Rural Health In Missouri – Opportunities for Improvement
In December 2018, Missouri Gov. Mike Parson held a rural health summit to address a number of issues that matter to rural Missourians. These issues – along with potential solutions – are explored by the Missouri Hospital Association through their #ReimagineRuralHealth initiative.
Expand Access to Behavioral Health Services
An estimated one in five young people in the U.S. are impacted by mental health disorders, but only 20 percent of them receive care from a specialized mental health provider. Missouri needs 500 more child psychiatrists to fill the gap. According to the Missouri Department of Mental Health, 90 of the 114 counties in the state didn’t have a single licensed child and adolescent psychiatrist in 2017.
The behavioral health shortage doesn’t just affect children. Nearly all of rural Missouri is a Health Professional Shortage Area for Mental Health, leading to patient boarding in hospital emergency departments and inpatient care. Not only are patients unable to receive appropriate care without access to behavioral health services, hospitals are also strained to treat these patients without the necessary resources.
While there’s no quick or simple fix for the issue, a number of things could improve the behavioral health services shortage, particularly in rural areas of the state.
Expand Access to Primary Care Providers
Six rural Missouri counties lack a primary care physician, and 71 lack obstetrics coverage. And, there’s a large difference in the number of primary care physicians between urban and rural communities. Moreover, six rural hospitals have closed in Missouri since 2014, which further strains the system.
A number of approaches could be effective in addressing this issue.
Increase Access to Care for Substance Abuse Disorder
The opioid and substance abuse crisis is one of the greatest public health threats facing Missouri. Overdose deaths now exceed traffic-related fatalities in Missouri. Changes in state policy, and targeted investment in intervention and recovery, could help curb the high toll on rural communities, which tend to be disproportionately impacted by this epidemic.
Missouri is the only state without a statewide prescription drug monitoring program. Gov. Parson has voiced support for the establishment of a PDMP. While more than 80 percent of Missourians are covered by the St. Louis County Department of Public Health’s PDMP, there are still more than 50 – primarily rural – counties and municipalities outside of the PDMP network.
Ensure Access to Quality Health Care
Health care in rural Missouri faces a number of challenges. Rural areas tend to have older populations and their residents have less healthy behaviors in some cases. Rural hospital closures make the problem worse when rural residents are forced to travel greater distances to receive care. An article from The New York Times highlights the effects the rural hospital closures have on their residents. For example, a young woman was forced to drive 100 miles to the nearest hospital to deliver her baby two months premature after her hometown hospital in Kennett, Mo., closed.
Missouri strives to provide the highest quality of care possible to its residents, despite challenges. And, some additional tactics could be enacted to further improve the quality of care in rural areas.
Collaborate to Identify and Address Social Determinants of Health
Social determinants of health are defined as “the conditions in which people are born, grow, live, work and age.” This means there’s more to maintaining good health than quality health care. Factors such as access to nutritious food, recreation, and gainful employment – all of which rural Missourians can face constrained access to – can have an impact on health.
Addressing the root causes of community-based problems that can lead to poor health can improve the health of at-risk populations.
Expand Teleheath and Telemedicine
Telemedicine is the remote diagnosis and treatment of patients by means of telecommunications technology. Enacted in 2018, House Bill 1617 withdrew many clauses that restricted the use of telemedicine. Now, Missouri’s Medicaid-enrolled providers can deliver services through telemedicine any time they can provide the same level of service as an in-person encounter and the service is within the scope of services offered by the provider, without any geographic restrictions. While HB 1617 is a step in the right direction, further expansion and improvement of telehealth services would ensure all Missourians have access to quality care, regardless of their location and other constraints that may keep them from an in-person provider visit.
Advocate for Improved Infrastructure
Gov. Parson has championed investment in infrastructure. And, improved infrastructure has an indirect, but significant, impact on health care.
- The expansion of broadband internet to rural communities remains a challenge, as 22 percent of Missourians still lack access to high-speed internet. Expansion of broadband internet services benefits the health of rural Missourians and provides opportunities for continuing education and financial prosperity.
- Public transportation in rural areas can be sparse, and for rural residents with special needs, it can be nonexistent. Access to transportation is essential to maintaining the health of rural Missourians.
- Missouri’s poor roads, and the greater distances to care for rural residents, complicate access to care. Rural hospital closures, which can lead to other health care providers leaving the community, adds further complications.
Support Emergency Services
Rural residents are at a higher risk of traumatic injury, including unintentional injuries from vehicle accidents, falls, drug overdoses, fires and drownings, than urban residents. Additionally, farmers use machinery that can expose them to crushing injuries that can require trauma care. Access to advanced emergency services is essential to support lifesaving care.
There is limited access to specialized emergency care in rural Missouri. Outside of the Kansas City and St. Louis metropolitan areas, there are two designated trauma centers north of Interstate 70. In southeastern Missouri, there is only one designated trauma center. Missouri’s pediatric trauma centers are in metropolitan areas. Therefore, rural residents often rely on high-cost air ambulance transport or extended ground ambulance trips, which can also be costly.
Partnerships that foster relationships between key players in the community and health care entities can have a number of positive effects on rural communities and the citizens that live there.