Urgent crisis: many reasons for the growing loss of rural health care State News

VERSAILLES – Missouri’s rural health needs help. From lack of access to lack of specialists, many patients who depend on rural health have disadvantages in receiving the care they need.

“Access is one of the biggest problems,” said Amanda Shipp, a physician at the Capital Region Physicians in Versailles. “From First Aid to Versailles Specialty and Hospital Care.”

Lack of suppliers

In places like Sullivan County and Morgan County — the residence of Versailles — there is not enough in the medical community.

“We’re really facing a supplier shortage in this area,” Shipp said. “It simply came to our notice then. One clinic closed, other providers moved forward, someone retired.

As a result, many rural communities are unable to provide 24-hour emergency assistance.

“At Versailles, specifically, we don’t have urgent care,” Shipp said. “Our clinics are only available during regular hours, Monday through Friday.”

Other rural areas of Missouri have no health care. There are counties without doctors, nurses or other medical providers, Van Dyne said.

“Basically, they are surveillance deserts,” he said.

The situation has worsened. Ten rural hospitals in Missouri have been closed since 2014, according to the Missouri Hospitals Association, as part of a national trend.

Jason Chrisman, general manager of Sullivan County Memorial Hospital, said the lack of the necessary facilities increases the need for the most basic health care providers.

“One of the things each community needs is more primary care physicians, like emergency care centers,” Chrisman said. “We don’t have any urgent care.”

When there is no primary care physician, Chrisman said many patients go to the emergency room for non-urgent medical problems, which affects ER traffic. This is the same problem that occurs in many urban areas with large pockets of low-income people.

“That can be tightened,” Chrisman said. “And it can increase wait times.”

Shipp said that patients who go to the emergency room may find it more difficult for non-emergency situations for those who are actually having an emergency.

“It’s pretty scary when you have a very sick child and you have to take them to the nearest emergency room for an hour and a half,” Shipp said. “You don’t know how long you’ll have to wait to see that child.”

Shipp said his community needs more health care providers.

“In the short term, we need more support,” Shipp said. “It’s often difficult to hire doctors in rural areas.”

It is difficult to hire and retain doctors and other health care providers in rural areas, said Melissa Van Dyne, executive director of the Missouri Rural Health Association. Part of this problem is related to Missouri’s residency programs.

A 2021 study by the American Medical Association found that nearly half of people who have completed their residency in Missouri are working as doctors in another state.

“There is no guarantee that the doctors who are trained will stay where they are trained, although that is certainly one of the goals,” said Laura Morris, associate director of the MU Health Care residential medicine program.

Too far for care

Van Dyne said transportation can also play a big role in getting health care in rural areas.

“It’s one thing to have a doctor in your community, but if you don’t have reliable transportation to get there,” adds another layer to the lack of access, Van Dyne said.

Shipp said that especially when patients are referred to specialists, most will drive an hour and a half to Columbia.

“When you think about preventative care, it’s easier for someone who lives in the city to go to the hospital and have a mammogram or a colonoscopy,” Shipp said. “It’s a little harder when someone has to drive you for more than an hour to do those tests.”

The State Department of Health and Elderly Services reports that Versailles ranks sixth among all Missouri locations in the longest average time for a hospital.

Further north in Sullivan County, many of the same subjects predominate.

“If someone comes into my hospital, the range of things we can do for them is not as huge as some of the big places,” Chrisman said.

The largest medical center near Sullivan County Memorial Hospital is 45 minutes away in Kirksville. That’s better than the situation in Versailles, but Chrisman said it can still affect patients.

“No one wants to drive for 45 minutes or an hour to do a procedure,” Chrisman said. “People who deal with chronic pain, you know, those long car rides are very rough.”

Insurance problem

Van Dyne said insurance is another major barrier to accessing health care in rural Missouri.

“We have a large portion of Missouri people who are insured or uninsured,” Van Dyne said.

Missouri expanded its Medicaid coverage in 2021 to help more people pay for health care. However, Van Dyne said there is still a long way to go to benefit many people.

“There is still an education that needs to be done to determine whether a person is eligible for Medicaid,” Van Dyne said. “And we still have to work to get these people enrolled in Medicaid.”

Reimbursement of health care also poses a problem when it comes to providing the care people need. Healthcare providers will typically receive a government payment that covers all or part of the cost of providing a medical service to an insurance company or patient.

But return rates tend to be low and do not cover the cost of a provider. And in the case of uninsured patients, health care providers often end up providing free care.

“That has certainly been detrimental to the hospital’s sustainability,” Van Dyn said. “We always ask hospitals to give us money back, at least at the rate that it costs them to do business, and they don’t.”

Possible solutions

Morris said that to increase the retention of doctors in Missouri, especially in rural areas, would be to expand rural residential programs.

“The only way to increase the chances of doctors returning to rural areas and training or returning or practicing is to be from a rural area, or to do some or all of their training in a rural setting,” Morris said.

The MU School of Medicine has a rural pipeline program aimed at bridging the gap between rural and urban access. His goal is to get more people from small towns in Missouri to attend medical school if they go to state university.

“We need to first look at who we bring to start training,” Morris said. “All we do is accept children from big cities and privileged backgrounds who qualify because they have high test scores, and then we hope that somehow these people will become doctors in small towns, they are not.”

This coming school year, the MU School of Medicine will begin its first rural residency program in the state. He will send two family medicine doctors to a clinic in Sedalia.

Although the goal of this program is to help address rural health inequalities, Morris said it is difficult to launch more of these programs.

“The main limitation is that federal regulations and the way we fund them prevent new programs from being launched or prevent the expansion of programs that are already in place,” Morris said.

Receiving more federal funding could be a solution to get more students and neighbors to train in rural areas to strengthen rural health care. But finding a special solution is like cutting the tip of an iceberg.

“This is a complex issue because a lot of it goes back to building rural health systems,” Morris said. “They can’t keep people working, they can’t turn on the lights, they can’t get paid enough. All of this is deeply rooted in some of the flaws in the American health care system. ”

Many state health care providers believe that expanding health care in rural Missouri is essential. Achieving that goal Chrisman said will give his community a chance to thrive.

“Would I like to see it grow and be able to provide more services to our community? Yes, ”Chrisman said. “It simply came to our notice then. Our community deserves that. ”

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