Rural Health in Ohio: Issues and Trends

Heather Reed, Administrator

Primary Care and Rural Health Program

Ohio Department of Health

Learning Objectives

Understand the uniqueness of rural Ohio as it relates to health status and health care access

Identify at least five rural-specific health status or health care access issues

Describe successful collaborative interventions to address rural health needs in Ohio

What is Rural?

Definitions of Rural

U.S. Census Bureau Urban = 50,000 people

Office of Management and Budget Metro areas + economic ties to core counties

Economic Research Service (USDA) Gaining popularity – combines Census Bureau

data with commuting patterns

Rural Ohio

Lawrence

Henry

Putnam

Coshocton

Holmes

Scioto

Highland

FayettePickaway

Greene

BelmontMuskingum

Monroe

Guernsey

Portage

Harrison

Jeffer- son

Richland

Seneca

Hardin

Sandusky

Licking

Delaware

Madison

Franklin

ChampaignMiami

Darke

Preble Mont-gomery

Carroll

Brown

Huron

Erie

Tus-carawas

Ash- landWyandot Crawford Wayne

Cuyahoga

Lorain

Summit

Lake Ashtabula

Trumbull

Geauga

Mahoning

ColumbianaStark

Noble

Gallia

ClintonWarrenButler

Shelby

Williams

Mercer

Allen

Auglaize

Hancock

Van Wert

Defiance

FultonLucas

Wood

Ottawa

Logan

Union

Clark

Hamilton

Paulding

MarionMorrow

Knox

Medina

Ross

Hocking

Jackson

Vinton

Morgan

Perry

Washington

Fairfield

Athens

MeigsPike

Adams

Clermont

Source: Counties designated as rural, partially rural, or urban under the definition used by the federal Office of Rural Health Policy, 9/2009

Rural County

Partially Rural County

Urban County

Appalachia

Rural Ohio

72 of Ohio’s 88 counties are considered rural or partially rural

32 counties in southeast Ohio make up the state’s Appalachian region

Approximately 24% of Ohio’s residents live in rural areas and the remaining 76% reside in urban areas

Why Define Rural?

Eligibility for federal rural grant programs

Implementation of programs and/or laws

Research purposes to allow for statistical consistency

Regional Comparison Rural Health Grants Ohio - $22,653,160 Michigan - $72,315,051 Pennsylvania - $18,973,046 Indiana - $12,301,109 West Virginia - $28,616,136 Kentucky - $30,531,145

Health Status and Health Care Access

Rural Populations and Chronic Disease Rural populations have higher rates of:

Hypertension Heart disease Cancer Stroke

Health Risk Factors

Rural populations report higher rates of:

Cigarette smoking Obesity Physical inactivity

Rural Health Access Issues

Chronic shortages of providers Aging population Increased reliance on Medicare and Medicaid Inadequate transportation Poverty/rural economic decline Rural consumers going “urban” for health care

services

HARRISON

BUTLER

CUYAHOGA

2C

MARION

4HAMILTON

FRANKLIN

3

3

h

WILLIAMS FULTON

HENRY WOODDEFIANCE

PUTNAM HANCOCK

WYANDOT CRAWFORDVAN WERT

MERCER AUGLAIZE

LOGANSHELBY

DARKE

UNIONDELAWARE

KNOX

LICKING

FAIRFIELD

MADISON

CLARK

CHAMPAIGNMIAMI

CLINTONWARREN

BROWN

ROSS

GALLIA

WASHINGTON

NOBLE

MUSKINGUM

TUSCARAWAS

STARK

WAYNE COLUMBIANA

PORTAGE

SUMMITMEDINA

GEAUGA

LAKE

LORAIN

ASHTABULA

ERIE

HURON

OTTAWA

BELMONT

MEIGS

HOCKING

JACKSON

SCIOTO

PIKE

ADAMS

HIGHLAND

PICKAWAYFAYETTE

HOLMES

LAWRENCE

VINTON

MORGAN

PERRY MONROE

JEF

FE

RS

ON

PAULDING

PREBLE

HARDIN

SANDUSKY

SENECA

MORROW

RIC

HL

AN

D

AS

HLA

ND

COSHOCTON

ATHENS

CARROLL

C

GUERNSEY

C

MONT-GOMERY

MAHONING

TRUMBULL

LUCAS

ALLEN

HARRISON

6

GREENE

2C

C

C

C

106

Ohio HPSA Map

= Geographic HPSA

= Special Population HPSA

= Facility HPSA

= Correctional Facility HPSA

C

Source: Ohio Department of Health, Primary Care Office, Sept. 2010

CLERMONT

Rural Access Barriers

Financial

Geographic

Organizational/Availability

Sociological/Acceptability

Rural Health System Plays Major Economic Role

Not only do rural health systems have an important role in health care delivery, they also have an important economic role

Health sector often largest employer in rural counties

However, most rural residents have little idea of the importance of the health sector to the economy

Health care

safety net

Urban vs. Rural “Safety Net”

Safety Net: Web of health care professionals and institutions that provide care to the poor and uninsured, regardless of ability to pay

Urban systems: Often depend heavily on teaching hospitals and

professional educational programs that use trainees to care for low-income patients

Also include health centers and homeless centers

Rural systems: Generally do not have these types of resources

Rural Safety Net

Instead, the rural safety net depends upon a variety of different individual providers and provider types:

Rural hospitals Rural Health Clinics Community Health Centers (e.g. FQHCs) Public health departments Private practitioners

Ohio’s CAHs, FQHCs, and RHCs

Source: Ohio Department of Health, State Office of Rural Health, July 2010

Successful Collaborations

Galion Community Hospital Needs assessment with broad community

support and involvement

CAO of Scioto County Health Clinic Expanded services for low-income women

Knox County Health Department Maintenance of a community-wide wellness

coalition

Additional Resources

Federal Office of Rural Health Policy, HRSA www.ruralhealth.hrsa.gov

Rural Assistance Center www.raconline.org

National Rural Health Resource Center www.ruralcenter.org

For More Information

Heather Reed, AdministratorPrimary Care and Rural Health ProgramOhio Department of Health 246 North High Street, 6th FloorColumbus, OH 43215(614) 752-8935 Phone(614) 995-4235 Faxheather.reed@odh.ohio.gov