Rural residents often encounter barriers to healthcare that limit their ability to obtain the care they need. Access to healthcare implies that healthcare services are available and obtainable in a timely manner. Yet rural residents often encounter barriers to healthcare access. Even when an adequate supply of healthcare services exists in the community, there are other factors that may impede healthcare access. For instance, to have healthcare access, rural residents must also have:
Rural populations are more likely to have to travel long distances to access healthcare services, particularly subspecialist services. This can be a significant burden in terms of travel time, cost, and time away from the workplace. In addition, the lack of reliable transportation is a barrier to care. In urban areas, public transit is generally an option for patients to get to medical appointments; however, these transportation services are often lacking in rural areas. Rural communities often have more elderly residents who have chronic conditions requiring multiple visits to outpatient healthcare facilities. This becomes challenging without available public or private transportation. RHIhub's Transportation to Support Rural Healthcare topic guide provides resources and information about transportation and related issues for rural communities.
Are mental health facilities in India adequate
Healthcare workforce shortages impact healthcare access in rural communities. One measure of healthcare access is having a regular source of care, which is dependent on having an adequate healthcare workforce. Some health services researchers argue that evaluating healthcare access by simply measuring provider availability is not an adequate measure to fully understand healthcare access. Measures of nonuse, such as counting rural residents who could not find an appropriate care provider, can help provide a fuller picture of whether a sufficient healthcare workforce is available to rural residents. See What state-level policies and programs can help address the problem of shortages in the rural healthcare workforce? on RHIhub's Rural Health Workforce topic guide, for more information.
A shortage of healthcare professionals in rural areas of the U.S. can restrict access to healthcare by limiting the supply of available services. As of September 2022, 65.6% of Primary Care Health Professional Shortage Areas (HPSAs) were located in rural areas. For the most current numbers, see the Health Resource and Services Administration (HRSA's) Designated Health Professional Shortage Areas Statistics. HRSA also includes statistics on mental health and dental HPSAs.
In rural areas, because there is little anonymity, social stigma and privacy concerns are more likely to act as barriers to healthcare access. Rural residents can have concerns about seeking care for mental health, substance use, sexual health, pregnancy, or even common chronic illnesses due to unease or privacy concerns. Patients' feelings may be caused by personal relationships with their healthcare provider or others working in the healthcare facility. Additionally, patients can feel fear or concerns about other residents, who are often friends, family members, or co-workers, who may notice them utilizing services for health conditions that are typically not openly discussed, such as counseling or HIV testing services. Co-location or the integration of behavioral health services with primary care healthcare services in the same building can help ease patient concerns. Understanding Rural Communities, a 2018 podcast from the Hogg Foundation for Mental Health, features an interview with Dennis Mohatt, the Vice President for Behavioral Health at the Western Interstate Commission for Higher Education (WICHE), discussing rural health and the stigma surrounding mental healthcare in rural communities.
Access to mental health providers and services is a challenge in rural areas. As a result, primary care providers often fill the gap and provide mental health services. However, primary care providers may face challenges that may limit their ability to provide mental health care access, such as inadequate financial reimbursement or lack of time with patients.
Mental Health HPSAs are scored 0-25, with higher scores indicating a greater need for mental health providers. The November 2022 map below highlights mental health HPSAs for both metro areas, in multiple shades of purple, and nonmetro areas, in various shades of green.
Due to the lack of mental health providers in rural communities, the use of telehealth to deliver mental health services is increasing. The June 2016 Agency for Healthcare Research and Quality technical brief, Telehealth: Mapping the Evidence for Patient Outcomes from Systematic Reviews, found that mental health services can be effectively delivered via telehealth. By using telehealth delivery systems, mental health services can be provided in a variety of rural settings, including rural clinics, schools, residential programs, long-term care facilities, and individual patient homes. Additionally, the Calendar Year (CY) 2022 Medicare Physician Fee Schedule Final Rule made permanent the ability for FQHCs and RHCs to be reimbursed by Medicare for telemental health appointments. RHIhub's Telehealth Use in Rural Healthcare topic guide has many more resources on how telehealth can improve access to care. For additional resources on access to mental health services in rural areas, see RHIhub's Rural Mental Health topic guide.
A shortage of mental health and substance use disorder clinicians in rural communities led to the development of new models to bridge the gap and provide needed mental health and substance use disorder services using allied behavioral health workers, such as:
Local rural healthcare facilities may choose to join healthcare networks or affiliate themselves with larger healthcare systems as a strategic move to maintain or improve healthcare access in their communities. These affiliations or joining of healthcare networks may improve the financial viability of the rural facility, provide additional resources and infrastructure for the facility, and allow the rural healthcare facility to offer new or expanded healthcare services they could not otherwise provide. However, the benefits of an affiliation with a larger healthcare system may come at the expense of local control.
An adequate workforce is necessary for maintaining healthcare access in a community. In order to increase access to healthcare, rural communities must use their healthcare professionals in the most efficient and strategic ways. This might include allowing each professional to work at the top of their license, using new types of providers, working in interprofessional teams, and creative scheduling to offer clinic time outside of regular work hours.
RHIhub's Rural Healthcare Workforce topic guide discusses how rural areas can address workforce shortages, such as partnering with other healthcare facilities; increasing pay for staff; adding flexibility and incentives to improve recruitment and retention of healthcare providers; and using telehealth services. The guide also discusses state and federal policies and programs to improve the supply of rural health professionals, such as loan repayment programs and visa waivers.
The federal Indian Health Service (IHS) provides healthcare and prevention services to AI/AN people. Broken Promises: Continuing Federal Funding Shortfall for Native Americans, a 2018 report, states that federal funding for Native American programs in the past 15 years has been severely inadequate and does not meet the basic needs and services of the federal government's obligations to the populations they serve, which in itself is a barrier to accessing healthcare for AI/AN people. IHS provides direct healthcare services at an IHS facility or Purchase/Referred Care (PRC) provided by a non-IHS facility or provider through a contractual agreement, and these services are not considered healthcare insurance coverage. This is explained further in RHIhub's Rural Tribal Health topic guide question Is access to Indian Health Service (IHS) resources considered health insurance?
When it was enquired about the available mental health services under DMHP, NMHP, only Asha workers heard about these and said that few times they had meetings on the same and took some patients for treatment to district hospitals. Whereas, the community people were not aware of these services. The community people agreed that awareness is increasing gradually compared to previous years.
It was found that most of the people who have mental illness were poor and depended on daily wages. If they need treatment, they need to go to a district hospital which is far away which was adding to the transport cost and denying their daily earnings. Further, the research findings were also found that in some villages, there was no PHC. Apart from the distance, it was found that transportation facilities were very limited. As a result, many patients avoid going to the hospital.
The Charter, released today for World Patient Safety Day, calls on governments\r\n and those running health services at local levels to take five actions to better protect health workers. These include steps to protect health workers from violence; to improve their mental health; to protect them from physical and biological hazards;\r\n to advance national programmes for health worker safety, and to connect health worker safety policies to existing patient safety policies.
In addition to the Health Worker Safety Charter, WHO has also outlined specific World Patient Safety Day 2020 Goals for health care leaders to invest in, measure, and improve health worker safety over the next year. The goals are intended\r\n for health care facilities to address five areas: preventing sharps injuries; reducing work-related stress and burnout; improving the use of personal protective equipment; promoting zero tolerance to violence against health workers,\r\n and reporting and analyzing serious safety related incidents. \r\n 2ff7e9595c
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