Living in a frontier area comes with its own set of unique challenges when accessing and delivering health care. People living in these areas face many of the same health issues those in rural communities do, but care comes at a higher cost and less convenient access. With more than 12.2 million people living in these areas, it’s important to explore ways convenient, timely health care can be delivered.
Sparsely populated, these are the most isolated places along the “rural-urban continuum” in the US. Though described in several different definitions, the USDA Economic Research Service categorizes frontier areas into four levels:
Level 1: At least 60 minutes of travel to reach an urban area of 50,000-plus
Level 2: At least 45 minutes of travel to reach an urban area of 25,000 to 49,999
Level 3: At least 30 minutes of travel to reach an urban area of 10,000 to 24,999
Level 4: At least 15 minutes of travel to reach an urban area of 2,500 to 9,999
Mostly located in the West, frontier areas are part of geographically large counties that often lack access to health care facilities, schools, grocery stores, and other resources (Rural Health Information Hub). Access can be further impeded by a lack of infrastructure (i.e. roads) and seasonal changes, like blizzards, floods, or ice that impact transportation. For those that live in more wilderness areas, air travel is the only option. Needless to say transporting goods and services to these areas are especially difficult.
Adding insult to injury, employment in these areas often centers around tourism, farming, ranching, logging, and mining- occupations that carry a higher risk of injury than other occupations.
Barriers to Health Care
Thirty percent of frontier counties do not have a hospital and ones that do are often short staffed (Online Journal of Nursing Informatics). Many health care providers choose to practice in more urban areas that are less remote and have higher pay. More remote clinics must balance the higher cost of running a remote clinic with providing needed medical services to a much lower volume of patients.
Yet these remote areas also see the same health conditions as people in rural communities: high rates of youth substance abuse, tobacco use, hypertension, injuries due to motor vehicle accidents, suicide, obesity, and death from serious injuries.
Even in frontier areas, like in other rural areas, those who struggle with certain conditions like substance abuse or mental health issues often fear being stigmatized so avoid seeking care. It’s a serious problem, and without adequately trained health care professionals or resources, can lead to suicide- an increasing trend we’re seeing in many parts of rural America.
So, how do we address this problem? Fortunately, there are a number of innovative ideas that are being implemented to improve access and delivery of care.
Providing Health Care in Frontier Areas
The Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law in 2009 to promote the adoption and meaningful use of health information technology, like telemedicine. Part of the $31.2 billion investment was used to create loan and grant programs to expand access to technology in frontier areas. The Recovery Act Broadband Initiatives Program (BIP) is working to expand broadband access to rural and frontier areas while the Distance Learning and Telemedicine Loan and Grant Program (DLT) uses telecommunications to connect teachers, medical providers, patients, and students in frontier areas to one another. Already, more than 2.8 million households in 31 tribal lands and 125 persistent poverty counties have been impacted by the HITECH Act.
New Workforce Models
According to RHI.org, obstetric, mental, dental, and substance abuse services are the most difficult to access in rural and frontier areas. In addition to Rural Health Clinics and Frontier Extended Stay Clinics, dental therapists, behavioral health aides, community health aides (CHAs) are also ways to address workforce shortages in frontier areas. CHAs are trained in a variety of conditions like mental health and trauma. Investment in programs like these are all the more important as people living in frontier areas most often lack access to dental, mental, and substance abuse services. And with the growing availability of telemedicine, it can make their work even more impactful.
Frontier Community Health Integration Project (FCHIP)
As stated earlier, 30 percent of frontier counties do not have a hospital. And the ones that do frequently have higher costs and staff shortages. The Frontier Community Health Integration Project (FCHIP) is testing ways to better integrate health care delivery on the frontier in an effort to shrink the distance between Medicare beneficiaries and acute and extended care. It’s currently being tested in 10 critical access hospitals in frontier areas. The goal is to see how to improve not only access to care, but how dollars can be spent more wisely to ensure patients are receiving the health care they need.
Recruiting Health Practitioners
One of the main challenges frontier clinics and hospitals face is adequately staffing their facilities with trained health care professionals. In addition to living and working in a remote location, health care professionals in these areas also see lower wages. Some areas are working to improve recruitment of medical professionals by offering tax credits to rural practitioners and creating partnerships with higher education institutions that include clinical rotations and internships in frontier clinics and hospitals.
Delivering and accessing health care in frontier areas poses unique challenges. However, with new technologies and increasing support from the federal government with programs like FCHIP, overtime, health care can become more affordable and accessible for millions of Americans.