Rural Health: Addressing Barriers to Care
Published on: October 25, 2023.
80% of rural America
is medically underserved.
About This Infographic
While over 46 million individuals reside in rural areas, a staggering 80% of rural America is still considered to be medically underserved. Rural Americans face significant barriers to health care, which include high rates of uninsurance, the necessity to travel longer distances for medical care, and a shortage of health care providers. These obstacles contribute to poorer overall health outcomes and shorter life expectancies among the rural population, when compared to urban individuals.
This infographic explores the state of rural health and health care access in the US, including barriers to care and how telehealth services can be utilized to improve health care access.
This infographic was reviewed by Carrie Cochran-McClain, Chief Policy Officer, National Rural Health Association, https://www.ruralhealth.us/
Who Lives in Rural America?
46.1 million people live in rural areas: James C. Davis et al., US Department of Agriculture, Rural America at a Glance: 2022 Edition, 2022
- Note: “Rural” and nonmetropolitan (nonmetro) are used interchangeably in this report and are defined the same on the basis of counties.
Percentage of each state that is rural: US Census Bureau, Urban and Rural, 2020
- Note: Based on most recent census data, 2020.
15% of the US population resides in rural areas: Sally C. Curtin & Merianne Rose Spencer, CDC National Center for Health Statistics, Trends in Death Rates in Urban and Rural Areas: United States, 1999–2019, 2021
Rural population has been increasing: James C. Davis et al., US Department of Agriculture, Rural America at a Glance: 2022 Edition, 2022
Rural residents are older: US Food and Drug Administration, Rural Health, 2021
Rural vs. urban life expectancy: David Clove, Ballard Brief, Healthcare Access Disparities among Rural Populations in the United States, 2023
Rural Health Disparities
Rural residents have a higher rate of dying from several conditions: Sally C. Curtin & Merianne Rose Spencer, CDC National Center for Health Statistics, Trends in Death Rates in Urban and Rural Areas: United States, 1999–2019, 2021
- Note: Standard population refers to age-adjusted distribution of deaths.
Rural residents are also more likely to be at risk for -
Hypertension: Claudine M. Samanic et al., Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Prevalence of Self-Reported Hypertension and Antihypertensive Medication Use by County and Rural-Urban Classification — United States, 2017, 2020
Diabetes: Sagar B. Dugani et al., JAMA Network Open, Assessment of Disparities in Diabetes Mortality in Adults in US Rural vs Nonrural Counties, 1999-2018, 2022
Obesity: Elizabeth A. Lundeen et al., Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Obesity Prevalence Among Adults Living in Metropolitan and Nonmetropolitan Counties — United States, 2016, 2018
Food insecurity: Feeding America, Hunger in rural communities, 2023
Poor physical activity: Centers for Disease Control and Prevention, About Rural Health, 2023
Cigarette smoking: Centers for Disease Control and Prevention, About Rural Health, 2023
Rural health population disparities: Office of Minority Health and Health Equity, Food and Drug Administration, Rural Health, 2022
Barriers to Accessing Care in Rural Communities
People living in rural areas are at greater risk for poor health conditions: Centers for Disease Control and Prevention, About Rural Health, 2023
80% of rural America is medically underserved: Eli Saslow, The Washington Post, ‘Out here, it’s just me’: In the medical desert of rural America, one doctor for 11,000 square miles, 2019
Medically underserved definition: National Center for Advancing Translational Sciences, Underserved group, US Health Services Administration definition, 2023
Rural hospital closures -
Closures 2005 - Present: The Cecil G. Sheps Center for Health Services Research, University of North Carolina Chapel Hill, Rural Hospital Closures, 2023
Government relief funds: Nancy Ochieng et al., Kaiser Family Foundation, Funding for Health Care Providers During the Pandemic: An Update, 2022
Closures and conversions: US Public Health Service, Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce, 2022
- Consolidation, Acquisitions, & Mergers:
Claire E. O’Hanlon et al., Health Affairs, Access, Quality, And Financial Performance Of Rural Hospitals Following Health System Affiliation, 2019
Arielle Dreher, Axios, Some states encourage hospital mergers while feds cast wary eye, 2023
Victoria Bailey, RevCycleIntelligence, Private Equity Ownership of Rural Hospitals is Growing, Report Finds, 2023
25% of rural hospitals in each state are at risk of closure: Center for Healthcare Quality and Payment Reform, Rural Hospitals At Risk of Closure, 2023
Rural Americans are more likely to be uninsured: Medicaid and CHIP Payment and Access Commission, Medicaid and Rural Health, 2021
1 in 6 rural adults is uninsured: Gina Turrini et al., Assistant Secretary for Planning and Education, Department of Health & Human Services, Research Report: Access to Affordable Care in Rural America, Current Trends and Key Challenges, 2021
Medicaid plays a central role: Julia Foutz et al., Kaiser Family Foundation, The Role of Medicaid in Rural America, 2017
Distance and transportation -
Longer distances to access care: Rural Health Information Hub, Healthcare Access in Rural Communities, 2022
Specialty services are less likely to be available: Rural Health Information Hub, Rural Health Disparities, 2022
Health literacy: Rural Health Information Hub, Social Determinants of Health for Rural People, 2022
Affordability: Munira Z. Gunja, The Commonwealth Fund, Rural Americans Struggle with Medical Bills and Health Care Affordability, 2023
Higher poverty rates in rural areas: Economic Research Services, United States Department of Agriculture, Poverty rates by select racial and ethnic groups, residence, 2019.
- Note: This is the most current estimation of poverty rate comparisons. Data is from the US Department of Commerce, Bureau of the Census, 2019 American Community Survey.
Poverty and health outcomes: Office of Disease Prevention and Health Promotion, Healthy People 2020, Poverty, 2020
- Note: Poverty is linked to increased risk of mental illness, chronic disease, higher mortality, and lower life expectancy. Additional sources can be found in the Healthy People 2020 report.
Workforce shortages -
- Ratio of patients to primary care physicians: National Rural Health Association, About Rural Health Care, 2023
Original report: Esther Hing & Chun-Ju Hsiao, National Center for Health Statistics, Centers for Disease Control and Prevention, State Variability in Supply of Office-based Primary Care Providers: United States, 2012, 2014
Workforce shortage areas: Bureau of Health Workforce, Health Resources and Service Administration, US Department of Health and Human Services, Designated Health Professional Shortage Areas Statistics, 2023
Only 10% of physicians practice in rural areas: American Hospital Association, Rural Hospital Closures Threaten Access: Solutions to Preserve Care in Local Communities, 2022
Improving and Addressing Access to Care in Rural America
Supporting and training rural providers: Elizabeth Burrows et al., National Rural Health Association, Health Care Workforce Distribution and Shortage Issues in Rural America, 2012
Improving access to specialized care: School of Public Health and Tropical Medicine, Tulane University, How to Improve Health Care in Rural Areas, 2023
Health care workforce distribution and shortage issues: Elizabeth Burrows et al., National Rural Health Association, Health Care Workforce Distribution and Shortage Issues in Rural America, 2012
Expanding non-physician provider abilities: Elizabeth Burrows et al., National Rural Health Association, Health Care Workforce Distribution and Shortage Issues in Rural America, 2012
Strengthening the rural provider safety net -
Rural emergency hospitals: Michael Topchik et al., The Chartis Group, LLC, Rural Health Safety Net Under Renewed Pressure as Pandemic Fades, 2023
School-based clinics: Angela Fairbanks, Boise State University, A helping hand in rural Idaho: Boise State and community partners open a school-based clinic, 2021
Critical access hospitals: Rural Health Information Hub, Critical Access Hospitals, 2021
Telehealth in rural communities -
- Telehealth plays a crucial role in addressing the challenges of rural health care:
- Telemedicine encounters pre- vs. post- pandemic: Annie E. Larson, American Journal of Preventive Medicine, Before and During Pandemic Telemedicine Use: An Analysis of Rural and Urban Safety-Net Clinics, 2022
Note: By using patient addresses linked to zip code approximations of rurality, the study was able to assign individuals as urban, large rural, small rural, or isolated rural. The categorizations were based on Rural-Urban Commuting Area (RUCA) codes, which are census tract-based classifications.
Limited access to digital technology: Michael Miller, University of Cincinnati, Narrowing the digital divide for health care, 2023
- Rural population that lacks broadband access: Federal Communications Commissions, Fourteenth Broadband Deployment Report, 2021
Note: This is the most current released Broadband Deployment Report.
Additional barriers to telehealth -
Licensing and Credentialing of Providers: Rural Health Information Hub, Licensing and Credentialing of Telehealth Programs, 2023
Age & Education: Wendy Brunner et al., Telemedicine Journal and E-Health, Determinants of Telehealth Technologies in a Rural Population, 2023
Comfortability with Technology and Virtual Care: Kathleen Y Li et al., Journal of Telemedicine and Telecare, Perceptions of telehealth among older U.S. adults during the COVID-19 pandemic: A national survey, 2023
Bridging the digital divide -
$40 billion in funding: The White House, Fact Sheet: Biden-Harris Administration Announces Over $40 Billion to Connect Everyone in America to Affordable, Reliable, High-Speed Internet, 2023
High-speed internet improves access to telehealth: Jacob Fischler, Washington State Standard, ‘The internet is no longer a luxury’: $667M from USDA for rural broadband, 2023
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Published on: October 04, 2023. Updated on: October 05, 2023.