07/30/2002

Rural Health Care

AUBURN, Ala. – Ruthie Meadows is tired. She sits in her warm living room, which once served as her garage, watching sitcom reruns and trying to stay wake.

The 58-year-old grandmother has had yet another long day. At least three times a week she travels from her White Hall home in Lowndes County to Montgomery. She takes the 40-minute trip not for work or shopping, but to stay alive.

Meadows makes the drive to Jackson Hospital in Montgomery three to five times a week for dialysis and medical treatment. She’s been going for the past four years, three of which were for her battle against breast cancer.

“It’s not easy,” said Meadows as she sits on her couch, surrounded by half-filled, orange prescription bottles. “Sometimes I get tired and don’t feel good, but you got to do what you got to do.”

Meadows isn’t alone. According to Alabama Agricultural Experiment Station (AAES) and Alabama Corporative Extension System (ACES) research, one-third of Alabama’s population resides in rural areas lacking health care. In fact 46 of Alabama’s 67 counties are rural, yet less than 20 percent of the state’s doctors practice there.

“These counties become known as professional primary health care shortage areas,” said John Dunkelberger, professor of agricultural economics and rural sociology at Auburn University and an AAES researcher. “This means that a standard ratio of people to doctors is not being met. There are too few doctors and too many people, so it becomes a shortage area.”

Rural Alabamians aren’t alone when it comes to lack of physicians and medical services. According to the U.S. Department of Agriculture (USDA), one out of every five Americans live in a rural community, but only one out of every 10 physicians practice in rural areas. This leaves 22 million Americans in health care shortage areas.

AAES researchers and the USDA have examined the reasons for the lack of available health care in rural areas. Limited access to health care services, low Medicare and Medicaid reimbursements and limited facilities are some of the possible causes for the current health care plight.

“The causes for such shortages are so numerous, you really can’t pinpoint just one,” said Laura Hall, a graduate teaching assistant who is helping Dunkelberger with AAES research on rural Alabama. “And with so many problems, not only with physicians but also with rural residents, it’s hard to eradicate.”

Dunkelberger attributes the lack of rural health care in part to specialization in the medical field. In 1998 federal surveys showed 89 percent of the country’s medical specialists were in urban areas, leaving only 11 percent in rural communities.

“Today so many doctors go into specialty fields and training,” Dunkelberger said. “When they do graduate they don’t go back to rural areas because their specialized fields are in less demand than in urban areas.”

The lack of facilities is also an increasing problem according to Dunkelberger. The United States has approximately 5,134 hospitals, 2,226 of which are in rural areas. These rural hospitals are often small, with fewer than 100 beds.

“Small cities and rural areas have health clinics that communicate and share information with larger hospitals,” Dunkelberger said. “Small clinics are all that are left after rural hospitals close.”

The USDA calculated an average of 5.5 percent, or 15 rural hospitals, close each year, double the number of urban hospitals. Operating costs and low funding are the main causes for the closings, which result in the loss of 70,000 beds.

“Many small hospitals close due to the cost of needed technology and equipment and staffing costs,” Dunkelberger said. “Often these factors take more money than the hospital is bringing in. A large hospital is just seen as not needed in these small areas.”

Many rural residents also lack modes of transportation to health care facilities. Ruthie Meadows is one of those residents.

“My daughter worked in Massachusetts, she quit her job and moved back here to take care of me,” Meadows said. “She doesn’t have a job now. She tries to get work, but it’s hard to work around our schedules.”

Meadows said that there is one bus that takes people to Montgomery, but it only runs twice a day, at 7:15 a.m. and 4:15 p.m. “I tried to ask them to run more often, but they just said they couldn’t,” Meadows said. “So I spend about $40 a week on gas and keep on going.”

Dunkelberger says that transportation can be a huge problem in getting proper health care. “The trips can take more money and time than people are willing to spend, so a lot of people just don’t go,” Dunkelberger said. “ It’s not like in urban areas where people have the option of taking a bus or cab.”

Lack of insurance can also be a cause for the absence of practitioners in an area. Some 16 percent of rural residents are uninsured. Ruthie Meadows uses Medicare to cover her bills. “I just can’t afford any insurance,” Meadows said. “Even with Medicare covering 80 percent of my bills, the medication and traveling put me in a bind.”

Insurance coverage is less available in rural areas because many employers in these areas don’t offer it. Agricultural workers are less likely to be covered and many are self-employed, therefore lacking insurance. Also, 30 percent of rural residents are age 65 and older, giving a major rise to the use of Medicare in rural areas.

In 1996 the federal government calculated that out of the United States’ 20 percent rural population, 23 percent benefit from Medicare. “With so many people in rural areas depending on Medicare and Medicaid, many hospitals and physicians just can’t make it, they don’t get paid enough,” Dunkelberger said.

AAES researchers and the ACES have been seeking a solution to the ever-increasing problem of rural health care. In doing so they have found a working partnership with the University of Alabama’s School of Medicine in Tuscaloosa.

AAES researchers supply information on rural Alabama to UA’s School of Medicine in hopes of bringing doctors back to rural areas. “The vision is to recruit doctors for rural areas to stay in rural areas,” said Laura Hall.

The program recruits undergraduate pre-medical and medical students, and gives them proper medical training as well as understanding of the conditions and culture of rural Alabamians. Dunkelberger said that many doctors do not know what life in rural Alabama is like and in turn don’t know what to expect.

“Our job was to give the program the information needed to allow students to identify with rural residents,” Dunkelberger said. “The material we supply is used in the program to make students aware of real situations in rural Alabama, that every small town isn’t Mayberry. With this knowledge they can gain become part of the community and gain the trust of their patients.”

Ruthie Meadows agrees that this is important. “Sometimes they send interns down here,” she said. “They expect a lot of money; we just don’t have it and they leave. People down here need confidence that the people helping them are doing a good job.”

“We’re going in the right direction,” Dunkelberger said. “Smaller clinics are making connections and programs within communities and people are becoming educated about the problem. Education is the key here just as it is in many things. Health care is a lot like education, you get what you pay for.”

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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

July 2002