Geographic Access Barriers

Key Questions (by Marie Pantojan)

What Regions of America Are Most Affected by Geographic Access Barriers to Health Care?

The issues surrounding the geographically determined disparities in health care access and quality are not generally front page headlines on the national news. These issues are, however, affecting approximately 20% of the nation’s population – those who reside in non-metropolitan counties, collectively referred to as Rural America. The residents of these counties have a higher chance to report fair or poor health and suffer more often from chronic conditions than their urban counterparts. (Refer to the fact sheet by the AHRQ for a good idea of health care disparities and rural health.) In particular, rural and frontier counties in the Midwest experience a large disparity in access to care, where there is a sparse distribution of general hospitals available in a very large area of land.

How Is the Quality of Health Care in Rural America?

The hospitals that are located in Rural America are often at a disadvantage from urban hospitals. For example, information technology can be a potential tool for increasing the quality of health care, but studies have shown that rural hospitals have difficulty implementing IT systems. The Journal of Rural Health released an articlethat puts health care on a continuum, and proposes ways for improving the quality of and access to health care in Rural America.

What About Access to Psychological Care?

The Journal of Rural Community Psychology is dedicated to the dissemination of information related to the sociological, psychological and mental health issues in rural and small community settings. To get a good grasp of the general problem, the APA’s article “Beyond Urbancentrism” is a great issue brief. Little is still known, however, about the differences between depression management care in rural and urban areas – but this issue is explored in a report published by the Journal of Rural Health.

Medicare Patients


Physician Access

  • Merritt Hawkins. Physician Access Index 2015. The Physician Access Index, as Merritt Hawkins’ ranking system is called, tracks nearly three dozen metrics that influence access to physicians, physician assistants (PAs) and nurse practitioners (NPs) in each state using a variety of proprietary and non-proprietary sources. Metrics include physicians per capita in the state, physicians trained per capita, physicians trained per capita who stay in the state, PAs and NPs per capita, percent of the population with health insurance, physician Medicare and Medicaid acceptance rates, household income, states incorporating telehealth, urgent care centers and retail clinics per capita, percent of physicians close to retirement, and a variety of others. Each state is given a score for each metric. The more favorable the metric (i.e., a high number of physicians per capita) the lower the score. Massachusetts, for example, has the most physicians per capita and is given a score of one for this metric, while Mississippi has the fewest and is given a score of 50.

Medically Underserved Areas

Rural Health

Inner Cities


  • Telemedicine Issues and Web Links (HealthHippo)
  • Telemedicine Links (Hardin MD: University of Iowa)
  • Telemedicine Resourcess
  • Telemedicine and the Law (Arent Fox)
  • On-line Doctor Visits
    •  This site offers California residents no-wait consultations with healthcare professionals from 9 a.m. to midnight every day.
    • MeMD. This site also offers  consultations 24/7 nationwide.  It does not dispense medications of any kind and is not an online pharmacy. MeMD will not route any e-prescriptions to online pharmacies. Any e-prescription issued through MeMD must be purchased and reviewed with a pharmacist, in person, at a local pharmacy. Medications cannot be purchased directly or indirectly through MeMD. The cost of a MeMD visit covers only the consultation with a medical provider and does not, in any way, apply toward the expense of purchasing a medication.
    • Teladoc. Teladoc is the first and largest telehealth provider in the nation, founded in 2002, offering  consultations 24/7. All of the doctors in its national network are U.S. board-certified family practitioners, PCPs, pediatricians and internists who use electronic health records to diagnose, treat, and write prescriptions, when necessary. Its quality process meets National Committee for Quality Assurance (NCQA) standards. Teladoc doctors are credentialed every three years.

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