Hawaii’s rural population — approximately 30 percent of the total state population — has less access to health care than residents in urban and suburban areas, according to a new study.
The study, which includes data collected from 1,006 U.S. primary care physicians and 2,000 individual consumers around the country, was conducted by UnitedHealth Center for Health Reform & Modernization, a research and policymaking arm of the UnitedHealth Group, parent company of insurance giant UnitedHealthcare and medical information and technology company Optum.
Nationally, 16 percent of Americans live in rural areas.
The study divides them into areas adjacent to urban areas (60 percent), regional population centers not bordering larger urban areas (nearly 30 percent) and geographically remote areas (about 10 percent).
Dr. Lewis Sandy, UnitedHealth senior vice president, said Hawaii is one of a few states in which physician shortage levels are not distributed throughout the high, medium and low levels used for the report. All 390,000 rural Hawaii residents are listed in the "low" shortage category, which might be due to the state’s unique geography and the shorter distances rural residents would have to drive to get access to health care relative to other states.
However, Sandy said, the situation could be complicated by the need for interisland travel should neighbor island patients need to receive care on Oahu.
According to the study, there are 93 primary care physicians per 100,000 rural residents, versus 128 per 100,000 urban and suburban residents. And while this disparity is not as pronounced as in many other states — Louisiana has just 54 primary care physicians per 100,000 rural residents versus 102 per 100,000 urban and suburban residents — the implications might still be worth considering as the study also found that, overall, America’s 50 million rural residents are older, poorer and more likely to be obese. They are also more likely to receive lower-quality health care and to participate in Medicare of Medicaid, the report said.
Sandy said the need to address inequities in the rural health care system is becoming more urgent given the impending expansion of Medicare and the Exchange insurance program that will begin in 2014. Using a micro-simulation model developed by the Lewin Group, the study’s authors estimate that as many as 5 million new rural residents will go on Medicaid and state Exchange insurance plans by 2019.
This, Sandy says, will result in "a severe strain to provide access to health care" in rural areas.
Among the study’s recommendations for preparing for the impending increase is the adoption of integrated, updated telemedicine initiatives.
Sandy said recent technological advances provide opportunities to take telemedicine beyond its traditional limitations. He said the first priority should be to establish universal broadband access.
"This will provide the infrastructure — the chassis — for the ability to use cloud-based technology for low-cost, easy-to-use applications and connect laptops, desktops and other devices," he said. "It’s a practical solution, but we have to get started now because it will take a few years. Telemedicine has been a convenience in urban and suburban areas, but it is essential in rural areas."
Sandy also suggested redesigning care-delivery systems to allow for a broader range of medical professionals to assume health care duties in rural areas.
Sandy said Hawaii is "more restrictive" than other states in how it defines the roles of different health care professionals. He said such restrictions should be reconsidered to allow physicians assistants, nurse practitioners and other health care providers to practice the full range of their abilities, thereby freeing primary care physicians from tasks that do not necessarily require their expertise.
