Have you experienced a medical emergency and been forced to travel miles for treatment? Or are you near a doctor but unable to make an appointment because the provider doesn’t accept your insurance? If such situations sound familiar you are likely living in a health desert. The term “medical desert” refers to an area of limited access to healthcare. In a perfect world, everyone has both equal access and equity. However, this is not the case and with COVID-19, it’s becoming increasingly difficult to find medical facilities and doctors in these areas.
Rural Areas Face Unique Challenges
A 2019 American Hospital Association report found there are fewer than 10% physicians practicing in rural areas, despite the fact that 20% of Americans live in them.
Rural communities tend to have a slightly older demographic and face economic barriers such as low income and lack of health insurance, as well as geographic barriers such as distance to a physician. Because of these significant gaps, rural communities are at a severe disadvantage. According to The Chartis Group, rural communities have less access to primary care than urban ones. This means that rural communities struggle with health activities such as maintenance, disease prevention, patient education, and diagnosis and treatment of acute and chronic illnesses. Before joining K Health, family physician Dr. Francis Goldschmid worked in rural care. “They don’t have access to hospitals. They don’t have access to a physician. They don’t have access to good data or good advice online or otherwise,” he said.
Families within these areas are discouraged from seeking care because of additional factors such as having to travel long distances or missing work to see a physician. Furthermore, broadband access restricts their access to quality information and education. According to a recent report by the Federal Communications Commission, about 22 percent of Americans in rural areas lack access to 25/3 Mbps fixed broadband as compared to only 1.5 percent of Americans in urban areas. This means a lack of healthcare access is also linked to a lack of education and information due to limited internet.
“In Denver, I’ll get a patient from, like, Nebraska, or South Dakota, or really far away, cuz we’re the closest hospital that has a specialist that that patient needs, which is wild in the US, you know, there’s whole states that don’t have specific specialists. And there’s just these huge gaps in the availability of care,” said Dr. Sarah Malka, an emergency physician at K Health.
K Health member, Olivia Halloway, who also works as a nurse care coordinator witnessed similar experiences. “In my work as a nurse care coordinator, I have patients (specifically Medicaid patients) who experience care deserts often. Most of the time they end up calling 911, even though they aren’t having a medical emergency, just for transportation to a healthcare provider. A lot of them do live in rural areas where the closest urgent care or primary care is an hour away, she mentioned.”
These troubling barriers adversely affect the health outcomes of patients living in rural areas. These barriers account for higher rates of premature deaths in rural areas compared to urban areas.
Situational Care Deserts
If you live in an urban area or close to the hospital, but still lack access and accessibility, you may be living in a situational care desert. A situational care desert is when certain circumstances prevent you from accessing quality care.
“In my city of Denver, I have patients that are really close to the hospital but can’t afford the specialists they need or they can’t take off to get there or public transportation around them is bad. So that’s a totally different kind of care desert where they’re right next to the hospital, they can see me but they can’t access it due to finances or time or transportation. And those care deserts are almost even sadder to me, because we’re like, right there looking at them,” said Malka. K Health member, Olivia, also had her own experiences with a situational care desert. “I experienced a care desert back in July when I discovered K Health. It was a Sunday afternoon, I live within a reasonable distance of a hospital or urgent care. However, the costs are impossible to afford. As a single mother, the thought of racking up another bill left me feeling more sick than I originally felt, she said.”
Circumstances such as language barriers are another form of situational care deserts. According to the AMA Journal of Ethics, patients with limited English proficiency experience lower-quality care and experience far worse health outcomes. A study showed that only 23% of trainees received instructions on working with interpreters. Communication barriers create a situational care desert because there’s a lack of comprehension of medical instructions, post-care regimens, and can increase distrust within medical professionals.
Situational care deserts can also mean that you did a lifestyle change like move and are having trouble accessing care.
“My sister just moved. She was in Missouri and was hospitalized about a month ago. And finding a quality doctor for her was a nightmare. And she was about an hour’s drive from the nearest hospital that she could go to. Even for like a well insured, educated person, just by location, she was and she had a really hard time and she got sicker than she needed to because there just wasn’t a good physician around her to help her out. Her primary care doctor was totally overwhelmed like never responded. So it was really difficult to even with like all the things that should have been in her favor just by the location she’s in.,” explained Malka.
Circumstantial barriers contribute to health disparities because ultimately the patient could have a worse health outcome due to lack of access based on their circumstances.
Disparities Within Minority Communities
Lack of access deeply affects communities of color and causes worse health outcomes. A study published by Jama Network back in August found that communities of color spent less on healthcare than their white counterparts.
The study offered insights that Black patients saw 12% more spending in the emergency room and 26% less spending on outpatient care than the average person. For White Patients, there was 15% more on outpatient care than the average person. These insights generally suggested that hospital and emergency room care were the types of care associated with people of color, which could be due to the lack of primary care providers in underserved areas. It suggests that White patients is using preventative care and tackling outcomes earlier rather than in the emergency room.
“A lot will not get care or they’ll just wait until it’s totally necessary to go to the ER for primary care, because even though they’re going to get a bill later, we treat them upfront no payments, in that the ER, fills that gap” saId Malka in her experience within the emergency room.
Communities of color also have a wider gap due to a lack of insurance. Kaiser noted in 2019 that communities of color had a higher percentage of being uninsured compared to their White counterparts. Uninsured rates skewed even higher with states that have not expanded Medicaid programs.
With a higher percentage of uninsured, communities of color aren’t able to access high quality providers and hospitals resulting in worse health outcomes.
Healthcare infrastructures within these communities are also not always the best. Malka who helps out part time on an Indian reservation explains how infrastructure can really be critical.
“The reservation has a very small hospital. So there’s one, maybe two physicians in the hospital overnight. So anyone that’s critically sick or has any, like special care needs, we would have to transfer to the nearest city, which the nearest small cities, probably about an hour, a little more away and the nearest large cities a few hours away,” said Malka.
“Lately, and a lot of Native Americans have really complex healthcare needs, which is, in the book, given the situation. In a lot of areas, clinics tend to be pretty understaffed. A lot of help comes from volunteers who are just willing to go help. So there’s not as much healthcare infrastructure for a population that really needs a good functional, affordable health care.”
Medical Deserts On The Rise
Medical deserts are growing and some of its growth can be attributed to hospital closures.
According to the Government Accountability Office, there have been over 100 rural hospital closures from January 2013 to February 2020. This is due to rural hospitals being less profitable than urban hospitals and having lower operating margins. With lower margins, there’s generally fewer beds and lower occupancy rates. However, closures can be life threatening as it means people within those areas have to drive miles away to get care leaving the health outcome less favorable.
The Chartis Center for Rural Health also determined that 453 hospitals are vulnerable to closure based on performance levels similar to rural hospitals. With increasing hospital closures, many people will be left without a healthcare resource.
Besides closures, COVID-19 also can be attributed to those within situational care deserts. More than 30% of Americans have failed to visit their doctor for a routine checkup since the COVID-19 pandemic started, according to a survey by the professional membership organization Society for Cardiovascular Angiography & Interventions (SCAI). Routine check ups act as a way to find preventable diseases or conditions and to manage conditions so they do not worsen. Without these check ups, millions of people are in situational care deserts due to their lack of access to get care and continuing the growing healthcare disparities.
“There are areas where COVID has shut down all their urgent cares, and people feel trapped at home.,” said Malka.
How To Get Quality Care If You Live In A Care Desert
In rural and urban areas, digital health tools have made a difference when it comes to accessing care. Virtual visits can be useful for those who want to see a doctor but cannot travel long distances or for those who wish to save money on their medical visits.
“I think honestly, 80 to 85% of medicine can be done through telehealth, especially through text. I mean, when you think about it, most of the medicine is maintenance, chronic disease, maintenance, and prevention,” said Goldsmidt.
Last month, the Department of Health and Human Services announced it was distributing about 20 million to improve telehealth services in rural and medically underserved areas. The money will teach patients how to take advantage of telehealth services while training doctors and nurses on how to conduct appointments. Ultimately helping these areas get access to the expertise they wouldn’t have with the current barriers.
At K Health, we offer primary care, urgent care, and mental health treatment services for $49/month or $39 per visit. This way we can give quality remote care for the whole of you.
“I think there’s universally a sense that people feel that the current in-person healthcare system is hard to navigate and scary to know, right now and are grateful to have [K Health] as an alternative,” said Malka
Switch Mindset from Reactive to Proactive
When you change your behaviors from being reactive to proactive, you are giving your body the care it needs before it breaks down. Taking a proactive approach to your healthcare can help prevent disease, thereby lowering healthcare costs.
“The healthcare system in this country, and really globally, is very reactionary. It’s not very proactionary or proactive. It’s reactive instead of proactive, I guess. So, that becomes the problem. It’s like, can you take care of somebody who’s had three heart attacks and they have a chronic stasis ulcer on their leg from diabetes. Can you do that via text? No. But can you take care of a million people that have those conditions to prevent them from becoming that patient? Yeah, absolutely.”, said Goldschmidt
Educate yourself on the resources available to you in your local area. There are some nonprofit clinics and sliding scale clinics that may be able to provide you with care at a lower cost or can tell you about local resources to get necessary care.
If you visit 211.org, you can learn about local resources and organizations in your area. You can receive information for low-cost mental health services, help in enrolling in health insurance, and advice on how to pay for prescription medications. Educating yourself with local community organizations and resources within your care desert can get you the help you need with people that want to see you do well.
“I think it’s my job to focus on the care deserts and the populations that are not getting cared for because that’s going to make everyone healthier. And that’s what I signed up to do,” said Malka