Association between rural demography changes and health care resource availability

Understanding the demography of rural America is vital to understanding what programs, interventions, and policy initiatives are needed to improve health care access, delivery, and outcomes. This research estimated the relationship between demography, changes in demography, and health care resource availability.

Methods: This analysis used Area Health Resources File (AHRF) available from the Health Resources Services Administration. Population characteristics included percentages over the age of 65, with a college degree, unemployment, uninsured, living in poverty, and non-white. Health care resources included primary care providers per 1,000 residents, hospital and hospital bed availability, and long term care availability. Our geographic analysis is based on the county of residence.  Counties were characterized based on level of rurality using, split into rural and urban.

Findings: those counties with a vulnerable condition in 2000 were positively associated with a decline in health care resources.  Specifically, those living in counties in the highest quartile for: over the age of 65 in 2000 had a decline in long term care and home health availability; for not having a college degree saw substantial declines in hospital availability and home health agencies; for percentage living in poverty and uninsured saw an increase in primary care providers, yet decreases in hospitals; and for unemployed quartiles there was a decline in hospitals and home health agencies. Differential effects were seen for rural vs. urban populations, with rural locations seeing a decline or lower growth in all areas, across all quartiles.

Conclusions:  counties with characteristics that indicate vulnerability saw a net decrease in health care resources availability.  Existing counties with such vulnerability should be targeted for interventions to ensure equitable access to care.