Beyond insurance: Potential policy solutions for barriers to children's health care in rural communities

According to 2000 U.S. Census data, 2.7 million rural children live below federal poverty. Of 2,052 rural counties, 444 (21.5%) had child poverty rates of at least 20%. The health profile of rural children is also poor in comparison to urban and suburban children. The child mortality rate in rural communities is 40% higher than for children living in metro (urban & suburban) counties and is generally associated with a lack of accessible pre and perinatal care. Rural children experience unmet medical, dental, and mental health needs at nearly twice the rate of other child populations. Rural children are almost twice as likely, 22% versus 12%, to be uninsured for all or part of a 12 month period. Federal policies must reflect that improving access to health care in rural communities is more complex than simply extending or mandating insurance coverage. Rural counties suffer from severe health provider shortages—not only in specialty areas but in general family and pediatric practice, mid-level practitioners, dentists, and mental health professionals. When providers may be available, rural populations live at great distances, lack access to public transport, and may have unreliable personal transportation. Creating equitable access to health care services in these communities must be met through a variety of overlapping federal policies addressing each of the following: economic barriers, provider-barriers, referral and transportation barriers, cultural and health knowledge barriers. This presentation will provide a profile of rural health access barriers and a summary of potential federal policy change solutions to each.