Electronic Health Reporter

Although life in rural communities offers many advantages, the rural healthcare system in America faces challenges not seen in urban areas, for obvious reason: population loss, poverty and access to healthcare have been problematic in recent years.

Taking a look at Pennsylvania, which is the sixth most populous and ninth most densely populated state in the US, based on information from the United States Census Bureau from 2010 and 2013, as a state it hosts a significant amount of rural areas. According to the Pennsylvania Rural Health Association, 48 of its 67 counties classified as rural, and all but two counties have rural areas. More than one quarter of Pennsylvanians live in rural counties.

Thus, it’s as good a place as any to examine some of the unique issues facing rural communities, who even though they may be within driving distance to some of the best medical care in the world, they are unable to access it each day without some sort of life altering obstacle.

In general, residents of rural communities in the U.S. are less healthy than those in urban environments. According to Unite for Sight, “rural residents smoke more, exercise less, have less nutritional diets and are more likely to be obese than suburban residents.” Already against the odds, residents in rural Pennsylvania face several specific problems that jeopardize the state of healthcare in the area.

Population Loss

Between 2000 and 2010, the Pittsburgh Post-Gazette reported that rural Pennsylvania counties grew by 2.2 percent while urban counties grew by 3.9 percent. However, the small increase in rural counties was only because of the eastern counties. Western rural counties decreased by 0.9 percent, and by another 0.5 percent from 2010 to 2012.

In some places, the situation is bleak. The newspaper highlights the population loss in Taylor Township, a part of Lawrence County that experienced a 13.6 percent population loss from 2000 to 2010. “Of its 1,052 residents, more than twice as many are over age 65 as under 18. That ratio is practically unheard of among municipalities and doesn’t bode well for the township’s future.”

For rural areas where population is declining or (slowly) rising, healthcare faces challenges. Economic opportunity is threatened when workers and students pursue a better future. And when healthcare professionals depart, accessibility is undermined. In addition, communities with a disproportionately older population can require more healthcare resources, at the same time as access is dwindling.

Economic Challenges

According to the Rural Assistance Center (RAC), rural communities in Pennsylvania lagged behind urban areas in poverty, unemployment and income for 2013:

• 3 percent poverty rate; 13.6 percent in urban areas
• 9 percent unemployment rate; 7.3 percent in urban areas
• $36,099 per-capita income; $46,202 for the state

The Center for Rural Pennsylvania adds that from 2007 to 2011, 39 percent of rural households had incomes below $35,000.

Access to Healthcare

Rural communities in Pennsylvania, as is representative of the rest of the country, also have less access to healthcare than those in urban areas. The Center for Rural Pennsylvania reports that in 2008, rural counties had just one primary care physician for every 1,507 residents, while urban counties had one physician for every 981 residents. In 2009, rural counties had one practicing dentist for every 2,665 residents, while urban areas had one for every 1,845 residents.

Solutions and Initiatives

In response to some of the healthcare system challenges facing residents in rural Pennsylvania, the following solutions and initiatives have been developed.

Telehealth

Based on a 2014 research report from The Center for Rural Pennsylvania, telehealth can promote strong health to reduce chronic conditions and diseases, educate the public and healthcare workers, enable senior citizens to remain in their homes and much more. Using videoconferencing, online remote monitoring and diagnostic scans, electronic health records and other tools, telehealth can help providers give high-quality, affordable and accessible healthcare even in remote locations.

The study estimated that telehealth’s universal implementation would result in a 22 percent savings for the first year, increasing to 66 percent for the 20th year. Instead of a healthcare cost of $25,500 per person each year, the cost would be just $8,500; Pennsylvania would save $194 billion in the 20th year of implementation. Not only would the healthcare be less expensive, it would also be higher quality.

Currently, telehealth in rural Pennsylvania is not widely used and quality is poor.

Rural Healthcare Funding

Federal programs are available to help rural areas across the country may improve healthcare delivery. One example is the Rural Health Care Coordination Network Partnership Program, which supports organizations that are trying to improve the outcomes of chronic diseases, specifically chronic heart failure, chronic obstructive pulmonary disease and Type 2 diabetes. It awards up to $200,000 per year for three years to qualified rural health networks.

These types of programs can help overcome the economic disparity that most rural communities faced, compared to urban areas. The Office of Rural Health Policy (ORHP), part of the Health Resources and Services Administration (HRSA), offers other grant programs and initiatives to help support healthcare in rural areas across the country.

Expanding the Scope of Healthcare Workers

The need for more accessible healthcare is not just an issue in rural areas. According to the HRSA, there is a projected shortage of 20,400 primary care physicians across the U.S. for 2020, if the current system remains unchanged. To counter this trend, the HRSA projects the number of nurse practitioners and physician assistants to increase.

Nurses are expected to play an integral role in meeting the need for increased healthcare practitioners. In 2010, the Institute of Medicine announced that nurses would need to respond to the changes taking place in the healthcare system, which gives nurses more opportunities to provide quality care. It called for higher education standards, including 80 percent of all nurses to hold bachelor’s degrees. To meet these needs, nursing is growing quickly; the Bureau of Labor Statistics already expects the profession to grow by more 19 percent through 2022, making it one of the fastest growing professions in the country.

A higher concentration of educated nurses could help make up for this shortage of physicians and the changes taking place in the healthcare system in rural areas.

Current nurses can impact healthcare in rural areas by advancing their education. More leaders are needed, and education fills the gap created by a shortage of nurses and the evolving healthcare system.

This post is sponsored by the Alvernia University online RN to BSN program.