“We have a healthcare crisis in this state,” said Dr. Daniel P. Edney, Mississippi’s State Health Officer.
Dr. Edney made these comments following the closure of a Greenville hospital’s neonatal intensive care unit and, more recently, the decrease of Greenwood-Leflore hospital’s labor and delivery services. These Mississippi hospitals’ struggles highlight the difficulty of finding and sustaining adequate healthcare in rural areas. Unfortunately, the healthcare crisis in rural areas in Mississippi is not just a Magnolia state problem. It’s a nationwide dilemma.
Nationwide, 14 % of the population, about 46 million people, live in rural communities. However, rural communities account for about two-thirds of primary care health professional shortage areas. The Kaiser Family Foundation estimated that nearly 15,000 additional healthcare providers are needed to eliminate the shortage. There are also logistical challenges to accessing care, as a 2018 report found the average time to drive to a hospital was 65 % longer in rural areas than in urban communities. A shortage of providers and difficulty getting to providers forces many people living in rural communities to seek healthcare in emergencies instead of making regular visits and seeking preventative care.
Financial barriers, scopes of practice, and the rural setting itself all serve as factors that restrict rural communities access to quality healthcare. Making healthcare more accessible in rural areas improves healthcare as costs dwindle by providing people with preventative healthcare solutions.
Financial constraints play a fundamental role in the current healthcare shortage in rural areas. In 2021, the medical school graduate debt was $203,062, and in 2020, the average dental school graduate debt was $304,824. The high costs of medical school limit who will apply, and the debt accrued from going through medical school can force physicians to pursue higher salaries more available in dense, urban areas.
Advanced practice registered nurses (APRNs) and physician assistants (PAs) are vital cogs in the healthcare system that can provide care for patients. States have different rules about whether APRNs and PAs can practice independently and what medications they can prescribe. Despite APRNs and PAs not being registered physicians, a 2018 study found no statistical difference in outcomes in rural areas when states expensed scopes of practice for nurse practitioners.
The low population density of rural areas makes traditional healthcare unsustainable as they may need to see more patients to cover their costs. Non-traditional forms of healthcare, such as telemedicine and mobile clinics, could fill the void. Forty-three states and Washington D.C. have telemedicine coverage requirements for private health insurers, but less than half of those states mandate equal reimbursement for telemedicine services or telemedicine parity.
The method used for services can result in unequal reimbursement for similar services. This leads to increased costs, especially for those living in rural communities. Enacting telemedicine parity regulations for Medicaid and private insurers would lessen the financial burden for rural communities, making the platform more accessible for those who need it most.
Mobile clinics, vehicles that provide prevention and healthcare services, have proven their value to healthcare. For example, the Family Van, a Massachusetts mobile clinic, estimates that from January 2010 to June 2012, they helped patients avoid nearly 3,000 emergency room visits resulting in statewide savings of about $1.4 million. However, clinics primarily rely on third-party funding to cover their costs resulting in 58 % reporting a lack of financial capacity as the most significant obstacle they face.
Everyone should have equal access to healthcare. However, that is not a reality for most people currently living in rural communities. That is not to say that something cannot be done about it, as solutions such as alleviating the financial concerns of medical professionals, expanding scopes of practice, and investigating non-traditional healthcare methods are available. Like everything, these solutions cost money, but the long-term benefit will save the healthcare industry millions in costs associated with hospital visits.
