05/05/1994

Quality Medical Care Could Become Scarce in Rural Areas

AUBURN, Ala. - Availability of health care is being hotly debated among the nation's policy makers, but what is the health care situation on the grass roots level? For Alabama, a vacuum in health care services appears to be forming.

Brian Vaughn, professor of family and child development in Auburn's School of Human Sciences, has been conducting surveys regarding the availability of health care for society's most vulnerable members -- pregnant women and infants. Results indicate that Alabama could face a crisis in the delivery of pre- and postnatal medical care.

"The issues are really: who's going to get health care, what are the choices and how are they paying for it?" said Vaughn.

An initial survey conducted in 1991 through the Alabama Agricultural Experiment Station (AAES) at Auburn sought to discover the trends in availability of health care throughout Alabama by examining reasons that Alabama obstetricians might continue or cease to practice.

"Responses to the survey revealed that nearly half of Alabama's counties (30 out of 67) are without services of obstetric or pediatric specialists," said Vaughn. "Counties without these services tend to be more rural than urbanized."

Results also showed that many physicians are considering discontinuing their services, though generally the number of retiring or closing practices is being offset by the opening of new practices. Unfortunately for rural Alabamians, many of the new practices are being opened in larger towns and cities, which could cause a vacuum of medical services in rural areas.

While cost of malpractice insurance and other factors influence a physician's decision to close, the survey indicated that overwork was a primary reason that rural physicians consider discontinuing their practices.

"Many of these physicians don't have back-up, so they become overwhelmed. They are the only resource in the community, and there is no way for them to get relief," explained Vaughn.

In a follow-up AAES survey, Vaughn polled 1,125 obstetric and pediatric patients to determine their perceptions of availability and quality of health care, how they finance medical services and how much travel is required to receive the services.

Most respondents said they are satisfied with the quality of care they are receiving from their obstetricians and pediatricians. The vast majority said they are willing to follow their physicians to new locations within their respective counties.

"About one out of four people reported that if their present medical provider was to stop practicing, they would not be able to find equivalent care in their community," said Vaughn. "They estimated that, if that occurred, they would have to travel about three times as far, from about 12 miles to more than 36 miles to and from to get equivalent care. Some people had to travel much farther than that." On average, respondents said they are would have to commute an extra 26 miles to reach a physician.

"This suggests that for many people there is a limited choice of physicians," he continued. About 600 of the women who responded to the survey worked outside the home, and one-third of these said that employer-paid health insurance was a major reason that they worked. An additional 120 women reported that medical benefits influenced their spouses' work decisions.

"Overall, these surveys suggest that Alabama residents living in rural counties are under-served with respect to obstetric and pediatric services," said Vaughn. "Should these services be lost, many rural patients will find it very difficult to replace them with services of equal quality."

The information gained in these surveys is helping define problems already experienced by citizens, and can be used by decision makers as they decide health care policies on state and national levels.

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News from:

Office of Ag Communications & Marketing

Auburn University College of Agriculture
Alabama Agricultural Experiment Station
3 Comer Hall, Auburn University
Auburn, AL 36849
334-844-4877 (PHONE) 334-844-5892 (FAX)

Contact Jamie Creamer, 334-844-2783 or jcreamer@auburn.edu
Contact Katie Jackson, 334-844-5886 or smithcl@auburn.edu

May 5, 1994