Health care for seniors in rural Texas is in jeopardy | #healthcare | #elderly | #seniors
Due to demographic shifts, equitable health care access in rural areas of Texas is in jeopardy.
Recent census counts show the population is getting older while seniors are experiencing higher rates of depression (up 71%) and obesity (up 34%), according to the United Health Foundation. These trends are amplified in rural populations (especially along the U.S.-Mexico border and in the Panhandle), which are older and experience worse health outcomes than their urban counterparts. Many rural hospitals have closed, and people in rural areas may be distant from health care providers. Rural populations are also, on average, older than the general population and have lower household incomes, less education and lower insurance coverage.
Compared to other states, Texas has some of the highest rates of uninsured seniors and seniors who skip care due to cost. Partly because of this, rural hospitals are closing rapidly and leaving communities at increased risk of inadequate care.
A recent Government Accountability Office report shows that Texas lost 24 rural hospitals between 2005 and 2020, the most in any state. Financial blows that led to hospital closure most often included lower hospital volume, reduction in Medicare bad-debt payments, and reduction in Medicare reimbursements. Rural hospital closures also lead to job and population loss, which further decreases the economic pull for health care services.
Even when considering poverty and health care supply, researchers at UCLA found that distance is one of the biggest contributors to health disparities. Distance from physicians and pharmacies leaves rural populations less likely to keep up-to-date on vaccinations, prescription medications and services such as blood pressure screenings, according to research from Texas Tech University. These barriers feed into each other to deepen economic risk factors: declining rural economies forcing hospital closures, communities losing major employers, and residents having to travel further for health care.
Texas legislators can take steps this session to address these barriers. The first step is expanding Medicaid. Medicaid expansion would increase financial viability for rural hospitals, give rural seniors greater ability to pay for care, and invest in the health of all Texans to help lower the chance of high health burdens for future senior populations.
The next step is to expand telehealth services by making regulatory changes for the service itself and expanding broadband coverage across the state. An important regulatory change would be to make permanent the temporary pay parity for telehealth and in-person services that has been in place for the pandemic to ensure that telehealth is an economically viable service to provide.
This will be much more impactful if broadband services are expanded to the 17% of Texans who do not have reliable internet access. While almost the entire state has access to the internet through mobile LTE (the standard wireless data transmission used in cellphones), recent data from the Federal Communications Commission shows that standard broadband coverage (25 Mbps download/3 Mbps upload) is incomplete. In 84 counties, less than 50% of the population has access to fixed broadband and in another 163 counties, coverage is incomplete.
The U.S.-Mexico border region has by far the lowest percentage of the population with a household computer or a broadband subscription. Recent research published in the Journal of Medical Internet Research conducted during the COVID-19 pandemic showed that seniors with access to the necessary resources are, overall, willing to engage in telehealth even if it means taking lessons on how to operate the technology.
Since these counties have some of the worst health factors, lowest access to physicians, and highest percentage of the population with low English-language skills, expanding internet coverage and computer access may be a more financially viable option than expanding traditional health care access. By lowering the geographic barriers to care, telehealth gives patients the ability to see providers more frequently and proactively and to see providers, including specialists, who are otherwise outside the radius patients are willing to travel.
Researchers at the University of Texas found that the opportunity for more attentive care can help prevent repeat hospitalizations. Home health providers can also see more patients in a day and see patients more regularly because of the time no longer lost to travel.
Finally, extending the hours of operation for rural transportation services and subsidizing rates for medical appointments statewide could lower the transportation barrier and complement telehealth expansion.
Development in these sectors can help lower payment and distance barriers to care while ensuring the financial viability of providers.
Sallie Sherman is a graduate student at the Bush School of Government and Public Service at Texas A&M University and a 2021 Texas Lyceum Fellow. She wrote this column for The Dallas Morning News.