Health inequalities are a problem across the world, whether in terms of differences in health outcomes among rich and poor, or access to service between urban and rural dwellers. New research from Saint Louis University College for Public Health and Social Justice highlights how a lack of talent is resulting in people in rural areas suffering because too few professionals exist to help them.
The researchers examined Medicare data for patients with chronic health problems, and found that the talent shortage is so severe that extreme health inequalities are emerging.
“People on Medicare with chronic conditions such as heart failure or diabetes who live in rural areas have higher death and hospitalization rates than their urban peers,” the researchers say. “The biggest reason for this appears to be that people in rural areas have less access to specialist physicians like cardiologists and endocrinologists.”
Improving coverage
The researchers advocate a number of strategies that could help to improve coverage in rural areas, and therefore reduce health inequalities. These include:
- Expanding telemedicine in key areas, such as cardiology, to provide routine specialty care visits through technologies such as video conferencing
- Adding incentives for physicians to practice in rural areas such as loan forgiveness
- Considering differential payment rates that offer specialists who practice in rural areas more money
- Incentivizing rural and urban hospitals partnerships
- Bringing urban specialists into rural health systems on certain days of the week
The findings were consistent across a range of conditions, including diabetes and heart disease, and covered some 10% of Medicare beneficiaries. The evidence clearly showed that seeing a specialist more frequently was greatly linked to improved health outcomes, ranging from preventable hospitalizations all the way to death.
“Our research shows that all Medicare beneficiaries with chronic conditions–urban and rural–have lower death and hospitalization rates when they visit a specialist at least once annually,” the researchers say. “Primary care is important, but it is not enough by itself; specialist care is needed as well.”
