Running Head: HEALTH CARE DISPARITIES IN RURAL AMERICA

Population / Community Health Promotion Project

Health Care Disparities in Rural America

With a Focus on Sussex County, Delaware

Susan Hensler

Delaware Technical Community College

NUR 330 Nursing Research

November 19, 2017

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Healthcare Disparities in Rural America

With a Focus on Sussex County, Delaware

Health care, health insurance, and accessibility to medical services are top conversations

in the news today, and with good reason: a patient seeking health care requires not only

insurance or the financial means to pay for a providers services, but also easy access to a

healthcare facility or provider. In 2004, Hartley related that rural health research and healthcare

policy was a bourgeoning field of study aimed at creating an awareness of the health disparities

between the 80% of urban/suburban America and roughly 20% of the population comprising

rural America. Hartley (2004) also discussed the need for federal funding aimed at the shortage

of providers in rural populations and the need for increased Medicaid/Medicare reimbursement.

The Federal Office of Rural Health Policys preservation of rural hospitals and the creation of

policy interventions directed toward closing the healthcare disparity gap rural Americans face

were a major focus of Hartleys (2004) study.

Data Review

Fast forward from 2004 to 2015 and Rural Healthy People 2020, a companion document

to Healthy People 2020, and the goals for rural America remain the same: increase the number of

rural providers, mitigate Medicaid and Medicare cutbacks, and reduce the number of rural

hospital closings (Texas A&M University, n.d.). Sadly, the goal target of 83.9% of Americans

with a PCP missed the mark with only 77.3% in 2011 (Office of Disease Prevention and Health

Promotion, 2014). Hopefully, 2020 will show greater improvement.

Lack of Providers and Facilities

Much of rural America faces a critical shortage of health care providers and facilities.

Bolin (2015) asserts that while rural America constitutes 17% of the nations population, only
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9% of doctors and 16% of registered nurses practice in rural areas. The Office of Disease

Prevention and Health Promotion (ODPHP) (2014) found that having a regular Primary Care

Physician (PCP) increases the likelihood of appropriate care through better communication and

trust, reduces the likelihood of premature death, and increases the quality of life. Furthermore,

the ODPHP asserts that access to health services profoundly affects every aspect of an

individuals health, yet roughly 25% of Americans do not have a primary care provider.

According to County Health Ranking (2017), finding a healthcare provider can be a challenge

for those in rural Sussex County, Delaware, which has a ratio of 1,520 persons to each physician,

significantly below the national top performer of 1,040 patients per physician, a comparison

model used as an achievable goal.

Inability to Pay

With up to 22.5% of rural Americans relying on Medicaid and with further budget cuts

expected, Families USA (2017), suggests the issue does not seem to have an easy resolution. The

Office of Disease Prevention and Health Promotion (2014) maintains that 20% of Americans

lack health insurance and County Health Rankings (2017) reported 11% of Sussex County

residents do not have health insurance. Sadly, the Office of Disease Prevention and Health

Promotion (2014) cites the Leading Health Indicator goal set forth by Healthy People 2020 of

100% of Americans having medical insurance falls short with only 83.1% insured in 2012, the

most recent data year.

Accessibility

According to a 2014 Rural Health Information Hub (2017) report, rural residents face

barriers in accessing healthcare. Even when primary health care is available, access is often

limited due to transportation issues, patient health literacy, financial constraints, or lack of
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awareness of health care resources available. If basic primary care is difficult to find, imagine the

struggle for special populations. For women, the challenges to finding health care can be even

greater. Not only do many rural counties lack hospitals that provide obstetric care, but from 2004

to 2014, the rate of areas without facilities increased from 45% to 54% due to closures of

existing obstetrical units. While 77.9% of micropolitan counties offered obstetrical services,

only 40.2% of rural counties offer these services (Hung, Kozhimannil, Henning-Smith, & Casey,

2017). And with the nationwide opiate crisis at an all-time high, it is important to consider the

statistics surrounding rural America and detoxification services. Most rural residents must drive

upwards of 100 miles to find a rehabilitation facility, and 82% of rural residents live in a county

with no detox provider.

Interventions, Goals, and Evaluation

How can these vital issues facing rural Americans be resolved? Fortunately, several

agencies are working to improve healthcare policy in rural America. The Rural Health

Information Hub (2014) reports that a major goal of the Federal Office of Rural Health Policy is

the dissemination of research findings to federal, state and local legislators toward rural

healthcare promotion policy. The Agency for Healthcare Research and Quality is mentioned by

the U.S. Department of Health & Human Services (2017) as an organization that conducts

research on rural healthcare and provides information and evidence-based outcomes. The

National Rural Health Association focuses on reduction of health disparities for rural Americans.

Offering financial incentives may be one option for maintaining or increasing rural providers

(Rural Health Information Hub, 2014). A recent article by The Kaiser Health News (2017)

reported that the Affordable Care Act is under scrutiny by the United States legislature and faces

potential insurance cost hikes. While goals for an increase in providers, affordability, and
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accessibility should be evaluated at least yearly, there is hope that by 2020 some of the goals of

Rural Healthy People 2020 will have been met.

Recommended Resources

There are hundreds of national, state, and local agencies both public and private that are

geared toward assisting rural Americans with a wide range of human service needs. Some

agencies focus on healthcare, dental, or behavioral health, while others steer consumers through

the complex maze of insurance and Medicaid / Medicare options best suited to their individual

needs. A resource for public transportation availability and schedules is available for those in

need of transportation to and from healthcare services (see Appendix A for resource information

and links).
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References

Bolin, J. (2015). Rural Healthy People 2020: New Decade, Same Challenges. The Journal of

Rural Health, 326-333.

County Health Rankings. (2017). Delaware: Primary Care Physicians. Retrieved from County

Health Rankings and Roadmaps: Building a Culture of Health, County by County:

http://www.countyhealthrankings.org/app/delaware/2017/measure/factors/4/description

Families USA. (2017, March). Cutting Medicaid Would Hurt Rural America. Retrieved from

Families USA: Familiesusa.org

Hartley, D. (2004). Rural Health Disparities, Population Health, and Rural Culture. American

Journal of Public Health, 94(10), 1675-1677.

Hung, P., Kozhimannil, K., Henning-Smith, C., & Casey, M. (2017, April). Closure of Hospital

Obstetric Services Disproportionately A ects Less-Populated Rural Counties. Retrieved

from Rural Health Research and Policy Centers: http://rhrc.umn.edu/wp-

content/files_mf/1491501904UMRHRCOBclosuresPolicyBrief.pdf

Kaiser Health News. (2017, August 2). 30 Percent Rate Hikes Reflect Uncertainty In Affordable

Care Act Marketplaces. Retrieved from Kaiser Health News: https://khn.org/morning-

breakout/30-percent-rate-hikes-reflect-uncertainty-in-affordable-care-act-marketplaces/

Office of Disease Prevention and Health Promotion. (2014). Healthy People 2020: Access to

Health Services. Retrieved from HealthyPeople.gov:

https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Access-

to-Health-Services

Rural Health Information Hub. (2014, October 31). Rural Health Disparities. Retrieved from

RHIhub: https://www.ruralhealthinfo.org/topics/rural-health-disparities#organizations
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Rural Health Research Center. (2017, May). Changes in the Supply of Physicians with a DEA

DATA Waiver to Prescribe Buprenorphine for Opioid Use Disorder. Retrieved from

Rural Health Research and Policy Centers : http://depts.washington.edu/fammed/rhrc/wp-

content/uploads/sites/4/2017/05/RHRC_DB162_Andrilla.pdf

Texas A&M University. (n.d.). Rural Healthy People 2020. Retrieved from Southwest Rural

Health Research Center: https://srhrc.tamhsc.edu/rhp2020/index.html

U.S. Department of Health & Human Services. (2017). HRQ: Agency for Healthcare Research

and Quality. Retrieved from Agency for Healthcare Research and Quality:

https://www.ahrq.gov/
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Appendix A

Resources for Rural Americans

Resources listed below are a sample of those available to assist rural Americans with

finding providers and health care facilities, locating services, obtaining insurance, and

determining qualification of free services. A resource is also provided for those in need of public

transportation.

Delaware Family Voices: Supporting families and children with special needs. Website:

http://www.delawarefamilytofamily.org/health-care is a clearinghouse type website offering

numerous sources for free or low-cost healthcare, dental, public health and insurance

information.

Delaware Division of Health and Human Services: Website:

http://dhss.delaware.gov/dhss/dph/index.html Telephone: 1-800-282-8672. This public health

website offers access to free or low-cost screenings, healthcare, behavioral, and social services to

Delaware residents.

Benefits.Gov: Website: https://www.benefits.gov can help determine individual qualification of

various government benefits

Centers for Medicare and Medicaid Services: Website: https://www.cms.gov This site has a

wealth of information that ranges from public health emergencies to affordable healthcare

options.

DART Delaware: Website: https://dartfirststate.com/ Public transportation website containing

information and schedules for public busses and trains in Delaware.