Hello and welcome back to my Civic Issue blog series, where I investigate some of the disparities and flaws in the American healthcare system. This semester’s topic is a bit heavy, but given the intricacy of the medical field in the U.S., there are so many areas of disparity to be investigated with regards to the various identities and groups being affected most. Unfortunately, despite being one of the richest countries in the world, the United States lacks in the area of healthcare. A combination of inaccessibility to care and a lack of quality healthcare whether because of poor understanding, communication, ignorance, or plain discrimination takes its toll on the citizens of the United States.
So often in the medical field, everyone’s focus is understandably centered on illnesses and diseases that harm the patients and how to fix them, not the ways that the healthcare field itself indirectly (or directly) hurts individuals, particularly those who are not white, straight, cisgender, or rich.
I understand that not everyone reading these blogs will be affected by the issues about which I write, as I, too, am not affected by all of them, but I think that it is important for everyone to be aware of the issues of any system or service they use, whether or not they are affected by said problems. Just because the healthcare system works favorably for one person does not mean that it is not flawed or harmful to other individuals.
For this instalment, I am going to segue a bit away from outright discrimination in healthcare to inaccessibility of healthcare. Particularly, I will be looking at the inaccessibility of healthcare in rural areas. I also would like to investigate the cost of healthcare, though I believe that topic to be a bit much to be condensed to half of this post and will therefore save it for the next.
During my junior year of high school we had a two-month long project for which we had to research a topic- any topic- interviewing professionals, gathering different sources, and, of course, constructing an argument before writing the research paper. I chose inaccessibility to healthcare in the United States, because, at that point, I didn’t know all that much about the U.S. healthcare system and thought it would be a good topic to learn about. I was not exactly prepared for what I learned. I was prepared to hear the expected “life-saving treatments tend to be expensive”, but did not really think that there would be much else past that.
You probably already knew that you have to pay to use an ambulance, right? Well, I did not. That one small thing, which is apparently so common, shocked me. But, moving on from cost, I wanted to investigate rural healthcare.
To start, let’s define what “rural” is for the purposes of this deep-dive into rural healthcare. With respect to accessibility to healthcare, I will be categorizing “rural” areas as areas with less than 10,000 permanent residents or areas with a lower population density.
Now, at first thought it would seem that the new wave of telemedicine would wash over rural areas with success, but this is sadly not true. The rural broadband internet connectivity is simply not good enough to support telehealth appointments on a large scale, leaving many patients stranded without care.
In addition to the lack of widespread access to virtual health appointments, there is a current shortage of trained physicians in rural areas, poor transport infrastructure, and a general lack of services all barring individuals living in rural areas from receiving medical care.
The shortage of trained physicians in rural areas is a result of many factors. One of these is that the physician population living in rural areas is typically older, and primary care providers are therefore aging out of the medical field and retiring. So, with more-or-less “current” doctors leaving rural healthcare, who is stepping up to take their place? The short answer is no one. Simply put, rural areas are not particularly attractive to young doctors looking to make their mark on the world (and pay off student loans!).
Rural areas don’t offer much opportunity for working spouses of doctors, schools tend to have fewer resources, the jobs do not pay as well, and there is a stigma around the type of care- family care- not being intellectually challenging enough for these great young minds who recently completed med school. The result of this is that there is a growing shortage of doctors in rural areas, leading to a lack of services for and poor care of patients. Rural areas just do not tend to be appealing to families of young doctors just starting their careers.
Not only are doctors sorely lacking, but so is the patient’s ability to get themselves to the doctor’s office. Rural areas are frequently overlooked in infrastructure planning for states and counties. Based on our definition of “rural”, any transport infrastructure put in place in rural areas would not benefit enough people to be considered significant either politically or when allocating funds. Consequently, if patients do not have a car, or their spouse does not have one, they are unable to get to the hospital or doctor’s office, cutting off care and services before it can even be considered an option. Of course there are things like Uber and Lyft, but these ride-share services are not nearly as accessible or common in rural regions. It is also not like patients can just get a ride in the ambulance, especially since it costs so much. Once transport to and from doctor’s appointments and hospitals are covered, there is still the issue of medicine. A patient is unable to pick up their much-needed medicine, even after they had to go to appointments that validated their diagnoses.
The combination of these factors, among others which were too broad to be effectively explored for this purpose, contributes to the comparatively lower quality of and access to medical care in the United States in rural areas. Addressing this disparities with action and funding is not exactly politically beneficial for those looking to win votes in the greater region, but it is necessary in order to see improvements in the quality of care and the subsequent improvements on the quality of life of rural Americans.
References:
https://www.aamc.org/news-insights/attracting-next-generation-physicians-rural-medicine
https://www.commonwealthfund.org/blog/2018/strengthening-health-and-health-care-rural-america
Thank you for giving me a bit of an identity crisis about the size of my hometown 🙂 Such a great post!! I have mixed feelings about telemedicine, but I agree that if implemented properly with enough coverage, it can be very helpful to rural communities.
I am in shock! I didnt know an ambulance cost money. I would rather just uber to the hospital if there was an emergency. I never looked at how rural communities could be affected by healthcare. This was very insightful.