By Alan R. Weil, Health Affairs, December 9, 2019
This month’s Health Affairs explores many dimensions of health and health care for the one out of five Americans who live in what the US Census Bureau defines as a rural area. Much attention is focused these days on the relatively poor health outcomes and heightened rate of socioeconomic disadvantage of rural America.
As Janice Probst and colleagues point out in their overview paper, rural mortality rates only started falling behind urban rates in the mid-1980s. The authors introduce the concept of “structural urbanism”—a bias in financing health care services tied to individuals that favors densely populated areas and fails to account for the fixed costs associated with delivering services to those living more remotely. Kevin Bennett and coauthors review how various government agencies define rural and point out the consequences of using definitions that may be inappropriate for a particular purpose.