page_title: Rural health
section_title: Access to healthcare
hierarchical_section_title: Rural health / Health determinants / Access to healthcare
caption_attribution_description: English: Dr. Juan Manuel Romero, a cardiologist at a hospital in Ciudad Obregon in Sonora, Mexico, engages in a pre-op consultation with Alma Guadalupe Xoletxilva and her doctor, Edgar Cuevas, who are 400 miles away in La Paz, Baja California. Besides enabling doctors who are geographically separated to hear and see each other while consulting, patient information such as charts and scans can be shared in seconds. Intel Free Press story: Virtual Medicine Extends Care Anywhere. Telemedicine carts help deliver care to patients in rural and remote locations across Mexico.
context_page_description: In medicine, rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments. The concept of rural health incorporates many fields, including geography, midwifery, nursing, sociology, economics, and telehealth or telemedicine.
  Research shows that the healthcare needs of individuals living in rural areas are different from those in urban areas, and rural areas often suffer from a lack of access to healthcare. These differences are the result of geographic, demographic, socioeconomic, workplace, and personal health factors. For example, many rural communities have a large proportion of elderly people and children. With relatively few people of working age, such communities have a high dependency ratio. People living in rural areas also tend to have poorer socioeconomic conditions, less education, higher rates of tobacco and alcohol use, and higher mortality rates when compared to their urban counterparts. There are also high rates of poverty among rural dwellers in many parts of the world, and poverty is one of the biggest social determinants of health.
context_section_description: People in rural areas generally have less access to healthcare than their urban counterparts. Fewer medical practitioners, mental health programs, and healthcare facilities in these areas often mean less preventative care and longer response times in emergencies. The lack of healthcare workers has resulted in unconventional ways of delivering healthcare to rural dwellers, including medical consultations by phone or internet as well as mobile preventative care and treatment programs. There have been increased efforts to attract health professionals to isolated locations, such as increasing the number of medical students from rural areas and improving financial incentives for rural practices.
  Canadians living in rural areas and small towns have access to half as many physicians (1 per 1,000 residents) as their urban counterparts. On average, these individuals have to travel five times the distance (an average of 10 km [6.2 mi]) to access these services. They also have fewer specialized healthcare services such as dentists, dental surgeons, and social workers. One study found ambulance service was available in only 40% of the selected sites, blood and Urine testing services in one third of the sites, and only one of the 19 sites had neonatal services. Nursing service had reduced from 26.3% in 1998 to 21.1% in 2005.
  The gap in services is due, in part, to the focus of funding on higher-population areas. In China, only 10% of the rural population had medical insurance in 1993, compared with 50% of urban residents. In the 1990s, only 20% of the government's public health spending went to the rural health system, which served 70% of the Chinese population. In the United States, between 1990 and 2000, 228 rural hospitals closed, leading to a reduction of 8,228 hospital beds. In 2009, patients living in rural areas of the United States were transferred to other facilities for care at a rate three times higher than that of patients in large central metropolitan areas.
  Rural areas, especially in Africa, have greater difficulties in recruiting and retaining qualified and skilled professionals in the healthcare field. In Sub-Saharan Africa, urban and more prosperous areas have disproportionately more of the countries’ skilled healthcare workers. For example, urban Zambia has 20 times more doctors and over five times more nurses and midwives than the rural areas. In Malawi, 87% of its population lives in rural areas, but 96.6% of doctors are found in urban health facilities. Burkina Faso has one midwife per 8,000 inhabitants in richer zones, and one per nearly 430,000 inhabitants in the poorest zone. In South Africa alone, half of their population lives in rural areas, but only 12% of doctors actually practice there. One solution has been to develop programs designed to train women to perform home-based health care for patients in Rural Africa. One such program is African Solutions to African Problems (ASAP).
  In order to improve health care availability in rural areas it is important to understand patient needs - hospitals need to use their distinct populations to their advantage. "Evaluating and processing patient feedback is important for understanding and solving quality of care issues in hospitals. It is critical for rural communities to understand their demographics in order to target specific care options. By involving patients in the process of identifying community needs and weak areas of service within the hospital, administrators can expect to see specialized patient care oriented feedback.
caption: Telemedicine consult: Dr. Juan Manuel Romero, a cardiologist in Sonora, Mexico, engages in a pre-op consultation with Alma Guadalupe Xoletxilva, who is 640 km (400 mi) away in La Paz, Baja California. Telemedicine helps deliver care to patients in rural and remote areas.
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