Rural Health Disparities and Achieving Health Equity with Telemedicine

Rural populations are more likely to experience health disparities than the urban public. These are characterized by health indicators like high mortality rates, rise in cases of disease and illness, low life expectancies, and more. In addition, the rural health disparities include limited opportunities, little access to medical services, geographic barriers, and lower socioeconomic status.

Herein, Telemedicine is one advantageous factor contributing to eliminating discrimination and inequities. This article highlights the benefits of Telemedicine and how to reduce rural health disparities and throws light on ways to bridge rural disparities to achieve better health equity.

What is the difference between health disparities and health inequities?

While inequity and disparity are largely interdependent words, they differ in context. As per research, health disparity is defined as a condition where an individual experiences discrimination based on social, environmental, or economic aspects.

For example, based on statistics released by the University of Southern California, over 30 million Americans do not have insurance, wherein more than half belong to a particular race. Herein, the factors of disparity result in circumstances causing a lack of healthcare access, resources, high mortality rates, etc.

On the other hand, health inequity means not valuing everyone with equanimity. The National Center for HIV/ AIDS, Viral Hepatitis, T.B. and STD Prevention (NCHHSTP) defines inequity as the disparity based on health outcomes that are avoidable, systematic, and unjust.

For instance, reports highlight a higher mortality rate of infants among black compared to white in the U.S. In short, it is a primary cause of mortality that can be prevented.

What are the causes of rural health disparities?

The rural disparity is not caused due to a single factor but encompasses many layers. Let us look at some of the causes in detail.

1. Reduced access to Rural Healthcare

As per HPSAs (Health Professional Shortage Areas), there is a high shortage of care providers that limits the supply of rural health service availability. Based on March 2021 reports, 61.47% are available in rural areas. Therefore, it restricts patients from availing healthcare facilities and getting treated in time.

2. Lack of adequate infrastructure and mobility resources

Rural communities face significant challenges in availing affordable and safe transportation. Lack of investment in bettering the road infrastructure is a significant factor as they are the primary source of transportation. As per the U.S. Department of Transportation highlighted, about 40% of roads are ineligible for travel, while 50% of bridges 20+ feet in length are not safe to use.

Additionally, mobility issues pop up during harsh winters with reduced mobility, especially for those who lack access to private transportation.

3. Rural Regions Account for Highest Percentage of Senior Residents

As per the statistics released in ‘The Older Population in Rural America’ report for 2012 – 2016 showcases 17.5% of people in the rural region were over 65 years compared to 13.8% in the urban region. That means 1 out of 5 older Americans is from rural areas. In addition, the total share of senior citizens across 33 states exceeded the national average of 22.9%. Besides, Maine and Vermont had older populations accounting for 52.7% and 65.3%.

4. Shortage of Healthcare Workforce

Mercer, a consulting firm, highlights the lack of healthcare workforce in the U.S., forecasting over 400,000+ shortage of health aides and over 29,400 nurses by 2025. These include the growing need to increase medical school access and residency in rural regions to allow patients for health care.

5. Lower Coverage for Health Insurance

The United States does not have universal healthcare. As per the research, only 91.4% of people in the U.S. are covered with health insurance as of 2020. Moreover, that accounts for only 30% of senior citizens, which is 10% of the total population compared to the urban regions.

Some challenges include infrastructure limitations, provider shortages and uninsured rates in urban and rural areas, higher health disparities, and undefined programs, policies, and resources for insurers.

6. Higher Rural Poverty Rates

Rural poverty is one of the major factors for health disparity. According to the 2019 American Community Survey (ACS), the rural poverty rate is 15.4%. Higher poverty rates and reduced access to healthcare directly impact access to health insurance.

7. Lower Literacy About Healthcare

Health literacy is imperative to eliminating health disparity. According to sources, an estimated 80 million adults in the U.S. have limited health literacy. Examples include incomplete registration forms, missing appointments, not following medications accurately, and not following assigned treatment programs.

8. Higher Risk of Behavioral and Mental Health Issues Amongst Rural Population

Lack of literacy related to health care is another factor that lays a higher risk for behavioral and mental issues. As a result, they are more prone to indulging in substance abuse, stress, anxiety, and depression about the lack of socioeconomic factors. Besides, the stigma related to approaching a professional or understanding mental and behavioral illness symptoms puts them at a higher risk of health issues.

9. Low primary care utilization among migrant and seasonal farmworkers 

The primary care utilization by seasonal farmworkers and migrants is comparatively lower than the rural communities. As they reside there for a shorter period, low significance is given to conducting periodic health checkups, educating them about transmissible diseases and measures to prevent them.

How to Reduce Rural Health Disparities :Top Recommendations

Rural health care disparities can be dealt with by focussing on different parameters that indirectly cause health inequity. These include changing the socioeconomic factors and improving healthcare access. Let us look at some of the top ways.

1. Redesigning reimbursements for rural designations in the rural health network

There is a growing need to segregate and redefine geographies that impact reimbursements. Currently, the geographic designations are divided into New York Upstate and Downstate. While the system is extremely simple, numerous factors affect reimbursements. It requires designing a reimbursement policy to allow better provider access and public health, which is specific to the region, adjust payments, and support for programs.

2. Increase incentives for the rural workforce

Expanding the incentives plays a significant role in flattening the curve of rural health disparity. It includes raising the tuition reimbursement and waving off loan programs to draw more primary care personnel.

3. Rising reimbursement rates for healthcare in rural regions

Primary health care is one sector that remains highly underfunded. It is the need of the hour to increase the total spending and reimbursements. As per sources, primary care accounts for over half of health encounters and only receives 5 to 8% of the total expenditures. 

In addition, the health care providers are underpaid compared to their urban counterparts, one reason being the lack of providers. Therefore, balancing and raising Medicaid and Medicare reimbursement can resolve many issues. In addition, creating designations for sole community providers will incentivize health providers to ease the travel time and obstacles and allow cost-based refunds to Rural Health clinics and Critical Access Hospitals.

4. Better Healthcare Access with Telehealth Among Rural Communities

Telehealth enables rural hospitals and medical organizations to offer better quality care at reduced costs. It allows patients to travel longer distances without the hassle of inadequate infrastructure or increased charges.

The potential of Telemedicine Services was witnessed during the 2020 pandemic. The Journal of Rural Health highlighted the advantage and convenience and addressed access issues, limited barriers, and enhanced satisfaction. It allowed specialists to connect with patients virtually and make a wide range of services available through chronic care management interventions, emergency care, home monitoring, e-consults, etc.

5. Achieving Health Equity with Telemedicine

Improved Telehealth helps reduce barriers to providing access to medical health care without barriers of race, gender, class, or age. In addition, It allows equal access to healthcare for everyone regardless of social and economic status. Adding health equity in Telehealth helps change analytics, digital literacy, and technology. In short, Telemedicine opens the door to preventing health disparities and making patients feel welcomed and heard.

Conclusion

The pandemic rapidly helped in shifting from traditional to Telemedicine for accessing health. Besides, it assists in bridging the gap between access to medical assistance for rural individuals.Equipo continues to expand its telehealth services among rural communities across the nation by providing convenient services, technology tools, and remote monitoring for timely access to health services. Their services, such as virtual monitoring, have helped rural regions face new challenges and promise to assist physicians in reducing health disparities in rural areas.