By: David Ostrowsky

Whether it’s met with great anticipation or utter dread, summer will soon be giving way to autumn. For many people living in picturesque New England, where The Phia Group is headquartered, seasonal change means an upcoming weekend of leaf-peeping. But when we’re checking out apple orchards and roadside maple sugar shacks, it’s easy to forget the sobering reality: life isn’t always so sweet for residents in these one-stoplight rural outposts as many face imposing barriers to healthcare.

Healthcare inequality is a glaring problem across our nation, but the issue is particularly acute in rural America where folks grapple with a perfect storm of factors restricting access to medical facilities. The following is by no means an exhaustive rundown of contributing factors, but hopefully it does provide some insight into a predicament that millions of our fellow Americans continue to face in their quest for survival.

Scarcity of resources and personnel – Certain areas, particularly rural ones, suffer from a severe shortage of healthcare facilities. Last year, ABC News released a report outlining that from 2010 to 2021, at least 136 rural hospitals and health systems went out of business; meanwhile, as of March 2023, over 40% of rural hospitals operate with negative profit margins. With healthcare professionals, including primary care providers, in such short supply across the rural landscape, facilities have had to adjust by hiring short-term travel nurses and offering overtime pay to existing medical staff. An already precarious financial situation is exacerbated by the fact that considerable funds have to be earmarked for recruitment and retainment initiatives.

Exceptionally long distances between medical facilities – Because some rural communities are well over an hour’s drive away from one another, finding proper healthcare can be a tall order. It can become a nightmarish logistical situation when public transportation and ride–sharing services are virtually non-existent – especially for those who don’t have the capacity or resources to drive. Sadly, elderly people in dire need of care so often comprise the majority of populations in rural areas and have no way to make the trek for potentially life-saving services.

Low Rates of Health Literacy –Residing in a remote rural region of America often means having severely limited broadband internet access – and thus, the ability to acquire healthcare information that could prove vital to one’s well-being can be severely compromised. Moreover, without this resource, many rural inhabitants are less aware of what services they are entitled to, whether it be via the Affordable Care Act, a healthcare exchange, or government-sponsored subsidies, and remain disproportionately uninsured compared to Americans living in more densely populated regions. In fact, a report published by the U.S. Department of Health and Human Services in 2022 outlined that 14.4 percent of rural residents under 65, and over five percent of children under seventeen, were uninsured.

Lack of Specialized Health Care

There’s an untold number of highly critical healthcare services (i.e., home healthcare, substance use disorder services, oral health services, OBGYN care) that can be agonizingly hard to find in rural communities. The aforementioned ABC News report revealed that over seven million women live in counties with restricted or no access to maternity care, which affects half a million newborns each year. In one instance cited, some expectant mothers in New Hampshire had to drive two hours to deliver their babies.

***

In sum, this confluence of factors (along with many others) often translates to an inordinate number of rural based patients arriving at healthcare facilities with ailments that have unnecessarily progressed. With such fettered access to adequate healthcare, many have to forgo procedures or surgeries for relatively minor medical problems until they significantly worsen as well as preventive and screening services that could deter future medical issues.  While developments such as the advent of mobile healthcare and Telehealth (at least for those with internet access) have provided some relief, there is simply no panacea for this crisis.