The Mercatus Center recently released a new report, “Promoting Maternal Health in Rural and Underserved Areas.” This report addresses how new and innovative policy and technology are needed to support maternal health in rural regions of the country. While legislation and programs have been attempted, such as the recently-introduced Rural Maternal and Obstetric Modernization of Services Act and the Rural Maternity and Obstetrics Management Strategies program, Dr. Darcy Bryan argues that these efforts are not enough.
“These initiatives are limited in scope and often focus on supporting academic research of rural deficiencies to increase provider training and communication. The root causes of the rural obstetric care crisis go deeper than education grants can successfully address. Many state-level public policies have exacerbated or even initiated barriers to quality and access in rural healthcare.”
The rural healthcare landscape is varied and complex. The Mercatus report sets out to unpack the complexity, describing the ways in which even defining rural communities do not allow for policies that can be tailored to the different community needs. But the broad generalizations that can be made present a harsh reality:
"To live in a rural area often means to be underserved and under stress, isolated from critical healthcare infrastructure.”
While many people have moved out of rural areas, this movement has only placed rural hospitals under greater stress as many experience financial risk. “The National Rural Hospital Association reports that ‘currently one in three rural hospitals is in financial risk. At the current rate of closure, 25% of all rural hospitals will close within less than a decade.’”
Lacking access to medical care is a problem for everyone, but it disproportionately affects reproductive-age women, who are unable to receive the obstetric care that they need. Because of the uncertainty and potential danger of pregnancy, prenatal care is critical for these women.
Not only do women in rural areas have difficulty seeing doctors, but Mercatus reports that “cesarean deliveries, the purview of obstetricians, were performed by general surgeons in 58.1 percent of low-volume rural hospitals surveyed from November 2013 to March 2014; none were performed by general surgeons in high-volume hospitals.” Cesarean deliveries already pose a greater risk to the health of the mother and child, and in these rural hospitals, almost 60 percent are being performed by a surgeon who does not specialize in the procedure.
To address the unique challenges that women in rural communities face, Mercatus suggests a number of innovative solutions. One is utilizing telehealth. This is already used in some rural settings and it could increase access to medical consultation without the cost of time and money spent traveling to an appointment far away. Using telehealth in combination with in-person visits could provide the necessary care for these women without overburdening them due to a lack of healthcare access in their area. Mercatus suggests:
“Telemedicine can also be used to access the expertise of subspecialists, such as providers in maternal fetal medicine, in the management of high-risk pregnancies, in interpretation of fetal monitoring, and in provision of care during delivery.”
While there are policy barriers, such as state-level medical licensing and licensing wait times, with cooperation between states these could be overcome and rural communities could have better access to the care that they need.
We need to get rid of policy measures that have proven not to work, instead of throwing more money at ineffective responses. Using technology such as telehealth to reach patients will ease the strain on rural health centers and improve the health of Americans in all rural communities.