New AHRQ Studies Identify Ways That Rural Communities Lack Healthcare Access

Press Release Date: December 3, 2019

Two new studies funded by the Agency for Healthcare Research and Quality (AHRQ) show how challenging it can be for residents of the nation’s rural areas to access mental health and hospital services. The research, published today in the journal Health Affairs, looks at services provided in areas where about 60 million people, or one in five Americans, live.

One of the studies found that rural residents with mental health needs received fewer mental health services than their urban counterparts from 2010 to 2015. The other found that rural residents often lose access to important clinical services (such as diagnostic imaging and primary care) following rural hospitals’ affiliation with larger health systems.

“Our small towns and farm communities are part of the essential fabric of the country, but healthcare in rural America is stretched too thin,” said AHRQ Director Gopal Khanna, M.B.A. “These studies show that more work needs to be done to ensure that all Americans, no matter where they live, enjoy access to a full array of mental and physical healthcare services.”

The 2010 U.S. Census found that 19.3 percent of the nation’s population resides in areas classified as rural—that is, communities ranging from densely settled small towns and “large-lot” housing subdivisions on the fringes of urban areas, to more sparsely populated and remote areas.

In one of the new studies, “Rural Residents With Mental Health Needs Have Fewer Care Visits Than Urban Counterparts

,” AHRQ researchers analyzed MEPS data and found stark differences in mental health services across rural-urban categories. For example, urban counties in the United States were significantly more likely than rural counties to have a psychiatrist. Researchers also found that residents of rural counties made significantly fewer visits to mental health professionals than residents of urban counties.

“We know that rural residents face higher death rates from suicide, overdoses, and alcohol-related liver disease than urban residents—but there is a real scarcity of mental health professionals in rural areas,” said lead author James B. Kirby, Ph.D., an AHRQ senior researcher. “These findings demonstrate the need to improve access to psychological therapy in rural communities, through in-person visits, telecounseling, and other innovations, especially in areas further away from metropolitan areas.”

The other study, “Access, Quality, and Financial Performance of Rural Hospitals Following Health System Affiliation

,” assessed the impact of rural hospitals moving from freestanding or independent status to affiliating with a health system. Analyzing data from the American Hospital Association and the federal Centers for Medicare & Medicaid Services, researchers found that rural hospitals that affiliated between 2008 and 2017 had fewer onsite diagnostic imaging technologies, fewer obstetric and primary care services and fewer outpatient nonemergency visits. However, affiliating hospitals did show a significant increase in operating margins.

“While joining health systems may improve rural hospitals’ financial performance, policymakers need to be attentive to potential reductions in access to services for rural patients,” said lead author Claire E. O’Hanlon, Ph.D., M.P.P., researcher at Veterans Affairs Greater Los Angeles Healthcare System and at nonprofit RAND Corporation, Santa Monica, California.

The study on health system affiliation was funded by AHRQ’s Comparative Health System Performance Initiative. Both studies are published in the December 2019 issue of Health Affairs, a monthly journal of health policy and research.

AHRQ, part of the U.S. Department of Health and Human Services (HHS), is the nation’s lead health services research, patient safety and quality Agency. Its mission is to produce evidence to make health care safer, higher quality, more accessible, equitable and affordable, and to work within HHS and with other partners to make sure that the evidence is understood and used.