Question

You are the Director of Public Health for your state. Your state is comprised of mostly rural areas. These rural areas do not have access to many state resources, especially in terms of medical care. As director, it is your job to come up with a plan to improve access. How would you do this? Please explain your plan in detail.

Answer 1

Healthcare Access in Rural Communities

The barriers faced by the rural resident’s limits their access to healthcare services and thereby limit the concepts of universal health. The Access to Healthcare in America, is the timely use of personal health services to achieve the best possible health outcomes as per the definition of 1993 National Academies report. A 2014 RUPRI Health Panel report suggest measures that can be used to determine access. They are: the residents should be able to conveniently and confidently access services such as primary care, dental care, behavioral health, emergency care, and public health services. Access to healthcare is important for achieving the goal of Healthy People 2020. Proper access to healthcare can ensure the following aspects:

• Overall physical, social, and mental health status
• Prevention of disease
• Detection and treatment of illnesses
• Quality of life
• Preventable death
• Life expectancy

In order to ensure adequate health care for rural residents, they must have sufficient healthcare access, availability of necessary and appropriate services in a timely manner. In spite of the adequate supply of healthcare services exists in the community some other factors affects the healthcare access like financial means to pay for services - health insurance coverage accepted by the provider, transportation means to reach and use services, medical leave - ability to take paid time off of work to use the services, effective communication with healthcare providers by overcoming the language barriers, confidence in the healthcare services without compromising privacy, trust in the quality of the care that they will receive.

The barriers to care, including workforce shortages, healthcare insurance status, geographical distance and transportation, poor health literacy, and the social stigma of certain conditions such as mental health or substance abuse issues - for those in rural communities also must be addressed to ensure equitable distribution of care. The barriers compel the patients to substitute local primary care providers for specialists or they may postpone or forego care from a specialist due to the burdens of cost and prolonged travel times.

The health of the rural population is vital in the healthcare status of the country. The population's well-being and optimal health can be ensured by the access to healthcare.

To improve health care access the barriers must be addressed effectively.

1. Health Insurance Coverage

The problem of lack of health insurance coverage hinder the rural people from seeking the proper timely care. The authorities must consider designing and implementation of appropriate programs, especially for the rural community.

2. Shortages of the healthcare workforce

The shortage of healthcare professionals in rural America is a factor for limited access to care by limiting the supply of available services. According to HRSA.gov Preformatted Report -September 2018, 57.27% of Primary Care Health Professional Shortage Areas were located in rural areas. The redistribution and strengthening of a workforce to ensure adequate representation of rural areas must be done promptly.

3. Distance and Transportation

The rural people have to travel long distances to access health care services, especially the specialist care services. This will add to burden in terms of both time and money. The arrangements of proper transportation by means like public ambulance can help in this situation. The care must be made available in the rural areas as far as possible. The periodic health checkups by the healthcare workers also can reduce the transportation barriers.

4. Social Stigma and Privacy Issues

Rural communities still have a social stigma and privacy concerns and they still act as barriers to healthcare access. The people will have concerns about seeking care for issues related to mental health, substance abuse, sexual health, pregnancy, or even common chronic illnesses due to this issues. Proper health awareness programmes can be helpful in this situation to improve their understanding about the confidentiality and the treatment means of a healthcare system.

5. Poor Health Literacy

The people’s ability to understand the health information and instructions from their healthcare providers also must be considered to improve the healthcare access. The healthcare workers with knowledge on the local languages and the use of local leaders to impact the people can reduce this barrier.

The basic healthcare -Primary care is the most important aspect to improve the health status of the rural people. Effective distribution of primary care along with emergency services can reduce the healthcare gap.

The primary care services to improve rural health:

• Prevention services like improving healthy practices, immunization and early disease detection
• Effective coordination of care
• Lower the mortality rates
• Reduction in low birth weight
• Improved health behaviours
• Ensuring effective obstetric Services with the help of midwives and thereby reducing the maternal and infant mortality and morbidity rates.
• Family-based Mental Health Services and behavioural health aides
• Promoters (or community health workers) with supplemental training in mental health
• Oral Health Services
• Substance Abuse Services offered at the grass root level

The adoption of rural healthcare delivery models like Frontier Extended Stay Clinics (FESC) and Frontier Community Health Integration Program (FCHIP) supported by the Federal Office of Rural Health Policy (FORHP) can improve the health care access of the rural community. The new initiative like Telehealth and involvement of organizations to improve rural health is advisable.