Across the country, rural hospitals are closing, leaving residents with limited access to health care—whether they are insured or not. Kaiser Health News reports that 48 rural hospitals have closed since 2010 and as many 283 more are at risk. These closing are partially due to national policy, including reduced reimbursement rates under the ACA, but also due to the many challenges involved in serving rural communities:
Rural hospitals also suffer from multiple endemic disadvantages that drive down profit margins and make it virtually impossible to achieve economies of scale.These include declining populations; disproportionate numbers of elderly and uninsured patients; the frequent need to pay doctors better than top dollar to get them to work in the hinterlands; the cost of expensive equipment that is necessary but frequently underused; the inability to provide lucrative specialty services and treatments; and an emphasis on emergency and urgent care, chronic money-losers.
These challenges make one of the best cases for telemedicine. The national doctor shortage that experts have predicted will hit rural areas much, much harder than it will urban areas. Newly minted doctors are reluctant to move to “the hinterlands,” but still pile into popular cities in large numbers. This is one instance of the “brain drain” that is depleting rural communities in general, and probably can’t be totally solved without more people making the decision to live outside major cities.Technology, however, can help alleviate the problem. Surgeries and other intensive procedures of course can’t be done at a distance. But doctors who choose to live in cities can see rural patients for routine primary care via Skype, while remote monitoring systems can allow health care providers to keep a close eye on the vitals of chronically ill patients from a distance (this is also cheaper than hospital care, as an added benefit). Legal barriers that limit the promise of telemedicine exist—for instance, regulations prohibiting doctors from being reimbursed for virtual visits. Meanwhile, the AMA supports telemedicine on the condition that doctors get licensed in every state in which they “see” patients, even virtually. The quicker we can tear these barriers down, the better we will be able to get more and perhaps better health care to underserved rural populations.