Using the attached Chapter 2 - Literature Review (TEMPLATE), write at least ten full double-spaced pages summarizing original scientific studies on the topic you chose. SEE INSTRUCTION WORD DOC.

CHAPTER 2: LITERATURE REVIEW

Student’s name

National University

COH 694B

July 23, 2023

CHAPTER 2: LITERATURE REVIEW

Challenges in Accessing Healthcare in Rural Areas Worldwide

Healthcare is one of the basic human needs in the sense that it deals with the health of people. Regardless of the situation, healthcare is a fundamental need that must be met. Despite the sensitivity of healthcare, millions of people across the globe still have challenges when it comes to accessing healthcare. Rural communities are among the most affected by the lack of proper access to healthcare. According to the United Nations, more than 56% of people living in rural areas cannot access critical healthcare services (UN, 2015). Different countries have different levels of access but generally, all rural areas worldwide have inadequate access to healthcare, and those who are lucky to access it, do not get the right quality that guarantees them efficiency and effectiveness. It is a global challenge that must be addressed to ensure equity in access to healthcare services regardless of location.

One of the significant reasons why rural communities across the globe do not have access to proper healthcare services is the lack of adequate infrastructure at the available healthcare facilities. It should be noted that healthcare facilities require costly investment so that necessary equipment can be availed for the locals to be served as they deserve. However, this is not the case, as most facilities in local areas lack even the basic equipment (Samuels et al. 2014). This situation is attributed to decades of underinvestment or lack of investment in the healthcare sector in rural areas. National health systems have continually neglected rural areas, making them lag in development. As a result, the local communities are deprived of essential services that could mean the difference between life and death for them (Charalambous, 2023).

The law guarantees healthcare in many governments, and all citizens are entitled to adequate healthcare. Despite all these ideal situations, the reality is different. In most countries, health sector development focuses only on urban areas because of the significant demand available. Rural areas are usually neglected, and this takes a toll on the communities. The lack of sufficient workers in rural healthcare facilities worsens the situation. Most professionals prefer working in urban centers due to the benefits and opportunities they are exposed to. As a result, healthcare facilities in rural areas are understaffed, creating a considerable workload on available workers. This affects their ability to deliver the best healthcare services and leads to poor access to healthcare by the locals. The International Labor Organization reports that 23% of healthcare professionals are deployed to rural areas even though half of the world population resides in rural areas. As aforementioned, the rates differ from one country to another but generally, it is a global problem.

Inadequate funding significantly contributes to rural areas' lack of essential healthcare services. There is a massive gap in terms of resources as well as financial resources between healthcare facilities in urban centers and rural areas. Lack of workers, inadequate facilities, and out-of-pocket payments have limited access to healthcare. This problem has existed since time immemorial and continues to affect different rural communities across the globe. As much as people wish to access the best services, it is not easy because of the numerous limitations. In other words, there is more demand than supply of healthcare services in rural areas. Many people require the services but for different reasons, they cannot get them. This limits their access to healthcare services.

Lack of Access to Healthcare for Rural Communities in the United States

Access to healthcare services is critical for all Americans. Healthcare is a fundamental need that every citizen is entitled to, regardless of where they live. Rural residents face different barriers to accessing quality healthcare, putting them at various risks (AAMC, 2017). A study conducted in 2014 by RUPRI revealed that there is a need for additional measures to be taken to reduce or eliminate barriers that hinder local communities in the United States from accessing quality healthcare services. According to the health requirements in the United States, citizens should confidently and conveniently access at least basic healthcare services such as primary care, behavioral care, dental care, and public health services, among others (Rural Health Information Hub, 2022). Accessing such healthcare services is important for many reasons, which include the following:

· Improving overall physical, mental, and social health status

Lack of access to quality healthcare denies rural communities in the United States the chance to improve their overall health. Accessing proper healthcare services ensures that different dimensions of health are catered for. It is essential for rural communities to access healthcare as this will ensure their overall health status is improved.

· Prevention of diseases

Accessing proper healthcare would enable rural communities to prevent diseases (NCSL, 2020). Many diseases are preventable but if rural communities cannot access the right healthcare services, they will not prevent diseases. They are at risk of suffering from a wide variety of health complications.

· Detecting, diagnosing, and treating illnesses

Proper access to quality healthcare makes detecting, diagnosing, and treating illnesses possible. When illnesses are detected early enough, they can be handled and the damage controlled (HRSA, 2022). However, rural communities do not experience this due to a lack of access to healthcare. Some of them have undetected illnesses; it could be too late by the time they are detected.

· Improving the quality of life

To a large extent, the quality of life is determined by the quality of healthcare received. To improve their quality of life, rural communities need to access quality healthcare services (Griffiths, 2009). Without access to the right quality of healthcare, the quality of life is compromised, putting the locals at risk.

· Avoiding preventable loss of life

Studies have also revealed that access to proper healthcare can save a life. According to the Federal Emergency Management Agency (2022), 8% of fires in the United States occur in rural areas. These are emergency cases that need immediate attention. Without access to healthcare, such cases lead to loss of life.

· Increasing life expectancy

Everyone wants to live a long, healthy life, but this is determined by the quality of healthcare they receive. According to the American Journal of Preventive Medicine, it is 76.7 years, while in urban centers, it is 79.1 years (Singh & Siahpush, 2013). The low life expectancy in rural areas can be increased by increasing access to quality healthcare. Inadequate healthcare compromises the quality of life, and this reduces life expectancy.

Residents in rural areas are often disadvantaged that they miss out on the basic benefits of access to quality healthcare services. Healthcare services are limited, and the available ones are not timely. This is a challenge that compromises the quality of healthcare received. In instances where adequate healthcare has been availed in rural communities in the United States, there are still factors that make it difficult for the residents to access the services (Bergum & Catlin, 2016).

Bridging the Gap to Increase Access to Healthcare in Rural Communities in the United States

Mobile Health

Mobile health clinics are in place to increase access to healthcare in rural communities in the United States (Waldrop & Gee, 2022). Mobile clinics enable healthcare professionals to provide healthcare services where the patient is. In conventional healthcare, it is the patient who visits the healthcare facility. However, in this case, it is the reverse. Mobile health providers are always on the move to ensure patients get the services in the comfort of their homes or places of work. They are usually referred to as "clinics on wheels" because they are always on the move. They help solve transportation problems that most residents in rural communities face. In 2020, a study by the International Journal of Equity on Health reported that 55% of mobile health clients are women and racial minorities at 59%. The study also revealed that most recipients of mobile services were not insured. Mobile clinics receive financial support from philanthropists because they primarily serve patients with financial problems.

Telehealth

Telehealth is a significant solution to increase access to healthcare in rural communities in the United States. This innovative solution enables patients to receive healthcare services without necessarily meeting with providers. Telehealth is usually done online, implying that there needs to be a stable internet service on both ends (Mayo Clinic, 2022). A smartphone or computer is also required for this service to be offered. Telehealth increases access to healthcare by reducing waiting time. In others, services are provided as soon as they are needed. Through a video call, a medical officer describes what patients should do to care for themselves (Regis College, 2023). This has ensured that healthcare services are available even in the most rural locations.

Partnerships and Collaborations

The delivery of quality healthcare is a collective responsibility. It requires the input of different stakeholders to make it achievable. Rural communities are challenging to reach. Therefore, organizations need to play different roles in ensuring people access services. An organization such as Families USA accesses the most rural areas in the United States and provides them with healthcare services (Tulane University School of Public Health and Tropical Medicine, 2023). The organization partners with others that cannot physically reach the rural areas. They provide resources such as finances and other items needed in service delivery. In other words, different organizations join their efforts and play different roles to ensure rural communities in the United States can access quality healthcare. As aforementioned, healthcare is a collective responsibility and various stakeholders have different roles to play to provide rural communities in the United States can access proper services. Partnerships and collaborations are essential because they enable rural communities to experience the following benefits:

· Efficient delivery of care

Partnerships ensure the available resources are utilized correctly (Rushton & Youde, 2017). There are no wastes, implying that maximum output is received from minimal resources.

· Improved services and performance

Partnerships and collaborations increase rural communities' resources, leading to improved services and better performance (PhRMA, 2022). Providers are motivated and patients are satisfied.

· More flexibility in terms of payment options

Flexibility in payment models is a benefit brought through partnerships and collaborations. Rural communities have a variety of options that they can use to make payments for healthcare services received (Tulane University School of Public Health and Tropical Medicine, 2023).

· More recruitment and retention of staff

Partnerships provide more resources, enabling rural healthcare facilities to recruit more employees. An increase in staff is good news for local communities in the United States. It allows them to receive better services because there is more manpower.

When smaller local facilities partner with larger ones, the rural communities are the greatest beneficiaries because they are the final consumers of the services.

Common Barriers to Access to Health by Rural Communities in the United States

Despite the efforts by different agencies and stakeholders to make sure rural communities can access quality healthcare, many barriers still hinder them from achieving their purpose. There are obstacles that they must deal with before services are delivered to rural communities.

Scarcity of Services

One of the significant barriers to accessing quality health care in rural communities in the United States is the scarcity of services (Harvard University, 2019). It is noted that some services need a lot of investment to be availed. However, this is not the case. Most rural healthcare facilities only offer essential services, and this limits what communities can access. When patients need advanced care, they have to travel to cities or major urban centers. The lack of such services in rural areas implies that most people cannot access them. Most facilities only offer primary basic care and cannot handle more complicated healthcare problems. Healthcare is about having a variety of services. When services ate limited, access is also limited.

Lack of Trained Physicians

Most trained physicians prefer working in urban areas because they get better incentives and are exposed to more opportunities that can help them to advance in their careers. This is a situation that limits the trained personnel available at rural healthcare facilities. Physicians who are not well trained cannot offer all the services patients need. Patients are not guaranteed that they access all the services that they need. This is a major barrier that interferes with the provision of healthcare services for rural communities in the United States. Sufficient staffing is required to provide the needed services so that patients can be served as they deserve. The lack of trained physicians implies that not all services can be offered. It is a situation that does not promote access to healthcare.

Transportation Challenges

Transportation is an important element in the delivery of healthcare. Without proper transport, it isn't easy to access healthcare. Rural areas have poor road networks, making it difficult for patients to get to a hospital. They spend too much time on the road and depending on the patient's condition, the outcome might be undesirable. Most healthcare facilities in rural areas also depend on roads to deliver supplies. Suppliers use roads to provide different items needed in the facilities. Due to poor roads, it is a challenge for the supplies to reach the facilities on time. In instances where perishable drugs should be delivered to facilities, it is a challenge because they are often given late, and sometimes they are already expired by the time they are delivered. Poor roads make transport difficult, which challenges patients and other stakeholders who need to be physically at the healthcare facility for different reasons.

Poor Internet Connectivity

The modern world is digitally connected and heavily relies on the internet for communication and research, among other important activities. Communities in rural areas do not experience the full benefits of the Internet because of poor connectivity. It is also tricky for telehealth to be operated when there is no internet. This is a concept where a healthcare professional links up with a patient through video calls or other forms of online communication (Strasser, 2003). It is a service that requires stable and fast internet connectivity. However, most rural areas in the United States are not lucky enough to access high-speed internet. This implies that the services they receive are limited. In the modern world, it is difficult to access even the most basic of services without the internet. The impact is felt in the healthcare sector as stakeholders cannot effectively be in touch with one another.

Healthcare facilities also need an internet connection to interact with other stakeholders. The lack of internet makes this communication difficult and significantly limits the services that can be offered in the facility.

Benefits of Accessible Health to Rural Communities in the United States

There are dozens of barriers to access to quality healthcare in rural communities in the United States. Most of these barriers are similar in most of the places. Before the community can realize benefits, the barriers must be eliminated. It should be noted that for a problem to be solved, it must first be understood (Bowling, 2023). It is the responsibility of relevant stakeholders, such as decision-makers, to understand the different barriers faced in different rural areas of the United States. Once the obstacles have been understood, corrective solutions can be devised to ensure they are solved in the best way possible (Advent Health University, 2022). Studies have indicated that organizations need to invest in understanding a problem before investing in implementing a solution.

Once the barriers have been addressed, solutions can be implemented, and locals will start experiencing the benefits of accessing quality healthcare (Rural Health Information Hub, 2023). One of the barriers addressed is poor transportation. If this is handled, there will be better roads in the rural areas, and this implies that it will be easier for locals to reach healthcare facilities for them to be treated for different needs. Healthcare is a basic need that everyone is entitled to. With proper access to healthcare, people will live healthier lives and life expectancy will also be increased (US Government Accountability Office, 2023). When people are healthy, they will have time to focus on other aspects of their lives that enable them to live happily. The government and other stakeholders must put their efforts together to ensure healthcare is accessible in rural areas (CDC, 2023).

References

AAMC. (2017). Health disparities affect millions in rural U.S. communities. Retrieved from https://www.aamc.org/news/health-disparities-affect-millions-rural-us-communities

Advent Health University (2022). How to improve healthcare in rural areas. Retrieved from https://www.ahu.edu/blog/improve-healthcare-in-rural-areas

Bergum, A. & Catlin, B. (2016). What works? Strategies to improve rural health. Retrieved from https://www.countyhealthrankings.org/reports/what-works-strategies-improve-rural-health

Bowling, A. (2023). Research methods in health: Investigating health and health services. Open University Press.

CDC. (2023). About rural health. Retrieved from https://www.cdc.gov/ruralhealth/about.html

Charalambous, P. (2023). Less staff, longer delays, and fewer options: Rural America confronts a healthcare crisis. Retrieved from https://abcnews.go.com/Health/staff-longer-delays-fewer-options-rural-america-confronts/story?id=97911613

CMS. (2022). Rural health strategy. Retrieved from https://www.cms.gov/files/document/rural-strat-guide-08-may.pdf

Federal Emergency Management Agency. (2022). The rural fire problem in the United States. Retrieved from https://www.usfa.fema.gov/downloads/pdf/statistics/rural.pdf

Griffiths, F. (2009). Research Methods for Healthcare Practice. Los Angeles: SAGE.

Harvard University (2019). Poll: Financial insecurity and limited access to health care plague many rural Americans. Retrieved from https://www.hsph.harvard.edu/news/hsph-in-the-news/poll-financial-insecurity-and-limited-access-to-health-care-plague-many-rural-americans/

HRSA (2022). Rural access to healthcare services request for information. Retrieved from https://www.hrsa.gov/rural-health/rfi-rural-health-care-access

Mayo Clinic (2022). Telehealth: Technology meets healthcare. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878#:~:text=What%20is%20telehealth%3F,technology%20you%20use%20from%20home .

NCSL (2020). Improving rural health: State policy options for increasing access to healthcare. Retrieved from https://www.ncsl.org/health/improving-rural-health

PhRMA. (2022). Addressing health disparities – Addressing barriers in health. Retrieved from https://phrma.org/equity?utm_campaign=2023-q2-equ-acc&utm_medium=pai_srh_cpc-ggl-adf&utm_source=ggl&utm_content=clk-pat-tpv_scl-geo_std-usa-all-pai_srh_cpc-ggl-adf-EquityEvergreenSearchWCDCKeyStatesMemberCo2-pra_equ-edu-inf-lrm-soc_txt-std-vrb-adf&utm_term=&gclid=Cj0KCQjw8NilBhDOARIsAHzpbLD_iy8DNZDGQv_622Qw48OgVFy79se3wPj1a--2uRnhwg7SynBEUWEaAoYaEALw_wcB

Regis College. (2023). Improving access to rural healthcare. Retrieved from https://online.regiscollege.edu/blog/rural-health-care/

Rural Health Information Hub. (2022). Health access in rural Communities. Retrieved from https://www.ruralhealthinfo.org/topics/healthcare-access

Rural Health Information Hub. (2023). Families USA. Retrieved from https://www.ruralhealthinfo.org/organizations/968

Rushton, S. & Youde, J. (2017). Routledge Handbook of global health security. Routledge.

Samuels, K., McClellan, M., Patel, K., & Darling, M. (2014). Transforming rural healthcare: High-quality, sustainable access to quality care. Retrieved from https://www.brookings.edu/articles/transforming-rural-health-care-high-quality-sustainable-access-to-specialty-care/

Singh, G., & Siahpush, M. (2013). Widening rural-urban disparities in life expectancy, U.S., 1969-2009. American Journal of Preventive Medicine, 46(2), 19-29.

Strasser, R. (2003). Rural health around the world: Challenges and solutions. Family Practice, 20(4,: 457-463.

Tulane University School of Public Health and Tropical Medicine. (2023). How to improve healthcare in rural areas. Retrieved from https://publichealth.tulane.edu/blog/how-to-improve-health-care-in-rural-areas/

United Nations (2015). New UN report finds bulk of world’s rural populations excluded from healthcare access. Retrieved from https://www.un.org/sustainabledevelopment/blog/2015/04/new-un-report-finds-bulk-of-worlds-rural-populations-excluded-from-healthcare-access/#:~:text=The%20ILO's%20findings%20%E2%80%93%20published%20in,cent%20of%20rural%20inhabitants%20are

US Government Accountability Office. (2023). Why healthcare is harder to access in rural America. Retrieved from https://www.gao.gov/blog/why-health-care-harder-access-rural-america

Waldrop, T. & Gee, E. (2022). How states can expand healthcare access in rural communities. Retrieved from https://www.americanprogress.org/article/how-states-can-expand-health-care-access-in-rural-communities/

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