Imagine living in an area where an appointment to see a primary care physician takes weeks or sometimes months. Or even worse, imagine if there were no primary care physicians in your area at all. These are realities many people in rural areas of the United States face. According to the Bureau of Health Professions, there are “2,100 rural underserved areas in the United States” (Health Resources & Services Administration, 2001) with roughly “20% of the U.S. population residing in a primary medical care Health Professional Shortage Area.” (Health Resources & Services Administration, 2007) The Agency for Healthcare Research and Quality states that Americans who reside in rural areas are more likely to: •
“Be older, to describe their health as poor or fair, and to lack private health insurance.” •
“Face longer distances to reach hospital or other health care services, especially dental or medical specialty care.” •
“Receive care in a less timely fashion as compared with urban dwellers.” (Agency for Healthcare Research & Quality, 2002)
With these issues to overcome, a few questions have to be asked: What are the barriers facing the rural population that need health care in the United States? Who makes up this underserved group of people? What are the barriers the rural population face when trying to access health care? What challenges do health care workers face when trying to deliver health care services to rural areas? Once these questions are asked, studied, and answered, we will then be able to discuss solutions that can alleviate some of the issues facing rural health care delivery in the United States. According to the U.S. Census Bureau’s classification, an area is classified as rural if it is located outside an “urban cluster - a dense area with between 2,500 and 49,999 people or an urbanized area -a dense area with at least 50,000 people with a 1,000 person per square mile overall density.” (Agency for Healthcare Research & Quality, 2002) Urban areas are typically defined and classified by multiple criteria whereas rural areas are defined by exclusion. The Office of Management and Budget and the U.S. Census classifies “rural” using different terms and criteria. The Office of Management and Budget classifies areas as metropolitan or non metropolitan and focuses on counties. The U.S. Census Bureau classifies areas as rural based on populations and area. The U.S. Census classifies “25% of the population (roughly 61 million) Americans as rural. The OMB classifies 23% (55.9 million) Americans as being non metro.” (United States Department of Agriculture, 2005) With these government agencies using different classification criteria, coming up with different numbers, and using a process of exclusion, none of which clearly defines what is rural, is there any wonder why this population is so often neglected? Between 2000 and 2005, the non-metro areas of the United States gained 1.1 million residents, an increase of 2.2%. According to Rural America at a Glance, a 2006 report issued by the U.S. Department of Agriculture Economic Research Service, International migration supplied nearly a third of the population growth in non-metro areas, and accounted for all statistical non-metro population growth in the Midwest. The states with the largest non-metro growth were North Carolina (111,308), Florida (110,471), Georgia (84,336), and Texas (77,724). The states with the fastest non-metro growth rates were Delaware (12.7%), Nevada (11.9%), Florida (10.9%), and Hawaii (10.3%). Age and ethnicity play a large role in the makeup of non-metro populations. In general, non-metro areas tend to have a higher concentration of older residents than metro areas. Almost “15% of the population that live in rural areas are 65 years old or older in comparison to 12% living in metro areas.”(Fox & Rosenthal, 2000) From 2000 to 2005, non-metro areas saw a 7.8% increase in people between the ages of 40-59 while there was a 5.3% decrease in non-metro...
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