Dissertation on "Rural vs. Urban Health Care Disparities"

Dissertation 67 pages (18449 words) Sources: 17

[EXCERPT] . . . .

Health Care Disparity in Maryland

Context of the Problem

Unsettling Disparities Occur

Approximately 1,600,000 individuals who live in Maryland either do not have access to healthcare as they cannot afford insurance and/or are underinsured.

In "Health care reform: a vital issue for Maryland's nurses," Anne S. Kasper and Leni Preston (2008) stress this unsettling fact, as they point out that Maryland ranks number 24 in the United States in the number of uninsured residents. Fifteen percent of Maryland's population, almost 800,000 people, in fact, is not insured. The significance of the fact relating to those who do not have access to healthcare, Kasper, and Preston (2008) assert, increases as this magnificent number of individuals without access to healthcare does not just adversely affect these individuals. This disparity in access to healthcare also significantly affects other individuals, not just Maryland residents. In response to this significant concern, this qualitative, exploratory study analyzes the disparity in access to health care services between rural and urban residences in Maryland and explores the impact of the lack of financial resources relating to this concern.

In rural areas, residents report a lower median household income with higher unemployment than the average family in the State. The discrepancy may evolve from "lower rural educational attainment, less competition for workers, and limited availability of highly skilled jobs" (Jenkins et al., 2007, p.10)

Since 2004, the median household income in Maryland totaled more than $60,000 annually. The average median household income reported in federally designated rural jurisdictions, however during this same time, equaled 30% less than the statewide average, and in state-designated rural jurisdictions equaled 14% less. In addition, the annual average unemployment rate in Maryland totaled 4.3% less than the 5.5% national average.

Access to Healthcare

The State of Maryland notes the following in regard to access to healthcare:

Access to healthcare refers to "the degree to which people are able to obtain care from the healthcare system in a timely manner" the study of barriers in access often differentiates financial and non-financial barriers and describes the extent to which individuals have a regular source of care. Financial barriers included whether or not an individual has insurance while nonfinancial barriers may refer to transportation, clinic hours and location of healthcare facilities. Having a regular source of care facilitates access to healthcare services and increases the likelihood of interacting with healthcare providers. In addition, having a regular source of care provides the entry point into the complex healthcare delivery system, particularly when specialty care is needed. (Maryland Plan to Eliminate..., 2006, p. 27)

Maryland reports a major shortage in the number of physicians in the State. In fact, the State has 16% fewer physicians available for clinical practice than the national average. The shortages are acute in three regions of the state:

Eastern Shore,

Southern Maryland, and Western Maryland. (Cowdry, 2004, p.4)

Experts project these reported shortages to increasingly worsen over the next seven years. If Maryland does not actively counter these shortages, consumers will experience even more problems gaining access to care and have to wait longer for treatment by a physician. Wait times to see a physician will also increase. More people will also rely more on currently crowded emergency rooms for health care. Maryland needs: "A combination of short, intermediate, and long-term strategies is needed to comprehensively address both primary and specialty care shortages across Maryland. Enhancing reimbursement is absolutely fundamental/critical/essential to the effort" (Cowdry, 2004, p.4). In addition to concerns, Maryland physicians' reimbursement from commercial carriers currently ranks at the bottom 25% of the states. Medical liability insurance and other expenses physicians incur also contribute to problems for physicians to consider practicing in one of the highest cost of living states in the U.S. Two insurers in the Maryland market, also contribute to concerns, as they reportedly reflect "take it or leave it" attitude in contract negotiations. Cowdy also notes;

The State of Maryland must enact designated incentive programs to attract physicians to practice in shortage areas within the state of Maryland, such as; Loan forgiveness programs for Physicians who will commit to providing health care for a minimum of five years in the designated shortage areas. This should be in combination with existing federal programs. Physician credentialing should be by public policy established as a statewide standard in law and be maintained by the Board of Physicians. These standards should be accepted by all licensed providers, insurance carriers and hospitals in Maryland. This credentialing can be based on national standards and adopted statewide. All licensed physicians should be able to have admitting and treatment privileges at the closest hospital to their private offices if they are working within a shortage region within the state of Maryland. (Cowdry, 2008 P.46)

Significance of the Research

Maryland Health Care

Maryland's inefficient, yet exceptionally expensive healthcare system costs others who live in Maryland, as well as individuals who live outside the state. Currently, the United States (U.S.) "spends more than twice as much per capita as countries that provide health care for all their citizens" (Kasper & Preston, 2008, ¶ 1).

The U.S., however, also stands out as the only industrialized country in the world without a universal health care system. The lack of a universal health care system that would allocate access to health care to all individuals, albeit, does not constitute the focus for this study. Instead, in light of the unsettling, significant statistics relating to the1,600,000 uninsured and underinsured individuals living in Maryland, this study examines the disparity in access to health care services between rural and urban residence in Maryland. This study also explores ways the lack of financial resources impacts Maryland's health care system. Bob Burdon, (2006), president and chief executive officer of the Annapolis and Anne Arundel County Chamber of Commerce, contends that in regard to costs and access to healthcare, "Maryland, like other states in the nation, is at a crossroad..." (¶ 1). The crossroad for Maryland, according to Burdon, constitutes decisions regarding how to gain control of health care costs. Maryland will have to choose whether to adopt a single-payer system or a market-based approach to counter these costs contributing to the reported blatant discrepancies in the health care system. The current paradigm Maryland utilizes to provide health care coverage to its citizens, and contemporary attempts to control health care costs Burdon (2006) contends, mirrors a flawed system. To remedy the system, either the single-payer system or a market-based approach, Burdon (2006) asserts, will eventually work to control care costs. The method to achieve the desired goal, however, significantly varies between the two choices. Burdon (2006) purports, albeit, that the practice of medicine needs to be put back into the hands of doctors and their patients. In addition, different alternatives for treating illnesses, as well as preventive care, need to be developed and implemented.

1.2 Study Area

During the study, the researcher examines the following areas:

The financial impact on access to health care in rural vs. urban areas in Maryland in terms of mortality rate.

The financial impact on access to health care in rural vs. urban areas in Maryland in terms of morbidity rate.

The differences in the impact of cost on access to health care in rural vs. urban areas in Maryland in terms of the ethnic makeup of the populations served. This study, as noted earlier, purports to analyze the disparity in access to health care services between rural and urban residence in Maryland, and explore the impact of the lack of financial resources relating to this concern. To answer the primary research question: What factors contribute to the current disparity in access to health care services between rural and urban residence in Maryland, and also attribute to the ensuing impact of the lack of financial resources? The researcher addresses this research problem in the directed research project by addressing the following sub-research questions.

Sub-Research Questions:

What is the financial impact on access to health care in rural vs. urban areas in Maryland in terms of mortality rate?

What is the financial impact on access to health care in rural vs. urban areas in Maryland in terms of morbidity rate?

What are the differences in the impact of cost on access to health care in rural vs. urban areas in Maryland in terms of the ethnic makeup of the populations served?

Study Hypothesis the research questions crafted for this study contributed to the determination of this study's hypothesis: If the challenges currently attributing to disparities in access to health care services between rural and urban residence in Maryland are effectively addressed and positive… READ MORE

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