Getting healthcare—and getting to healthcare—in the Appalachian Region

As part of the Health Disparities report, researchers documented issues in the Appalachian Region regarding residents’ access to care. Though there are multiple factors one must consider when examining access to care—including, of course, insurance coverage—there’s also a straightforward factor on the supply side of the equation: the number of providers available to a given population. According to the report, there are fewer high-level medical practitioners per 100,000 residents in Appalachia than in the United States as a whole. Take the following disparities:

• Primary care physicians – 12 percent fewer providers per 100,000 residents in Appalachia than in the country overall
• Mental health providers – 35 percent fewer
• Specialty physicians – 28 percent fewer
• Dentists – 26 percent fewer

It’s important to note that these figures are per 100,000 residents, which means that these lower numbers of medical practitioners throughout the Region cannot be explained away by lower populations.

Keeping that in mind, however, there does exist a geographic variation within the Region when it comes to the supply of practitioners: there are greater supplies of the four types of providers in metro areas than there are in non-metro and rural areas—and again, this is per 100,000 residents. (The lone exception is for mental health providers, where the rural figure matches that found in the metro areas, though the two non-metro categories report much lower supplies.) These findings are consistent with a recent analysis undertaken by the Health Resources and Services Administration, which shows that the majority of health professional shortage areas are found in rural areas.

There are also patterns based on the economic status of Appalachian counties, with each county’s economic status determined by three economic variables: income, poverty, and unemployment. (More information about ARC’s five-tiered economic classification system can be found here.) For each of the four types of practitioners, there are lower supplies per 100,000 residents in counties struggling economically (i.e., those found in the Distressed and At-Risk categories) than in the better-performing Transitional, Competitive, and Attainment categories.

Getting there

Locating more practitioners in rural areas would no doubt help matters, but even then a challenge would persist: getting residents to the practitioners. A recent poll by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health showed that 25 percent of people living in rural areas weren’t able to get needed health care recently, and that approximately one-quarter of these respondents said that the reason they weren’t able to was because the location was either too far or too difficult to get to. While this finding captures the problem of rural areas simply not having enough practitioners, there’s also another component to it: travel for people living in rural areas is oftentimes more difficult than those living in metro areas.

In a recent report released by ARC examining data from the 2013-2017 American Community Survey (ACS), vehicle availability by household was examined, and it was found that a higher percentage of households in the Region’s rural counties do not have access to a vehicle than in Appalachia as a whole (8.4 percent in the Region’s rural counties compared to 7.3 percent for Appalachia overall). Given that alternative transportation methods are oftentimes scarcer in rural areas, and the distances traveled further, this difference in vehicle access alone doesn’t entirely explain—or, do justice to—the transportation difficulties one might face when living in a rural area.

Another way

For some health issues, it’s not always necessary for the patient to physically visit the practitioner or healthcare clinic. Advances in technology have permitted telehealth to become an option in certain circumstances, and it’s one that is particularly important for those living in rural areas. Learn more from the Office of the National Coordinator for Health Information Technology on why telehealth is especially important for rural providers, and from the Mayo Clinic on the wide range of services encompassed by telehealth. For particular examples, consider two of the issue briefs released as part of this research initiative—one for smoking and another for opioid misuse—both of which include focused recommendations that include some element of telehealth.

In the simplest of terms, two things are needed in order to take advantage of a telehealth option: a computer device (desktop, laptop, smartphone, tablet, etc.) and an internet connection. If we look again at the ARC report examining 2013-2017 ACS data, we see that households throughout the Region lack in both of these areas:

• A lower percentage of households in the Appalachian Region have some sort of computer device: 82.7 percent of households, a figure lower than the 87.2 percent found in the United States as a whole.
• A lower percentage of households in the Region have an internet subscription: just 73.1 percent, which is lower than the 78.7 percent in the country overall.

If we consider the data based on a county’s metro designation, we see an even greater divide: non-metro and rural counties—places where residents would most benefit from telehealth services—have the lowest levels. Take rural counties throughout Appalachia: just 75.8 percent of households have some sort of computer device, and only 65.5 percent have an internet subscription.

Moving forward

Increasing Appalachian residents’ access to healthcare goes beyond insurance coverage; it includes increasing the number of medical professionals practicing in the Region and making it easier for patients to travel to these healthcare providers. And, when circumstances permit, it also includes ensuring that a larger percentage of residents have the ability to benefit from telehealth programs.

Like most things related to health, many factors affect a population’s access to care—and this is a good thing, because it means that many opportunities exist for stakeholders to begin working on improving access throughout their communities.