Health Care Can Be Hard to Find in Rural America

One major driver of these shortages is hospital closures. Since 2010, 150 rural hospitals have either shut down completely or stopped providing inpatient care. Besides driving out health care professionals, these closures create shortages of major medical, acute, and emergency care. 

In some rural areas, the local pharmacy is the only place to go for health questions, blood pressure checks, and minor acute care. But those may be going away, too. From 2003 to 2021, 836 pharmacies closed in rural areas – a trend that seems to be continuing. In 2021, 101 rural counties had no pharmacy at all. In some cases, pharmacists were the last available health professional in the area.

Cost of Care

Poverty rates are higher in rural America, and average incomes are lower. Still, rates of uninsured adults over age 65 are no higher in rural than in urban and suburban areas. Most Americans over age 65 are eligible for Medicare. But Medicare Advantage copays and deductibles are higher in rural areas than in other parts of the U.S. – adding financial burden to a group of people who may already be cash-strapped.

Distance to Care

Health care comes with other added costs when you live out in the country. As providers leave these areas, the distance to the next nearest provider grows. When a hospital closes in a rural area, it’s estimated that residents will have to travel an extra 20 miles for common health care services and an extra 40 for less common ones. This can be a serious hurdle for older adults who may not drive, have cars, or be able to afford the gas they’d need for a long trip to the doctor’s office. In an emergency, it could mean the difference between life and death. 

Delaying or Skipping Health Care

Though rural dwellers are generally older and sicker than their metropolitan counterparts, research shows that they use health care less. This is certainly due, at least in part, to the cost and the distance, which can prompt them to skip doctor’s appointments or put off picking up critical prescription medicines. 

The COVID-19 pandemic, a time when it was more common to delay care, helps illustrate the consequences of putting off procedures, doctor visits, and picking up prescriptions. A 2023 study in the Journal of the American Geriatric Society found that nearly a third of older adults put off health care during the pandemic. Though some went on to get that care later, 1 in 5 who delayed care said the decision had a negative impact on their health. 

It’s not only cost and distance that may lead rural adults to put off needed health care. Privacy may also be a more pressing concern for rural adults who feel they can’t go anywhere without seeing someone they know. In particular, this can prompt people to forgo care for conditions they perceive as shameful, such as mental illness or substance use disorders. 

As many as 1 in 4 rural older adults may have psychiatric conditions for which they cannot or will not seek care. Substance abuse disorders aren’t just for young people either. A 2022 study in Addiction and Health found that nearly 1 in 20 adults over 65, and counting, have a substance use disorder, most often involving alcohol, prescription drugs, like opioids and benzodiazepines, and over-the-counter meds. 

Rural Social Isolation

Mental illness and substance use disorders can be triggered or made worse by the social isolation that can be part and parcel of older age, especially in rural areas. 

Besides of its impact on mental health, social isolation has been connected to risks for Alzheimer’s disease, a weakened immune system, higher blood pressure, heart disease, and increased stress, which itself is another risk factor for many health conditions. Social isolation has also been tied to suicide risk. Research suggests that ongoing social isolation could be as bad for health as 15 cigarettes a day. 

Digital Connectivity: A Barrier and a Bridge

The internet offers powerful solutions to many of the challenges that older adults in rural America face. It can eliminate the distance to all kinds of engagements, from doctor’s appointments to book club meetings, through video conferencing. 

Project ECHO is an example of one of many ways the internet can increase access to care in rural areas. This program, based at the University of New Mexico, connects rural health care providers, including doctors, nurses, and physician assistants, with medical specialists that may be hundreds of miles away. The specialists consult on patient cases and make recommendations so they can reduce some of the need for rural people to travel long distances for specialty care. 

A Multi-Pronged Approach

Ensuring internet access for all Americans would help improve access to health care and begin to bridge the gap between metropolitan and rural people. But it will take much more to provide rural Americans with the kind of care that many city dwellers might take for granted. 

Struggling hospitals need support to stay open. Health care professionals need incentives to move to and practice in rural areas. Students who want to be health professionals need more exposure to rural areas during their training to make it more likely they will choose to practice in that type of setting. Rural residents themselves need transportation to distant medical appointments; support using the internet to access telehealth appointments; and more health care that’s closer to home. 

The Federal Office of Rural Health Policy (FORHP) administers grants and programs to help support rural health care. Along with that federal effort, many state and local government agencies, national nonprofit organizations, and private foundations are committed to the mission as well.