Report: Rural Patients Pay More, Receive Less Care Than Urban Patients

Cheryl Clark, for HealthLeaders Media , May 4, 2009

A new federal report says rural Americans pay a lot more for healthcare that is tougher to find and less specialized than for citizens in urban areas. And, the report said, the situation is exacerbated by the recession.

The challenge, said Nancy-Ann DeParle, the director of the White House Office of Health Reform, is for the Obama administration to find reform remedies that will be effective in towns with only one or two stoplights.

The report, entitled "Hard Times in the Heartland" shows us why we must pass comprehensive health reform this year," said U.S. Health and Human Services spokeswoman Jenny Backus.

"The problems of a thin provider workforce can be expected to worsen if action is not taken," the report said. Physicians in rural areas are also older, and more likely retirement age than in urban areas.

All such issues can lead to worsening health. For example, people with diabetes receive recommended exams less frequently in rural areas, and thus have a higher rate of hospital admissions than diabetes patients in urban areas. Rural women don't get mammograms or have pap smears as frequently as urban women. And both male and female rural residents are more likely to report they are in poorer health. More patients in rural areas also meet the definition of being obese.

Highlights of the report include:

1. Rates of poverty are higher with 15% of people in rural areas living below the poverty level, compared with 12% in urban settings.

2.Rural areas are losing jobs at a faster rate than the rest of the country, which means they are also losing health insurance. Rural areas dependent on manufacturing have lost nearly 5% of their jobs since the recession began.

3. There were 72 primary care physicians per 100,000 residents in urban areas in 2005 compared with 55 per 100,000 in rural areas, and 36 per 100,000 in small rural areas. Also, there were half as many specialists in rural areas and a third as many psychiatrists as in urban areas.

4. Rural residents have many part-time, seasonal workers or are self-employed, which makes it less likely they will have private, employer-sponsored healthcare benefits.

5. According to one survey of farm and ranch operators, while 90% have insurance coverage, one-third purchased it directly from an agent, compared to the national average of 8%.

6. Rural residents spend more out-of-pocket on healthcare than their urban counterparts. And 20% of rural residents spends more than $1,000 out-of pocket for medical expenses in a year. Rural citizens pay 40% of their healthcare costs out of pocket, compared with only 30% among urban residents.

7. One in five farmers has medical debt, and in one state, farmers who purchased an individual health plan spent $2,117 on average more than colleagues who purchased insurance through a group plan.

8. Rural residents report higher rates of postponing care because of cost than urban residents. This problem is worse among rural minority populations, who are twice as likely to have deferred care in the past year as whites who live in rural areas.

"Perhaps nowhere is the economic downturn felt more than in rural America," the report said.

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