Chartbook on Rural Health Care

• This chartbook includes:
  • Summary of trends in health care quality and disparities for rural populations.
  • Figures illustrating select measures of Access to Health Care and 6 NQS Priorities for rural populations.
• Introduction and Methods contains information about methods used in the chartbook.
• Appendixes include information about measures and data.
• A Data Query tool (http://nhqrnet.ahrq.gov/inhqrdr/data/query) provides access to all data tables.

Residents of Rural Areas

• Approximately 17% of Americans live in a nonmetropolitan, or rural, area.
• Although rural residents make up less than one-fifth of the U.S. population, 65% of all U.S. counties are classified as nonmetropolitan (Meit, et al., 2014).
• This includes 445 “frontier” counties (U.S. Census Bureau, 2010) that have a population density of fewer than 7 people per square mile.

Health Issues in Rural Areas

• Compared with their urban counterparts, residents of rural counties are:
  • Older.
  • Poorer.
  • Sicker (a higher percentage of residents has activity limitations due to chronic health conditions) (Meit, et al., 2014).

Life Expectancy in Rural Areas

• The life expectancy for U.S. residents decreases as the level of rurality increases:
  • In 2005-2009, those living in large metropolitan areas had a life expectancy of 79.1 years compared with 76.7 years for those living in rural areas.
  • This disparity widened over time.
  • Causes of death contributing most to lower life expectancy in rural areas include:
    • Heart disease.
    • Unintentional injuries.
    • Chronic obstructive pulmonary disease.
    • Lung cancer.
    • Stroke.
    • Suicide.
    • Diabetes (Singh & Siahpush, 2014).

Health Care Providers in Rural Areas

• Metropolitan, or urban, counties tend to have a greater supply of health care providers per capita than nonmetropolitan counties.
  • This is especially true for specialists such as neurologists, anesthesiologists, and psychiatrists.
  • The same is true for the supply of dentists, which decreases per capita as the level of rurality increases.
• Rural residents often live farther away from health care resources, which can add to the burden of accessing care (Meit, et al., 2014).
• Nonphysician practitioners, such as nurse practitioners and physician assistants are also an important part of the health care landscape in rural communities.

Hospitals in Rural Areas

• Many rural residents depend on small rural hospitals for their care.
  • There are approximately 2,300 rural hospitals throughout the country; 71% have 50 or fewer beds.
  • Most of these hospitals are critical access hospitals that have 25 or fewer beds and must meet certain distance requirements or be declared a necessary provider by the State.

Services Provided by Hospitals in Rural Areas

• Although rural hospitals vary widely, the typical rural hospital offers inpatient care that includes:
  • Surgical services.
  • Obstetric services.
  • Swing bed services.
• Rural hospitals typically do not include:
  • Intensive care unit.
  • Skilled nursing facility.
  • Psychiatric unit.
  • Rehabilitation unit.
• The typical rural hospital also offers outpatient care that includes outpatient surgical services and breast cancer screening/mammography but does not offer hospice services, home health services, chemotherapy services, dental services, or outpatient drug/alcohol abuse care (Freeman, et al., 2015).

Challenges Faced by Hospitals in Rural Areas

• Rural hospitals face unique challenges due to their size and case mix.
  • During the 1980s, many were forced to close due to financial losses.
  • The rate of closures slowed in the late 1990s and early 2000s but in recent years there has been an uptick in rural hospital closures, with at least 54 closures between January 2010 and July 2015 (North Carolina Rural Health Research Program, 2015).

NCHS Urban-Rural Classification Scheme

• This chartbook compares residents of nonmetropolitan (rural) areas with residents of large fringe metropolitan (suburban) areas:
  • Residents of suburban areas tend to have higher quality health care and better outcomes.
  • The National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme is used to guide analyses involving geographic location:
    • This scheme includes six urbanization categories, including four metropolitan and two nonmetropolitan county designations.
    • The 2013 NCHS classification system is derived from data gathered from three sources: the OMB metropolitan and nonmetropolitan designations, the Rural-Urban Continuum and Urban Influence coding systems, and the U.S. Census.

2013 NCHS Urban-Rural Classification System

Source: Ingram D, Franco S. 2013 Rural-Urban Classification Scheme for Counties. CDC, NCHS, 2013. www.cdc.gov/nchs/data_access/urban_rural.htm

Map Applying NCHS Urban-Rural Classification Scheme

Source: 2013 NCHS Urban-Rural Classification Scheme for Counties.

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