Vol. 13 Issue 2

Washington University Review of Health Spring 2020
Rural Healthcare Disparity: A National Concern
Writer: Rachel Ulbrich | Editor: Daniel Berkovich | Illustrator: Jennifer Broza
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W
e don’t have time to
wait for the ambulance
to get here.
We’ll just take her ourselves.”
The nine-year-old, curled into a
fetal position on the table, didn’t
care which vehicle would be
transporting her to the nearest
trauma center. She just wanted the
pain in her abdomen to go away, so
she could go back to school and
keep learning cursive. She couldn’t
understand why her parents were
panicking; after all, they were
doctors. They’d seen plenty of
pediatric patients with stomach
pain before. However, the image
that hung on the x-ray viewer
behind her would have unsettled
most seasoned physicians: an
unidentifiable mass overtook her
abdominal cavity and compressed
the vital organs within. Every
second counted. In the frightened
parents’ minds, there wasn’t time to
wait for a pediatric helicopter to fly
over 200 miles when they could
drive their daughter themselves.
Their Chevy Suburban broke a few
speed limits that day, but what’s a
speeding ticket compared to the life
of your child? That little girl was
me, and the choice my parents faced
that day is only one example of the
many ways that the rural healthcare
crisis continues to affect people
across the country.
Sixty million Americans live in an
area classified as “rural”; this
comprises a little less than 20% of
the American population. Only nine
percent of American physicians
practice in rural communities
(Rosenblatt, 2000). In the last 10
years, many of these rural Americans
have faced the closure of local
hospitals, 119 in total (Kahn,
Morgan, 2019); at that rate, 25% of
all rural hospitals will close within
the decade (NRHA, 2020). These
closures are primarily due to
financial circumstances unique to
rural areas: diminishing populations
are too small to support the existence
of high-profit specialty
departments and are less likely to
have high-paying insurances, while
Medicare’s Disproportionate Share
Hospital (DSH) policy disadvantages
rural hospitals compared to
urban ones. For Beverly Rollings of
Sedalia, Missouri (population of
22,000), the rural location of her
co-owned architecture firm directly
impacts the kind of insurance
options she’s able to offer her
employees: “In Pettis county…, if
you purchase through the Affordable
Care Act, you have one option.”
The limited network of this insurance
option doesn’t include providers
in Kansas City, the nearest
metropolitan area. One such
employee and his wife, after
learning that their unborn child had
polycystic kidney disease, were
forced to consider moving their
entire family to either Kansas City
or St. Louis in order to have some
kind of insurance coverage for the
treatment. After the insurance
company assured them that an
exception could be made in their
case, the couple chose to have a
C-section in Kansas City. Their
child, Simon, only lived for 12 hours
after birth. Following his death,
they received a bill for $50,000 in
the mail, as their insurance had
refused to cover the costs of their
procedure after all. The harsh
realities of this situation may be
shocking to some, but to inhabitants
of rural areas, it’s only another
anecdote highlighting the deficits
within the rural healthcare system.
Of the hospitals that remain open,
47% spend more money on a
monthly basis than is brought in,
leaving the future existence of these
hospitals in jeopardy (Kahn and
Morgan 2019). Hospital closures
cripple local economies, lead to
disinvestment in the area and
negatively impact a community’s
ability to attract other healthcare
providers to the area. For citizens
that already face a significant
commute to reach a healthcare facility,
these closures further limit the
ability of rural Americans to access
both emergency and preventative
care. In emergent cases, waiting an
additional 20 minutes for EMS to
arrive might mean the difference
between life and death. For farmers,
ranchers and other rural workers,
driving to a healthcare provider
may mean taking off work, which
delays the treatment of conditions
that otherwise might have been
preventable. Driving long distances
both delays the treatment of these
conditions and disincentivizes
people from consulting specialists.
Hospital closings have only increased
the distance people must
travel to gain access to basic
medical care. Dr. Roy Elfrink, a
general surgeon who’s worked in
Marshall, Missouri (population of
13,000) for over 25 years, notes that
low socioeconomic status and rural
culture both play a role in these
disparities.
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