EDITORIAL:
Communities need to address geographic disparities in care access, quality
If you take a medical road trip, watch out for the disparities
Consider it a twist on medical tourism, but this time we can call it the great American medical road trip. In fact, one of the most valuable pieces of medical technology available today just might be a GPS navigational device. Or, for those who prefer to go the low-tech route, just open up an old-fashioned road atlas.
As we’ve been reporting for some time now—the most recent stories being this week’s special report (p. 28) and last week’s cover story (March 19, p. 6)—so much of the access to healthcare and the quality of that care is determined by geographical location. Patients in search of healthcare options superior to what’s available in their communities might have to pack their bags and start driving.
Certain sections of the country, because of a complex confluence of economic and demographic challenges, have long been designated as underserved or ranked as underperforming—often severely so. Other areas, meanwhile, have dominated the top tiers of healthcare delivery, thanks to a more advantageous set of circumstances, especially a long-term commitment to public-health improvement efforts.
Last week’s cover story, by reporter Maureen Mckinney and headlined “For better or worse,” detailed the findings of a new Commonwealth Fund study ranking health system performance in more than 300 hospital referral regions nationwide. It was the first study by the organization to examine healthcare delivery at the community level, and once again exposed vast disparities in performance and how where you live affects the type of care you can expect to receive.
In the lowest-performing communities, high poverty levels contributed to the challenges facing healthcare providers and public-health officials. Shortages of primary-care practitioners also were cited as a factor.
The top city in overall performance was St. Paul, Minn., and one state health department official certainly wasn’t surprised by the rankings, saying, “There’s a long history in this state of working as a community for the health of everyone.” The investments have clearly paid off.
In this week’s special report, reporter Paul Barr looks at a phenomenon known as a “surgical desert,” reflected in large sections of rural America where access to a general surgeon is nonexistent or limited at best. What’s driving this problem? In addition to the general migration patterns affecting rural sections of the country, there are quality-of-life issues and other preferences that physicians cite when it comes to practicing medicine in the more remote parts of the nation. The big city is just a stronger draw for the younger generations. No surprise there.
There also should be no surprise at the risks these areas face because patients lack ready access to surgical services. As one rural surgeon said, “If you build in a two- to four-hour delay in getting access to a real surgeon, I can’t believe it’s not going to affect risk-adjusted quality. … When you have a low density of surgeons, morbidity and mortality go up.”
So when it comes to the dearth of surgeons, taking the medical road trip isn’t the best answer. The solution is to boost the local supply of providers to meet the already existing demand of patients. The best answer to the riddle of geographic disparities must include learning from the best practices of communities that already have made it to the top, and fix the things that are actually fixable. Private companies are already using incentive programs, with some positive results. And as the state of Minnesota and others that put up enviable numbers would probably tell us, it takes sustained public-health investments to make progress and to maintain that success.
It’s always best when the road to high-quality healthcare is just a trip around the block.