Academic journal Health Affairs devotes entire issue to rural health; read a summary of all the studies here

The peer-reviewed academic journal Health Affairs has dedicated its December issue to research about rural health. Here's a quick summary (with links) to the 12 articles. You will have to subscribe or pay to access the full articles (emailing the authors sometimes works too).

• U.S. health care spending increased 4.6 percent, to $3.6 trillion, in 2018, driven by accelerating Medicare and private-insurance spending. The increased spending was influenced by the reinstatement of the health-insurance tax. The total number of uninsured people increased by 1 million for the second year in a row, to reach 30.7 million in 2018. Read more here.
• Rural U.S. areas have had an overall higher death rate than urban areas since the 1980s, and the gap continues to widen. A 2016 data analysis found that rural mortality rates exceeded urban mortality rates in all but three states. The gap is mostly because of socioeconomic deprivation, physician shortages, and lack of health insurance. State laws that affect Medicaid access, health infrastructure and socioeconomic conditions can affect rural mortality rates. The study suggests state and policy efforts to lower rural mortality rates. Read more here.
• Rural mothers and their babies are at a higher risk of dying or experiencing life-threatening complications during childbirth, especially African Americans, Native Americans and Alaska Natives. Read more here. The Daily Yonder also has an excellent write-up of this study.
• Increasing staffing in rural community health centers can help improve behavioral health care, which includes treatment for mental health and substance abuse. The overall staff-to-patient ratio for behavioral health staffers in community health centers rose 66% between 2013 and 2017; staffing in urban centers grew 49%. Most of the added staff were clinical social workers and other licensed mental health providers, not psychiatrists or psychologists. Read more here.
• Rural residents have worse health outcomes; understanding why could inform policy proposals to close the rural-urban gap. A nationwide analysis of Medicare beneficiaries with one or more complex chronic conditions showed that such patients make up 61% of rural beneficiaries and 57% of urban beneficiaries. Rural residents had a 40% higher rate of preventable hospitalization and a 23% higher mortality rate than urban patients. Read more here.
• Rural counties with majority African American or Native American populations have the highest rates of premature death in the U.S., and are much higher than rural counties with majority white populations. Read more here.
• A 2017 law allowed nurse practitioners and physician assistants to get waivers to prescribe the opioid abuse treatment drug buprenorphine (brand name Suboxone), but there hasn't been much data about how many rural NPs or PAs have obtained such waivers. The researchers confirmed a sizeable jump in the numbers of rural clinicians who have obtained waivers. Read more here.
• Rural residents may pay more for private health insurance because they have smaller risk pools with more high-risk residents. However, the number of insurers competing in rural areas wasn't found to be a major factor in how much premiums cost. Read more here.
• Rural hospitals have been closing at an increasing rate over the past decade. That has not only reduced access to care, but has cut the number of rural physicians; when a rural hospital closes, the doctors who worked there may decamp to an urban hospital. Read more here.
• In 2017, President Trump halted the cost-sharing payments used to help low-income people with ACA Marketplace insurance. Researchers found that rural residents who were eligible for the tax credits were able to access Marketplace plans that were more affordable than those accessible to their urban counterparts, but rural enrollees without subsidies had some of the least affordable premiums for Marketplace plans. Read more here.
• Rural hospitals that affiliated with a group between 2008 and 2017 saw a significant decrease in on-site diagnostic imaging technologies, the availability of obstetric and primary care services and outpatient nonemergency visits, but saw a significant increase in operating margins. In short, joining groups may have kept some rural hospitals afloat, but reduced access to medical services for nearby residents. Read more here.
• Fewer rural residents apply to or get into medical school. Read more here, or read the more in-depth write-up on this study we did last week.