With an estimated 1 in 5 Americans living in rural areas of the country, access to reliable, affordable telehealth care is a cornerstone in ensuring the longevity of these communities. While the COVID-19 pandemic helped popularize virtual doctor’s visits and a reassuring 37% of adults used telemedicine in 2021, there are still barriers that make it difficult for many to get the online care they need.
Why rural communities are experiencing telehealth disparity
Rural communities historically have and are continuing to experience chronic disparity across different social and economic areas. According to the USDA Economic Research Service, poverty rates in rural areas were 3.5% higher than those in urban areas. These numbers increase significantly when you factor in race. Black and African American rural residents experienced a 10.3% higher poverty rate than their urban counterparts, 10.2% for Native Americans, and 4.8% for rural Hispanic residents (USDA ERS 2019). This is compounded by a lower average level of education, higher mortality rates, and higher risk of suicide despite having similar comparable rates of mental health issues.
There are several core reasons why rural communities are experiencing these disparities.
Availability and access
According to American Progress, rural communities shoulder two thirds of the primary healthcare shortage while being less than one seventh of the population, and this doesn’t even factor in specialty care. With there being a physician shortage in America as is, having less than 8% of doctors and surgeons choosing to practice in rural areas creates a world of problems. In addition to a lack of qualified healthcare professionals in rural areas, the issue of physically getting to a provider is tantamount. This not only requires having either a vehicle or access to other means of transit, but the ability to take time off of work to travel to a provider.
With the cost of healthcare already being a significant issue for Americans regardless of demographic and location, the financial burden is especially high for rural residents. The Rural Health Information Hub reports that a 14.4% of non-metropolitan residents are uninsured, 6.4% higher than the national average of 8%. Regardless of insurance coverage, services in rural communities are found to have higher premiums, a limited availability to low or no cost charity options, and a smaller variety of accepted insurance.
Rural communities are highly vulnerable to experiencing stigma that dissuades people from getting the care that they need, especially surrounding issues of mental health. With small populations and close-knit ties, anonymity around receiving medical care is not always available. In an effort to avoid being seen as weak or “other”, many will simply forgo treatment they need and suffer the consequences down the road.
Can telehealth bridge the healthcare gap in rural communities?
Having consistent access to affordable, quality healthcare is a huge piece of the puzzle in creating healthier communities and addressing the increasingly high death rates in rural areas. Telehealth is one of the best options medical professionals have to provide equitable care. From the Rural Health Information Hub, some of the services that telehealth can bring to these areas are…
- Chronic care management interventions
- Home monitoring for patients in between regular visits
- Long-term care for chronically ill and elderly populations
- Online therapy and remote counseling to help protect patient anonymity and allow access to a wider range of mental health professionals
- Interpretation services
- Medication services
- School-based telehealth
Not only does telehealth connect rural communities with a larger pool of providers and different specialities, it also allows for flexibility in scheduling and payment.
Limitations of telehealth
Unfortunately telehealth is not a silver bullet for healthcare disparities in all rural communities. Simply having access to an electronic device and internet connection is a hurdle for many, not to mention higher rates of media illiteracy in rural communities, specifically among elderly populations. This can cause a feeling of apprehension around choosing virtual care over in office.
Access to broadband in particular can pose a problem for many trying to receive virtual care. Broadband is a type of internet connection that provides fast and reliable access to the internet. This is important for telehealth because it allows for real-time communication between healthcare providers and patients, such as video consultations and remote monitoring of vital signs.
However, broadband is not as readily available in rural communities as it is in metropolitan and urban ones. One major issue is the cost of deploying broadband infrastructure in rural areas. Because the population density is lower, it can be more expensive to lay fiber optic cables and build cell towers to provide wireless internet access. As a result, some broadband providers may be less willing to invest in rural areas because the return on investment may be lower. For rural communities, this can mean paying more for the same or lower quality internet.
To address this, there are government programs aimed at increasing the access to reliable broadband in rural areas. The USDA for example launched their ReConnect program in 2018 to help fund the development of broadband infrastructure in rural areas.
The ability to access millions of health services from nearly anywhere in the country is an incredible step forward in bridging not only the digital divide but economic and social ones as well.