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Policymakers looking to improve healthcare outcomes in rural parts of the US may want to rethink strategies that focus on luring doctors to those areas and instead create subsidies to connect patients with care in larger cities, new research suggests.
A March research brief from the University of Chicago’s Becker Friedman Institute, which analyzed Medicare claims data from 2017, found that adding more doctors and health providers in rural areas—a key health equity strategy for many policymakers—could help patients in need of emergency care or time-sensitive services. But additional providers may not be enough to bridge the rural-urban divide in care quality and patient outcomes—particularly when it comes to specialty care.
“Even if care is moved to rural areas, those hospitals can’t attain the same levels of specialization, expertise, and experience that we see in larger markets,” said Joshua Gottlieb, a health economist and associate professor with the University of Chicago Harris School of Public Policy, who worked on the report.
Lawmakers should instead focus on improving transportation affordability and access so more patients can travel to cities for healthcare services—rather than incentives, like student loan forgiveness, for doctors who relocate to rural areas, the researchers argued.
Many patients in smaller markets are already traveling for care.
According to the report, more than one-fifth of US healthcare consumption involves patients who travel to a different region for services. Those rates can be even higher when it comes to uncommon, specialty procedures.
Half of patients who received left ventricular assist devices, for example, came from different regions than the surgeon for the rare cardiac procedure, researchers found. By contrast, just 15% of patients getting routine colonoscopy screenings traveled outside their home regions.
Still, a patient’s willingness to travel for medical care is often tied to their socioeconomic status, researchers noted.
Patients living in lower-income neighborhoods are far less likely than those living in higher-income zip codes to travel for healthcare services, according to the report. Therefore, lower-income patients need larger travel subsidies to improve health equity.
Imran Cronk, chief strategy officer and founder of New York-based medical transportation company Ride Health, told Healthcare Brew that the access issue isn’t just a problem in rural areas. Even though larger cities have more public transportation, those services may not be accessible to patients in wheelchairs or with other conditions that make travel difficult.
“Across the board—urban and rural—there’s serious challenges to address,” he said. “The resources are there, but it’s about how you connect the dots between the demand and supply side, and the funding around all of that.”