Rural access to health care presents a complex web of challenges.  We explore these challenges, and the disparities they create, in detail and discuss initiatives designed to address them.

Your cell phone vibrates in your pocket. Ride is here. Grabbing a jacket, you check the clock and note that it is just an hour until your doctor’s appointment. Cutting it close. Jim—the “friend with a reliable car”—waves at you from the driver’s seat as you step out your front door. Your own car is on the fritz, and the closest hospital—Allen County Regional Hospital—is 40 minutes away from your Burlington, Kansas, home.

This story is not uncommon in rural America. Rural access to health care presents a complex web of challenges that include limited facilities, high health care costs, health care provider shortages, and geographic isolation.

Below, we explore these challenges, the disparities they create, and how the Kansas Health Science University’s Kansas College of Osteopathic Medicine (KansasCOM) is working to address them.

Unpacking Barriers to Health Care Access: Provider Shortages, Social Determinants of Health, and Cost of Care

Rural Kansas faces a spectrum of equally pressing barriers to health care access.

Cost of Care: Comparison of Health Care Costs in Rural Kansas and Out-Of-State vs. National Averages

The Health Care Value Hub, supported by the Robert Wood Johnson Foundation and Arnold Ventures, ranked Kansas 49th out of 50 states plus Washington, D.C., on the Health Care Affordability State Policy Scorecard. Their study found that Kansas is among the most expensive states, with inpatient/outpatient private payer prices at 290% of Medicare prices, ranked 42 out of 50 states, plus the District of Columbia.

In some ways this is unsurprising, as the cost of health care in rural areas is often higher per capita compared to urban centers. While health care expenses are generally lower in absolute terms due to the reduced availability of services, individuals in rural Kansas often face higher out-of-pocket costs. Rural health care facilities tend to charge more for services, driven by lower patient volumes and higher operational costs.

Additionally, rural residents have other factors to consider. This can include travel expenses for specialized treatments or income reductions due to limited employer health benefits—this is all on top of higher care costs.

Provider Shortages: Availability of Health Care Providers in Rural vs. Urban Areas

Rural hospitals and clinics are often seen as “less attractive” employment opportunities, making it difficult for them to hire and retain employees. This leads to health care provider shortages, particularly in specialty practice areas.

Provider shortages impact all aspects of health care, including hospitals, primary care clinics, oral health providers, and mental health services. According to the Kansas Department of Health and Environment, the state has a critical shortage of primary care physicians in rural regions.

Kansas has 105 counties, 50 of which are classified as 100% rural by the U.S. Census Bureau. Many of these regions are designated as Health Professional Shortage Areas (HPSA), meaning they lack sufficient health care professionals in primary care, dental health, or mental health services to meet the needs of the population. The ratio of health care providers per capita in rural Kansas is starkly lower compared to urban areas; while there are 1.5 physicians (MD or DO, any specialty) per 1,000 people in urban counties, rural counties have only 0.8.

Hospitals: Of the 124 hospitals in Kansas, 82 of these are classified as Critical Access Hospitals (CAH). These hospitals have fewer than 25 beds and offer limited services compared to larger facilities. Further complicating this landscape is the fact that 82% of the state’s rural hospitals recorded financial losses on patient services in 2023. 59 of the state’s rural hospitals are in jeopardy of closing, and 28 are at immediate risk of collapse.

Rural clinics and health care providers are also sparse, with many small towns relying on a handful of practitioners for primary and urgent care. Combating these shortages is not easy. Rural health care facilities face significant challenges in attracting and retaining health care professionals, including:

  • Professional isolation
  • Lower pay compared to urban areas
  • Limited career advancement opportunities
  • A lack of amenities for professionals and their families

KansasCOM is committed to improving health care access in rural areas through various initiatives aimed at training the next generation of health care professionals.

KansasCOM fosters a sense of service among its students, encouraging them to consider careers in rural health care through mentorship, rural clinical rotations, and partnerships with local health care providers.

Social Determinants of Health: Income, Education, and Employment

Social determinants of health—such as the inability to take time off work or low trust in the health care system—often delay rural Kansas residents from seeking care. This exacerbates existing health conditions, particularly for chronic illnesses that require ongoing management.

Insurance Access

Rural Kansans are more likely to be uninsured or underinsured compared to their urban counterparts. The lack of employer-sponsored insurance—coupled with lower income levels—makes it harder for rural residents to afford health coverage. Many rural workers are employed in agriculture, small businesses, or industries that do not provide health benefits, leading them to rely on the individual insurance market or government programs such as Medicaid. This underinsurance exacerbates existing health disparities and contributes to the poorer health outcomes observed in rural areas.

Health Literacy

Lack of resources in rural communities can contribute to lower rates of health literacy, making it harder for patients to navigate the health care system, self-advocate, and understand treatment options. Low health literacy hinders the ability of rural folks to recognize health issues early and stigma around health care (especially mental health) might stop them from pursuing care even when they do recognize symptoms.

Transportation

For those living in rural communities, hospitals and primary care providers are often a distance away. These communities often lack public transportation, too. Even with a car, the long travel distance required might mean that individuals have to take off from work to receive care, which may not be an option for people straddling the poverty line. These challenges might have a particularly limiting effect on parents who might need to hire babysitters or tap family for support, increasing either the cost associated with supporting their health or the burden on family members.

“At KansasCOM, we know that understanding how socioeconomic factors impact access to health care and basic resources is crucial for any health care professional,” explains Zachary Taylor, a student doctor. We intentionally build experiences into our curriculum that help our students explore potential solutions to address systemic barriers to health and well-being. These curricular elements (such as poverty simulations) underscore KansasCOM’s dedication to producing empathetic health care professionals. By immersing students in low-income and/or rural realities, KansasCOM fosters empathy and humility, empowering students to make a difference in the communities they serve.

Impact on Patient Outcomes and Access to Necessary Treatments

Limitations in health care infrastructure in rural Kansas directly affect patient outcomes. Residents in these areas are more likely to experience late-stage diagnoses—especially for conditions such as cancer and heart disease—due to delayed or infrequent access to screenings and treatments. This is especially true for the top five leading causes of death:

  • Heart disease
  • Cancer
  • Unintentional injury
  • Chronic lower respiratory disease
  • Stroke

Preventive care services—such as vaccinations, cancer screenings, and chronic disease management—are also less readily available. This results in higher rates of preventable diseases. For example, individuals with diabetes or hypertension in rural Kansas may struggle to maintain consistent care due to the lack of nearby providers.

The shortage of mental health services in rural America leads to higher rates of untreated mental health issues, including depression and substance abuse disorders. The U.S. Centers for Disease Control and Prevention (CDC) data surrounding these negative outcomes is staggering:

The responsibility for person-centered care lies with everyone involved in the health care system, from doctors and nurses to medical care systems and their administrative staff. The most crucial participant, however, is the patient. We believe in customizing care to the insights, values, and preferences of our patients. In the case of rural care, we ultimately craft a care journey that truly reflects a patient’s needs, grounded in the realities of living a rural lifestyle.

Students are trained in telemedicine and other innovative care delivery models that can bridge the gap in health care access for rural populations. Read more about that here.

KansasCOM is paving the way to more equitable rural health care. Join us.