Literature Review: Exposing Some Important Barriers to

Health Care Access in the Rural USA

Breanna Balingit

California State University, Channel Islands

July 24, 2022

 2

Literature Review: Exposing Some Important Barriers to

Health Care Access in the Rural USA

Douthit, N., Kiv, S., Dwolatzky, T., & Biswas, S. (2015). Exposing some important barriers to

health care access in the Rural USA. Public Health, 129(6), 611–620.

https://doi.org/10.1016/j.puhe.2015.04.001

Article Summary

The purpose of this article was to explore and elaborate on how access to healthcare is

lacking in rural parts of the United States. The study was designed to review all literature that

objectively researches this specific public health issue in various populations in the U.S. The

methods of research for collecting data were conducted through platforms such as Pubmed,

Proquest Allied Nursing and Health Literature, National Rural Health Association Resource

Center, and Google Scholar. As a result, it was discovered that there is indeed a significant

difference in the access to health care between low-income, rural populations and urban

locations.

Article’s Purpose & Results

The main objective of this article was to further examine the significant difference in

access to healthcare between rural populations and urban areas of the U.S. This topic of

healthcare access has been an issue throughout healthcare history and continues to fuel debates.

This article discusses the existence of disparities that exist due to access to quality healthcare or

lack of access to healthcare. It’s evident that rural populations suffer from inequality in the

system and are prone to have higher levels of chronic disease. According to the article, a rural
 3

population isn’t clearly defined but involves a sparseness of population, and the US Census

Bureau states that urban populations are areas of 50,000 or more residents. As stated in the

introduction of the article, “the most recent data from the Health and Human Resources

Administration of the US Department of Health and Human Services, rural areas of the United

States demonstrate a visible and disproportionate lack of services in medically underserved

areas, including a paucity of primary care physicians, i.e., family doctors, pediatricians, and

internists” (Douthit et al., 2015). As previously mentioned, it’s very clear from the health

disparities among all rural groups in their population that better access to quality healthcare is a

demand.

The methods of information collection were done through several different databases as

stated in the summary paragraph. The English literature gathered was specifically searched for

the time period from 2005 to 2015 in order to analyze the data before and after the passage of the

Patient Protection and Affordable Care Act in 2010. Some keywords used in the search were

‘utilization, ‘trends’ and ‘supply and distribution,’ ‘access,’ ‘rural’ and ‘health care,’

‘inequalities in health care in the USA,’ etc. The results produced were various examples from

34 different articles each producing significant data/information vital to the research article.

There was an emphasis on articles dealing with specific disparities (cancer, cardiovascular

disease, diabetes, etc.) as indices to monitor the quality of health care. The focus of the articles

selected were on disparities in access to health care and the difference in health care-seeking

patterns in both rural and urban areas.

The results gathered from the literature show that cultural perception has affected access

to health care. It was stated in the article that patients in rural areas are often worried about any

type of discrimination, stigma, and whether or not they can trust that their information is being
 4

kept confidential. There is also evidence that citizens of these rural populations are also hesitant

to seek out health interventions, especially anything related to mental health. As a result of being

a rural population, the patients feel that they are dealing with health care providers who are

prejudice, therefore it makes them wary to seek any type of care or services. Another obstacle

that was discovered in the research, is the lack of appropriate transportation to health care

venues. “Patients are less likely to travel to see the doctor if they live far away. Pathman et al.

showed that increased travel time and the perceived difficulty in traveling to see the doctor are

prohibitive” (Douthit et al., 2015). Other obstacles that become evident through the research and

date were the absence of services, financial burden, and great poverty. It’s clear from these

findings that there are great disparities that exist in these populations. The demographics in these

rural populations are so different from urban areas, therefore the health needs will look different

as well. “Nearly two-thirds of uninsured people in rural areas live in a state that is not currently

implementing the Medicaid expansion, meaning they are disproportionally affected by state

decisions about ACA implementation. As a result, uninsured rural individuals may have fewer

affordable coverage options moving forward” (Vann Newkirk and Anthony Damico, 2014).

Overall, the results showed evidence that there is a significant difference in the in what health

care services are being provided to rural populations. In comparison to urban areas, rural

populations suffer from lack of transportation, financial means to pursue health services, and

lack of services available to them.

 5

Indications for Further Research

In the research that was collected, it was stated that there was no real uniform definition

for what constitutes a rural population. It may help in future research to clearly define what rural

communities are made up of instead of it being an inconsistent generalization.

Conclusion

In conclusion, this article provided very elaborate examples and comparisons of the

difference in access to healthcare between rural and urban populations. Its research method was

extensive and has great attention to detail. The overview of barriers and what contributes to

disparities among the rural populations was very clear and helped to better understand this

serious issue. It’s clear that these barriers in access to health care have a significant impact on the

health outcomes of the rural populations. Interventions that are culturally appropriate, effective,

efficient, and fair were suggested as one of the solutions to this major health issue. There is a

strong call to action for health care providers and policy makers to better the health care system

and find ways to deliver quality healthcare to these rural populations in need.
 6

References

Douthit, N., Kiv, S., Dwolatzky, T., & Biswas, S. (2015). Exposing some important barriers to

health care access in the Rural USA. Public Health, 129(6), 611–620.

https://doi.org/10.1016/j.puhe.2015.04.001

Hoffman, C., & Paradise, J. (2008). Health Insurance and access to health care in the United

States. Annals of the New York Academy of Sciences, 1136(1), 149–160.

https://doi.org/10.1196/annals.1425.007

Oliver, A. (2004). Equity of access to health care: Outlining the foundations for action. Journal

of Epidemiology & Community Health, 58(8), 655–658.

https://doi.org/10.1136/jech.2003.017731

Rural Health Information Hub. (2018). Health Information Technology in Rural Healthcare.

Retrieved from: https://www.ruralhealthinfo.org/topics/health-information-technology

Vann Newkirk and Anthony Damico Published: May 29, 2014. (2014, May 30). The Affordable

Care Act and insurance coverage in rural areas. KFF. Retrieved July 24, 2022, from

https://www.kff.org/uninsured/issue-brief/the-affordable-care-act-and-insurance-

coverage-in-rural-areas/