Access to disability services is better in rural communities than in urban ones, according to a new report from the University of Minnesota’s Rural Health Research Center.
Urban residents are more likely to report barriers to accessing health care than rural residents, the report explains. The research team looked at 11 barriers to care among rural residents without disabilities, rural residents with disabilities, urban residents without disabilities, and urban residents with disabilities.
Although adults with disabilities, regardless of location, reported difficulties accessing care because of nine of the barriers, some urban residents – both with and without disabilities – reported having trouble overcoming many of those barriers.
“We found more differences by disability status than we did across rural and urban areas,” Alexis Swendener, the lead author of the study, said in an interview with the Daily Yonder. “There were some actual urban disparities, with folks in urban areas having less access compared to folks in rural areas.”
While the analysis is still preliminary, Swendener said there were similarities that were striking just in people with disabilities delaying care because of those barriers.
“People with disabilities and without disabilities were likely to delay care due to appointment availability,” she said. “I think that really just speaks to our struggles across location, but even in urban areas, of not necessarily having access to healthcare facilities or services during times that work for them.”
Urban residents with disabilities were more likely to cite delaying medical care due to the hours clinics were open (9.7%), a provider’s insurance acceptance (7.7%), and appointment availability (15.5%), according to the analysis. Those residents were also more likely to report financial difficulty paying for mental health services and dental health services than their rural counterparts, although both groups reported similar rates of delaying medical care due to cost, and not being able to afford prescriptions.
Rural residents with disabilities, however, often face different barriers to accessing healthcare, including long travel distances, limited access to transportation, lack of access to specialized providers, and inadequate or inaccessible housing, according to the Rural Health Information Hub.
“These, combined with higher rates of poverty and underinsurance, create ‘service deserts’ in many rural areas,” information on the RHIHub said.
Urban residents without disabilities were the most likely to report delaying care because of appointment availability (13.1%), the Rural Health Research Center analysis found. More than one-tenth of rural residents without disabilities (10.6%) also reported delaying care because of appointment availability. However, residents with disabilities in both urban (10.1%) and rural (7.9%) were less likely to report that as a barrier.
Rural and urban residents with disabilities were more likely to delay medical care due to a lack of transportation (15.8% and 14.0%, respectively) compared to rural and urban residents without disabilities (4.8% and 4.9%, respectively). But residents with disabilities were less likely to report having a usual place to go to for medical care, with only 6.4% of urban residents and 3.0% of rural residents, compared to 11.7% of urban individuals without disabilities and 8.3% of rural residents without disabilities.
“Transportation is an issue for rural people (without disabilities), but it’s also an issue for both rural and urban people with disabilities just being able to find transportation,” Swendener said. “Whether you’re in a big city or you’re in a small town, those locations are going to (impact) what that transportation is going to look like, but it’s still a problem.”
But Sandy Hanebrink, a disability advocate in upstate South Carolina and the executive director of Touch the Future, an organization that helps disabled individuals with assistive technology, said she felt the analysis was too limited to draw any broad conclusions from.
In her view, the sample sizes and the definition of disability impacted the outcomes.
The economic differences between rural residents with disabilities and urban residents with disabilities could explain some of the results, Hanebrink said.
“More people with disabilities in urban areas have access to more opportunities (like) education, employment, recreation, public transportation… which can make schedules busier,” she said in an interview with the Daily Yonder. “I think access to preventative, timely, and effective healthcare in rural communities is problematic, as there are higher rates of disability per capita. I believe significant barriers to equal and equitable healthcare for disabled Americans is a huge problem, no matter where you live.”
While Hanebrink is an occupational therapist who also advocates for disability laws, she is also a patient with disabilities. When she was a student athlete at the University of Florida, she was in a car accident. During treatment, she had an allergic reaction to an antibiotic that resulted in transverse myelitis and left her a quadriplegic. So she understands first-hand the challenges that rural residents with disabilities face.
Although she lives in Anderson County, South Carolina, which has more than 200,000 residents, she helps clients in more rural areas of the state. Healthcare access for those with disabilities is limited, she said.
“In Anderson County, most disability services are provided by nonprofits, especially if you do not have Medicaid. The only medical provider I have in my county is a dentist,” she said. “All my other healthcare needs are at least 45 minutes away (two providers) to two-to-five hours away (five providers), including from out of state (three providers),” Hanebrink explained.
“It actually scares me to think about if I end up in an emergency situation at a local hospital, will they make things worse as, historically, this has happened to me. They don’t have the training or facilities to support my complex care needs… As I age, we have had discussions on whether we need to consider moving, but doing so is cost-prohibitive.”
Swendener’s research team acknowledged the limitations in the data set in terms of undercounting people with less severe disabilities. Still, the analysis highlights issues faced by Americans with disabilities, whether they live in urban or rural areas, Swendener said.
“I think this speaks to larger issues, concerning access and availability,” she said. “There’s a lot of work to be done. It’s important to look at these (barriers) across locations, but there are some shared barriers, and a lot of times we don’t necessarily think about the wider barriers among people with disabilities for various reasons related to structural inequalities and drivers of health.”
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