The Department of Health and Human Services’ Rural Action Plan aims to address longstanding and widening healthcare disparities between America’s rural and urban areas. It does so with a four-pronged approach that emphasizes the use of technology to provide care to rural residents, with a focus on telehealth. However, some experts worry that the plan’s funding structure is insufficient to address these disparities, particularly given the financial and cultural conditions that affect rural communities’ access to and comfort with technology.
A number of challenges contribute to unequal healthcare access in rural areas. These include weak broadband and a lack of healthcare facilities [1]. Meanwhile, 130 rural hospitals have closed since 2010, pointing to the problem’s increasing urgency [2]. These differences have severe impacts on health and life expectancy. Rural Americans die an average of two years earlier than their urban counterparts. For those in impoverished and minority communities, the effect is compounded. In a study by James et al., 40.3% of non-Hispanic Black or Native American rural residents reported chronic health conditions, compared to 36% of non-Hispanic whites [3]. The COVID-19 pandemic has exacerbated inequalities, causing many rural areas to embrace telehealth and adopt new technologies in order to provide healthcare to their residents [4].
The HHS Rural Action Plan aims to improve healthcare in these areas by offering funding toward four goals: creating a health and human services network in rural America, leveraging technology, preventing disease, and increasing access to care [5]. The plan will invest over $2 million in cancer control grants and will increase funding to programs such as the Community Health Aide Program, which trains tribal health providers. The latter addresses a particularly urgent issue, since rural Native American tribes experience especially marked health disparities and shorter average lifespans [6]. The plan’s technological investments include research into improved screening for postpartum depression and $8 million in the Telehealth Network Grant Program, which will help rural providers offer emergency care using telehealth [2]
At the same time, some experts worry that the plan offers insufficient funding to support rural health initiatives, and that it fails to take into account rural/urban divides regarding technology. Senior counselor to the Benton Institute for Broadband & Society Andrew Jay Schwartzman points out the sheer expense of funding broadband for the many rural households who have none—these households make up a full one third of the population, according to Pew Research Center studies. [1,7]. Many rural residents not only lack broadband but are also less comfortable using the technology they do have. Only 76% of rural U.S. adults report daily internet use, compared to 86% of their suburban counterparts. In a survey-based study by Cole et al., healthcare providers in rural Colorado also expressed concerns that the families most in need of telehealth access were least likely to have internet access at home [8].
The new HHS Rural Action Plan creates or increases funding for a diverse range of rural healthcare initiatives, emphasizing telehealth as a tool for providing access to rural patients. Growing disparities in health outcomes between rural and urban Americans reveal the need for action. At the same time, some studies suggest that telehealth funding can succeed only when underlying issues concerning access to technology are addressed.
References
[1] LaRock, Zoë. “HHS’ Rural Action Plan Contains Shortcomings That Could Mute Its Potential.” Business Insider, 9 Sept. 2020, www.businessinsider.com/hhs-rural-action-plan-falls-short-when-comes-to-funding-2020-9.
[2] Stephenson, Joan. “Federal Plan Proposes Improving Rural Health Care Through Telehealth.” JAMA Health Forum, vol. 1, no. 9, 2020, doi:10.1001/jamahealthforum.2020.1186.
[3] James, Cara V., et al. “Racial/Ethnic Health Disparities Among Rural Adults — United States, 2012–2015.” Surveillance Summaries, vol. 66, no. 23, 2017, pp. 1–9., doi:10.15585/mmwr.ss6623a1.
[4] Hirko, Kelly A, et al. “Telehealth in Response to the COVID-19 Pandemic: Implications for Rural Health Disparities.” Journal of the American Medical Informatics Association, 2020, doi:10.1093/jamia/ocaa156.
[5] Bendix, Jeff. “HHS Releases Plan to Strengthen Rural Healthcare.” Medical Economics, 30 Sept. 2020, www.medicaleconomics.com/view/hhs-releases-plan-to-strengthen-rural-healthcare.[6] Carron, Rebecca. “Health Disparities in American Indians/Alaska Natives.” The Nurse Practitioner, vol. 45, no. 6, 2020, pp. 26–32., doi:10.1097/01.npr.0000666188.79797.a7.
[7] Perrin, Andrew. “Digital Gap between Rural and Nonrural America Persists.” Pew Research Center, Pew Research Center, 21 Aug. 2020, www.pewresearch.org/fact-tank/2019/05/31/digital-gap-between-rural-and-nonrural-america-persists.
[8] Cole, Beth, et al. “Report on the Use of Telehealth in Early Intervention in Colorado: Strengths and Challenges with Telehealth as a Service Delivery Method.” International Journal of Telerehabilitation, vol. 11, no. 1, 2019, pp. 33–40., doi:10.5195/ijt.2019.6273.