It is well known that with COVID-19 cases on the rise in much of America, extra stress has been put on healthcare workers and departments. One specific area of great focus includes rural areas, where hospitals were financially ill-prepared for the onset of COVID-19. Rural hospitals are finding themselves in vulnerable positions as they consider how to manage both the extreme loss in revenue due to canceled elective surgeries and the costly nature of acquiring ventilators.
Due to the precarious situation rural hospitals have encountered (only having an average of 21.3 days of cash on hand for Rural PPS Hospitals 26-50 beds), multiple rural hospitals across the US have been forced to close and many more are under threat of closure. These increasing closures in many rural areas cause residents to grapple with overall decreased access to care. With restricted access to care and hefty provider costs, healthcare workers are scrambling to find adaptive, modern solutions.
However, access to care in rural settings has always been a critical issue in the US as there has been much need for the development of medical infrastructure providing affordable and high-quality care to 20% of the population. In fact, of the 170 rural hospitals that have closed in the US since 2005, only 11 have shut down in 2020. With this context, it is important to understand what barriers to healthcare are still present for rural patients today, as well as what potential modern solutions will help increase overall access to care in the US.
Distance and Transportation
One of the main barriers to healthcare in rural areas is transportation. Since rural areas tend to be less densely populated, patients often travel long distances to see their medical providers. In a study by the Pew Research Center, the average urban travel time to a hospital was 10 minutes, while the average rural travel time was 17 minutes, with the top 25 percentile over 35 minutes.
While urban residents benefit from public transportation and the relative proximity of their providers, for rural residents large travel times can be a serious problem for those who require immediate care. However, they can also act as an obstacle for more mild cases, deterring patients from reporting symptoms, completing patient onboarding, or seeking primary care. The significant increase in travel time introduces a myriad of other burdens for rural residents. When a patient travels to seek medical attention, they may suffer from lost wages, time away from home, and transportation fees. Patients should not have to weigh these costs in their consideration of receiving healthcare.
cliexa’s solutions in Remote Patient Monitoring alleviate these difficulties in transportation by lowering the number of unnecessary hospital visits. Through a focus on patient engagement, wearables integration, and self-reported patient outcomes, providers can deliver high-quality care to patients exclusively through mobile devices. Also, patient intake and registration forms can be completed remotely, saving time for patients and clinicians. With the ability to receive care from the comfort of their home, patients no longer have to face the barrier of transportation.
Health Professional Shortage Areas (HPSA’s) are more abundant in rural locations. While many countries regulate the geographic distribution of healthcare providers, the US does not.Instead, physicians have complete discretion on where to work, leading to unequal health professional coverage across the country. According to the Bureau of Health Workforce, 61% of the country’s HPSA’s are located in rural areas. As a result, rural patients are less likely to have regular access to care.
Healthcare workforce shortages present a dangerous situation to rural residents who may have difficulty finding an appropriate provider. In urban areas, there are about 84 physicians per 100,000 people; however, in rural areas this number drops to 68. cliexa alleviates stress on HPSA’s by virtually connecting patients and their providers. By eliminating travel times and automating digital intake, telehealth solutions dramatically increase efficiency, allowing health professionals to reach more patients.
Poor Health Literacy
Health literacy is an important topic in modern day healthcare as new developments in the field, including new forms of treatment, can sometimes confuse patients or leave them feeling like they are not an important part of their own care decisions. According to the Rural Health Information Hub, poor health literacy can negatively impact “a patient’s ability to understand health information and instructions from their healthcare providers.” The bottom line is, poor health literacy can deter patients from taking a major role in their health journey and, in some cases, from even pursuing care in the first place.
This is a real problem especially in some rural areas where there may not be an interpreter on the staff to help non-native English speakers understand health information and services related to their care. Even aside from that case, according to the US Department of Education, only “12 percent of adults had proficient health literacy,” and “adults living below the poverty level had lower average health literacy than adults living above the poverty threshold.”Furthermore, this plays a significant role in rural areas given that The United States Department of Agriculture reports that “the large majority (301 or 85.3 percent) of the persistent-poverty counties are nonmetro… ”
However, cliexa helps patients be engaged and educated in regards to their care. All of our services have at least some features built into them to support patient education so they can be proficient in the subspecialty of care that is most relevant to them. From the Office of Disease Prevention and Health promotion, studies have shown that “adequate health literacy may increase a person’s capacity to take responsibility for their health and their family’s health,”further promoting their access to care
Another way that cliexa supports improving health literacy is through our telehealth services. Telehealth is the “delivery and facilitation of health care services through the use of remote mobile technologies.” We know that our telehealth services help patients be more connected and active in their care. With remote access to care, rural residents can utilize our telehealth services to improve their poor health literacy and find easier solutions to their barriers to care.
Health Insurance Coverage
Health insurance coverage plays a crucial role in determining access to healthcare. Rural areas tend to have consistently less coverage than metropolitan areas. According to a U.S. Census report, 9.1% of rural populations live without any health insurance compared to 8.4% of urban populations. Additionally, an article from ACA Implementation reveals that premiums are higher in rural areas and “on average, $39 more per month (10% higher) than those in urban areas”.
A higher percentage of uninsured individuals can lead to significant gaps in healthcare in rural areas. A report from the Office of the Assistant Secretary for Planning and Evaluation found that more than 25% of uninsured individuals withheld from receiving healthcare due to costs. This issue has become even more prevalent in the last few months as 5.4 million Americans have become uninsured due to Covid-related job losses.
cliexa combats sparse health insurance coverage in rural areas with innovations in telehealth. Telehealth allows patients to receive health care at lower costs than in-person visits. Virtual visits also provide a safer alternative to access care under the current conditions of COVID-19 in America, potentially saving thousands of dollars for vulnerable, uninsured individuals.
Social Stigma and Privacy Issues
A common trend across rural areas is the lack of anonymity associated with living there. This plays an important role in healthcare as some rural residents may avoid seeking necessary care as a result of social embarrassment or privacy concerns. The main avenues of care that this directly impacts includes substance abuse, mental health, sexual health, and chronic illness.
In fact, a report from the US National Library of Medicine National Institutes of Health reports that although HIV cases in rural areas have been on the rise since before 2005, “HIV-related stigma can significantly impact care utilization and health outcomes including quality of life and medication adherence and people living in rural regions often experience high levels of HIV-related stigma.” Not only is HIV-related stigma a prevalent factor in rural social settings, mental health is not regarded as much in rural areas as in urban areas. The CDC reports that “children in rural areas with mental, behavioral, and developmental disorders face more community and family challenges than children in urban areas with the same disorders.”
Although “rural adults have higher rates of alcohol abuse, tobacco use, and methamphetamine use, [and] prescription drug abuse and heroin use has grown in towns of every size… rural areas often lack options for specialty substance abuse treatment programs… which may discourage treatment utilization among vulnerable, underserved populations.” Learn more about how cliexa is taking part in Combating the Opioid Crisis with Pain Management Technology.
cliexa’s platform is perfectly geared towards helping rural residents receive care without social stigma or fear of privacy issues. Our Remote Patient Monitoring Platform lets patients report their symptoms and update their care providers securely and privately. Furthermore, our forms and assessments, such as the Fagerström Test for Nicotine Dependence (NIDE), offered on our Behavioral Health Platform, help providers have easy, reliable access to information about multiple patients coming from a wide range of areas. Finally, our Adolescent Resiliency Platform is perfectly geared towards users at risk for a number of personal health issues including sexual health, depression, and anxiety. Overall, it is clear that cliexa’s options will greatly help improve access to care for rural residents, by providing ways to circumnavigate social stigma and privacy concerns.
Rural health is in a critical state in the modern day healthcare world due to rural hospitals being financially at risk, rural residents at risk for a variety of serious conditions (including substance abuse outcomes and chronic illnesses), as well as physical and organizational barriers that limit patients’ access to care. As Georgetown University’s Health Policy Institute cleanly states, “the rural population is consistently less well-off than the urban population with respect to health.”
cliexa, however, is a virtual health platform that is set on improving access to care for rural residents via remote patient onboarding, remote patient monitoring, telehealth, secure and private form access, and patient education models. One of our fundamental goals is improving outcomes, a goal which is greatly limited due to access to care being restricted for a variety of reasons in the rural world. We are confident that our host of solutions are perfectly suited to resolving these issues and improving outcomes in one of the most critical areas of the modern healthcare world.
 UNC Rural Health Research Program; Findings Brief: Most Rural Hospitals Have Little Cash Going into COVID, May 2020. https://www.shepscenter.unc.edu/programs-projects/rural-health/projects/north-carolina-rural-health-research-and-policy-analysis-center/publications/
 UNC Rural Health Research Program: 170 Hospital Closures: 2005 – Present. https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/
Designated Health Professional Shortage Areas Statistics, Bureau of Health Workforce Health Resources and Services Administration (HRSA) U.S. Department of Health & Human Services, June 30, 2020.