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GAO-23-106651 1 (2023-05-16)

handle is hein.gao/gaooqf0001 and id is 1 raw text is: GAOL U.S. GOVERNMENT ACCOUNTABILITY OFFICE HEALTH CARE CAPSULE ACCESSING HEALTH CARE IN RURAL AMERICA May 2023 In 2020, more than 60 million people-or one fifth of the US. population-lived in rural areas thatgenerally have a population less than 2,500. Rural residents are, on average, older and generally experience worse health outcomes than urban residents. Rural Populations Face Challenges Accessing Health Care We and others have reported that people living in rural areas often face challenges accessing health care. For example, limited availability of health care providers-such as physicians or certain specialists-can make access- ing care difficult. Some reasons for limited provider availability in rural areas include difficulty recruiting and retaining providers. Our prior work also suggests lack of insurance coverage and low reimbursement rates may negatively influence access to care in rural areas. For example, low reimbursement rates can contribute to financial distress in rural hospitals, which can lead to hospital closures. The COVID-19 pandemic exacerbated many of these challenges. Our prior work indicates that some populations, such as veterans, preg- nant people, and American Indians and Alaska Natives (AI/AN), may ex- perience unique challenges accessing health care in rural areas. Examples of Populations Affected Examples of Health Care Access Challenge! Provider availability hospital closures. From 2013 through 2020, 101 (4 percent) rural hospitals closed. As a result, data show that counties with rural hospital closures generally had fewer health care providers. Limited services. More than half of rural counties did not have hospital-based obstetric services in 2018. Limited service availability is due, in part, to difficulty recruiting and retaining maternal health providers, according to experts. Recruiting and retaining providers. Various federal agencies cited difficulty recruiting and retaining providers. Difficulties stemmed from several factors, such as a lack of housing. At least 17 percent of people living in rural areas lacked broadband internet access in 2019, compared to 1 percent of people in urban areas. Insurance coverage Often rural residents either rely on Medicaid or lack insurance coverage. Both scenarios are associated with less access to care and increased risk of poor health outcomes, including maternal mortality. Travel and transportation Rural residents tend to travel farther to access health care and have fewer transpor- tation options than people living in urban areas. Internet access F5_1 Telehealth is one option to ad- dress limited provider avail- ability in rural areas; however, rural communities may have fewer broadband internet options than urban ones. Veterans. One third of veterans en- rolled in the Veterans Health Admin- istration (VHA) lived in rural areas in 2021. VHA data suggest rural veterans use certain VHA mental health ser- vices less than urban veterans, raising questions about access. (GAO-23- 105544) Pregnant people. Rural communities have higher rates of maternal mortali- ty and other adverse health outcomes. Data from 2011 through 2016 show that deaths during pregnancy or up to one year postpartum due to pregnan- cy-related causes are higher in rural areas compared to urban areas. Data also show pregnancy-related mortality rates were higher for some racial and ethnic groups, such as non-Hispanic Black people. (GAO-21-283) GAO-23-106651 Accessing Health Care in Rural America j DJ 7 CJi

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