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Rural Healthcare Needs the ACA

 |  By Cora Nucci  
   January 26, 2011

People who live in rural areas have less access to medical care than residents of urban areas, ergo they receive fewer health services, such as surgery, right?

Not so fast. Despite all that's been written about barriers to access and an acute shortage of providers in rural areas, a study published this month in the Archives of Surgery offered a surprising revelation.

The study's authors set out to determine whether Medicare beneficiariesin rural areas were less likely to undergo a variety of surgicalprocedures compared with their urban counterparts. What they concluded was the exact opposite: "Medicare beneficiaries living in rural areaswere more likely to undergo a broad array of surgical procedurescompared with those living in urban areas."

Specifically, researchers from Texas Tech University Health Sciences Center and Southern Illinois University School of Medicine found that compared with urban Medicare beneficiaries, ruralMedicare beneficiaries were more likely to undergo:

  • carotid endarterectomy (35%)
  • lumbar spine fusion (32%)
  • knee replacement (30%)
  • abdominal aortic aneurysm repair (28%)
  • prostatectomy (22%)
  • aorticvalve replacement (18%)
  • open reduction and internal fixation of the femur (16%)

What's going on here?

Is this population sicker than its urban/suburban/exurban counterparts? Does it need these surgeries at greater rates than its urban/suburban/exurban counterparts? Is there a true medical need for 30% more knee replacement surgeries, or do Medicare reimbursements enter into the "to cut, or not to cut" decision-making process?

The study looked only at Medicare recipients, which usually covers persons age 65 and older, so it's logically sound to presume that this population is sicker. This group might also tend to delay getting care because of limited access to providers and/or other reasons (cost, for example).

Treatment delays, of course, may exacerbate certain conditions, speeding a patient's course toward surgery. So perhaps, the finding was not as surprising as on first glance.

Concerns about poor access to rural healthcare services, and the costs associated with private payers are very real. In remarks published in the Kansas City Star last week, Department of Health and Human Services Secretary Kathleen Sebelius spoke in defense of the Affordable Care Act:

"Families in rural areas are often forced to choose between a few powerful insurance companies. The result is that rural Americans are more likely to be uninsured, have higher out-of-pocket costs, and pay more for their insurance premiums than the rest of the country… By holding insurers accountable, the law frees families in rural communities from the worst abuses of the insurance industry and helps keep premiums down … Yet some in Congress say they want to repeal the law. We can’t afford to let that happen."

One study showing robust rates of surgical services for rural Americans should not be taken at face value. Healthcare services for this group are sorely lacking, but provisions within the ACA are in place to begin boosting both the amount and quality of healthcare. Repeal of the law would be a significant blow to this group.

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