How digital solutions can help fill the gap in rural healthcare
by: Andrew Wegrzyn, Principal, SixThirty
Co-Authored by Rutgers students: Andrew Rudolph, Gauri Kshirsagar, Matthew Knappenberger, Ziqiang Zhou, and Mayank Saboo
As innovation trends sweep over the business landscape of every industry from financial services to healthcare, questions of equal access to innovation follow, with data surrounding the utilization and uptake of new technology. Nowhere are these trends more evident than in healthcare — particularly when considering access to vital healthcare services in rural versus urban communities in the US.
Health care providers and patients in rural areas confront numerous challenges beyond those in urban areas. These factors can be divided broadly into economic, technological, and access related elements. Addressing these key challenges is vital to closing the rural to urban healthcare gap and ensuring broad uptake of new technologies that lead to better health outcomes.
Rural populations are on average older, with 18% of rural populations over age 65 compared to 12% of urban populations. Rural residents are also 30% more likely to describe their health status as poor and rural adolescent residents smoke at twice the rate compared to urban residents. At a demographic face value, access to vital healthcare services is in greater demand for rural populations given the inherent economic and demographic trends. But access to vital care is often much harder to come by in rural communities.
In urban locations, access to physicians is more convenient. According to the US Department of Health and Human Services, there are only 40 physicians per 100,000 inhabitants in rural areas, compared to 54 physicians per 100,000 in metropolitan areas[1]. Access to specialists is particularly disparate. In rural locations, specialists in mental health and other disciplines are nearly ten times less prevalent than in urban areas. And while telehealth has alleviated many issues related to access, internet connection remains an issue in many rural areas. According to recent studies, 50% of rural residences fall short of the FCC’s internet access criteria. Longer distances in rural areas make medical transportation, delivery services, and physical accessibility challenges. Most people living in rural areas have almost a 20-minute drive to the hospital for example. Access to transportation is also a barrier to rural healthcare, especially for the elderly population who may require multiple visits to different outpatient facilities.
Rural hospitals confront unique challenges due to staffing shortages, aging infrastructure, and cybersecurity risks. Persistent difficulties rural hospitals face, as outlined in a recent AHA report, include low patient volume, substantial reliance on government payers, and an aging population with chronic diseases.
Innovative digital health solutions and new technology can alleviate rural healthcare challenges corresponding to these pressing issues. Telehealth, staffing and digital health solutions, and behavior-based digital solutions represent key areas of opportunity for addressing the most pressing rural health obstacles.
Since 2000, rural home broadband access has quickly increased (driven even higher with a 10% increase in one year due to the COVID-19 pandemic)[2]. And, although rural broadband access is still not as comprehensive as suburban and urban environments, future spending and investment on infrastructure may alleviate this issue. If recent regulatory changes that expand access to telehealth continue to persist, rural healthcare could benefit tremendously over time.
Retaining and hiring new medical staff is a major issue for many rural healthcare providers. Many rural hospitals consistently find themselves understaffed (exacerbated due to higher demand during the pandemic coupled with medical staff burnout). Rural hospitals can find themselves relying on the services of traveling nurses; however, this can prove to be very costly (the average annual salary of a travel nurse is $108,000 compared to $75,000 for a staff nurse)[3].
Community health workers (CHWs) have successfully provided rural medical services in the past, especially in lower/middle-income countries with limited healthcare funding. A community health worker can have many functions, ranging from health service delivery to outreach and advocacy[4]. Rural communities may find benefits in combining the services of CHWs with telemedicine/telehealth services to provide rural populations with an integrated digital and in-person health experience.
Lastly, digital health solutions that make their way into homes and the smartphones of rural residents have a powerful potential to close healthcare access and outcome gaps. Beyond telehealth, digital health solutions that can impact personal behavior through incentives, gamification, education and more posses powerful potential for rural communities.
Companies like Vincere Health are building solutions that make their way into the pockets of patients for addressing issues like smoking cessation — meeting patients where they are and encouraging the healthy behaviors that have long term and lasting positive health impact.
As the influence of digital health solutions continues to grow, particularly outside hospitals and clinics, the benefits to rural communities and indeed the entire US population are myriad and far reaching into the future.
References
[1] https://www.hhs.gov/ and Health Resources and Services Administration and Rural Health Information Hub.
[2] https://www.pewresearch.org/17-04-20_ruraltechuse-1/
[3] https://www.travelnursing.org/why-travel-nurses-make-more-money/#:~:text=The%20average%20annual%20salary %20for,of%20Labor%20Statistics%20(BLS).
[4] https://explorehealthcareers.org/career/allied-health-professions/community-health-worker/
