report speculates that this increase in insured patients could exacerbate the shortage of rural physicians. It also predicts these problems will be worse in the West and South than in the Midwest.
However, the report lists a number of possibilities for correcting these issues, including incentives to get more physicians into rural areas; more teamwork among doctors, nurse practitioners and others; more collaboration between rural and urban providers; and greater use of health information technology and telemedicine.
NFU understands the importance of affordable, accessible and quality health care and has long been supportive of incentivizing rural physicians and implementing telemedicine strategies as ways to address rural health care shortfalls. Passage and implementation of the Affordable Care Act is the first step toward addressing some of these inequity issues, but, as these recent findings indicate, there is considerable ground yet to cover.