Rural News

Healthcare Access in Rural Communities

Access to healthcare services is critical to good health, yet rural residents face a variety of access barriers. A 1993 National Academies report, Access to Healthcare in America, defined access as “the timely use of personal health services to achieve the best possible health outcomes.” A 2014 RUPRI Health Panel report on rural healthcare access summarizes additional definitions of access with examples of measures that can be used to determine access.

Ideally, residents should be able to conveniently and confidently access services such as primary care, dental care, behavioral health, emergency care, and public health services. In 2012, Healthy People 2020 identified that access to healthcare is important for:

• Overall physical, social, and mental health status
• Disease prevention
• Detection, diagnosis, and treatment of illness
• Quality of life
• Avoiding preventable deaths
• Life expectancy

Rural residents often encounter barriers to healthcare that limit their ability to obtain the care they need. Access to healthcare implies that healthcare services are available and obtainable in a timely manner. Yet rural residents often encounter barriers to healthcare access. Even when an adequate supply of healthcare services exists in the community, there are other factors that may impede healthcare access. For instance, to have healthcare access, rural residents must also have:

• Financial means to pay for services, such as health or dental insurance that is accepted by the provider
• Means to reach and use services, such as transportation to services that may be located at a distance, and the ability to take paid time off of work to use such services
• Confidence in their ability to communicate with healthcare providers, particularly if the patient is not fluent in English or has limited health literacy
• Trust that they can use services without compromising privacy
• Confidence that they will receive quality care

This guide provides an overview of healthcare access in rural America, including discussion of the importance and benefits of healthcare access and the barriers that rural residents experience. The guide includes information regarding:

• Barriers to care, including workforce shortages, health insurance status, transportation issues, health literacy, and stigma in rural communities
• Access issues for specific populations and healthcare services
• Strategies and resources to improve access

For information on access to public health services in rural communities, see the Rural Public Health Agencies topic guide.

Rural and urban economies can improve with cooperation

Data revealed Thursday at MadREP’s “State of the Madison Region Economy” event highlighted significant challenges facing the seven counties outside Dane while also breaking down research reports on the region’s target economic sectors: agriculture, food and beverage; advanced manufacturing; health care; information communications technology; and bioscience.“Our rural areas are significantly under-performing compared to Dane County,” said MadREP President Paul Jadin, who presented the region’s next five-year economic development strategy.There are many reasons for that, not the least of which is the lack of robust broadband connections in parts of those counties, a farm economy that is suffering in some sectors – and a mix of opportunity and social factors that have contributed to rural out-migration in America for a century or more.Some of the friction in Wisconsin is cultural and political. Local officials in parts of the state often see cities such as Madison and Milwaukee as wealthy enemies, even if so much of the state’s economy depends on healthy urban centers. City officials, on the other hand, are sometimes accused of land grabs to build municipal tax bases.

Opportunity Zones Skip Over Hard-Hit Rural Places

Shelterforce is right on the money in their article, “Pushing Opportunity Zones to Fulfill Their Promise.” The piece urges urban leaders across the country to set guiding principles to make sure this new tax incentive, called the “most significant community development program to pass in a generation,” leads to equitable development and not displacement of low-income residents and people of color. Opportunity Zones were created by the federal tax overhaul in 2017 to entice private investors to underserved areas by eliminating capital gains taxes owed on prior investments if reinvested in Opportunity Zone communities for at least a decade. The new program has already attracted $28 billion in investment capacity.But many rural communities, like many urban neighborhoods, need outside investment to create jobs, build affordable housing, provide critical services, and incent broadband and renewable energy infrastructure. So why are rural communities barely targeted in the Opportunity Zone marketplace? According to the experts, the deals are too small, the risk is too high, the real estate doesn’t appreciate so as to produce capital gains, and investors don’t know rural places and players.At least six states, however, are testing strategies that can crack the code for rural. Three states, Kentucky, Alabama, and Texas, are seeking to sweeten the deal for investments in rural Opportunity Zones through proposed legislation enabling state tax credits on top of the federal ones. Just signed into law in the State of Washington is a new tax preference for state taxpayers who contribute to a Rural Development and Opportunity Zone Fund, for a total of $65 million/year. But perhaps most useful are Virginia’s, Oregon’s, and Alabama’s efforts to respond to the persistent challenge of limited development capacity in rural places—lack of local expertise to move qualified deals forward and connect them with state and national capital sources.

Rural Strength and Possibility

Smart and effective community development financial institutions are investing in the success of rural America. The results contradict arguments that America should write off everyone who lives outside large cities. Rural America isn’t going to hell in a handbasket. There’s more strength and possibility in rural areas than today’s popular narrative would have us think. I’ve spent much of my career on and around rural development issues, and I believe we can’t just write off 14 percent of the country’s population and 85 percent of its land mass, throw up our hands, and tell people to buy a bus ticket out or be doomed. There is a power to place. We need people in rural America.Modern American agriculture leads the world in food, fuel, and fiber innovations—there’s a strength here that as a nation we need to encourage. some of the most forceful, creative, and capable community development practitioners—community development financial institutions (CDFIs)—are fighting in and for highly distressed rural areas. They are proving the fight can be won.CDFIs have proven experience and the conviction that decent housing, clean drinking water, and life enriching community facilities and opportunities can happen in even the remotest and poorest areas. We’re not grappling with the mysteries of cancer. We know how to solve problems in rural infrastructure, housing, banking, small business, and healthcare. The solution is capital, resources, and perseverance.