Accessing healthcare in rural areas can be a challenge, especially if you live in rural Texas. Over the last several years, healthcare centers across the state have been slowly closing their doors, leaving patients with few alternatives. Patients routinely drive long distances to access vital care services, or even just to update their prescriptions.
Of the 254 counties in Texas, 170 are considered rural, and nearly 20% of the state’s population – more than 3 million people – reside in rural areas. Rural Texans tend to be older, poorer, and less healthy compared to those living in urban areas, making the situation all the more dire. Find out what it’s like to look for healthcare in rural Texas and why so many facilities are closing their doors for good.
The State of Healthcare in Rural Texas
Rural Texas doesn’t have a lot of options when it comes to healthcare. According to the 2018 report, “What’s Next? Practical Suggestions for Rural Communities” conducted by the A&M Rural and Community Health Institute and the Episcopal Health Foundation, more than 20 hospitals in rural Texas have closed in recent years, and 60% of the 164 remaining hospitals are at risk of closing.
The report also found that of the state’s 254 counties:
- 35 counties have no physician
- 80 counties have five or fewer physicians
- 58 Texas counties are without a general surgeon
- 147 Texas counties have no obstetrician/gynecologist
- 185 Texas counties have no psychiatrist
With nearly half the state lacking access to mental health and specialty care services, patients regularly face long wait times and even longer commutes. Older, sicker patients tend to have trouble securing a ride to and from the doctor’s office, especially if they don’t have a driver’s license. They may have trouble getting in and out of a vehicle. Traveling in a car may also worsen their symptoms.
Low-income patients may also have trouble getting to and from the doctor’s office. Traveling long distances means more time away from work. Parents may have to take their kids with them to the doctor’s office or find a sitter. All that extra gas money can eat away at a family’s savings.
Who’s to Blame?
According to the report from A&M Rural and Community Health Institute, healthcare facilities are closing their doors for a number of reasons, most notably because of a lack of funds and patients. Patients can be hard to come by when you’re working in one of the most rural states in the country. The state’s demographics are also shifting rapidly as more Texans move to major cities like Austin, Dallas, and Houston.
Texas also has one of the highest uninsured rates in the country. Just over 5 million Texans lack health insurance, which makes accessing care even more challenging. Patients may put off care or avoid the doctor entirely if it means paying for services out of pocket. Around 17.7% of the state’s population is uninsured, which is more than double the uninsured rate for the country at 8.5%.
Poor management and even fraudulent behavior also contributed to the string of recent closings. An investigation by Modern Healthcare found that some rural Texas hospitals closed their doors after billing insurers for extremely high volumes of lab tests that may not have been performed for their patients or even in their facilities. A Texas hospital cited in the probe “reported extremely high outpatient lab charges in 2015 and 2016: $213.6 million and $372.2 million, respectively. Outpatient labs accounted for 62% of the hospital’s total charges in 2015 and 86% in 2016.”
Hope for the Future
As dire as the situation may seem for some rural Texans, there is some hope for the future. The state is quickly embracing telehealth – using live video and audio to remotely connect with patients. Telehealth spending has more than doubled in recent years as more providers invest in this technology. This makes it easier for rural patients to access vital care services. They don’t have to secure a ride or leave their home to visit with their care provider.
Thanks to a recent law, initial in-person consultations are no longer required, so providers can quickly take on new patients without forcing them to make the commute. The law also removed the requirement for a designated clinical place of service, as long as the setting doesn’t compromise the standard of care. This means patients can access telehealth services on the go, at school, or from the comfort of their own homes.
The state is also putting an emphasis on mental health as it gets these new programs off the ground. In Texas, the majority of telemedicine and telehealth services are used to treat clients with behavioral health conditions. Among these clients, common diagnoses included attention deficit hyperactivity disorder, major depressive disorder, bipolar disorder, and unspecified mood disorder.
Texans seem to be taking a liking to this new technology, as well. The number of patients utilizing these services has increased dramatically over the last few years.
Texas isn’t the only state grappling with these challenges. Across the U.S., accessing care in rural areas continues to be a problem for both patients and providers. Opening a clinic or hospital in rural Texas might not make a lot of sense from a business perspective. Patients will continue to depend on telehealth services until more options become available in the state.