The ongoing closures of rural hospitals across the United States are forcing many Americans to travel long distances for surgeries, with some patients facing hour-long drives to reach surgical centers, according to two recent reports.
By 2020, data revealed that 99 million Americans were already struggling to find “timely, high-quality, and affordable surgical care,” according to the University of Michigan.
For those living in rural areas, the problem is even more severe.
“The closure of over 150 rural hospitals in the past 14 years has been a major factor, but other elements in the health policy landscape are also contributing,” said Dr. Cody Mullens, lead author of both studies.
The issue isn’t just the distance; out-of-pocket costs for surgeries are also on the rise, even for patients with insurance.
“While fewer patients lack access due to not having insurance, more are underinsured due to high-deductible health insurance plans and other factors,” explained Mullens, a resident physician in surgery at Michigan Medicine.
The studies were published in the February issue of Annals of Surgery and on February 12 in the Journal of the American Medical Association.
The study in Annals of Surgery analyzed data from 2011 to 2020, using information from Medicare, Medicaid, the American Hospital Association, and other sources.
The findings show that nearly 100 million Americans lacked local access to affordable surgery by 2020. Rural Americans were particularly affected.
The researchers defined good access to surgery as being within an hour’s drive of a hospital that offers surgical care and has a Medicare quality rating of at least three stars. Additionally, patients should be able to afford out-of-pocket costs after insurance coverage.
Using this definition, the study found that nearly 7% of rural patients lacked access to surgical care, compared to just 2% of urban patients.
The second study, published in JAMA, focused on rural Americans who underwent one of 16 types of surgery between 2010 and 2020. These included both low- and high-risk procedures.
By 2020, 44% of rural patients had to drive over an hour to get surgery, up from 37% in 2010. On average, these patients traveled 55 minutes to reach a surgical center.
The combined challenges of long drives and high costs can seriously affect patients’ health, Mullens said.
“Looking at these factors together helps us understand the real impact of our health policies on patients, who may delay surgery, resulting in worsened conditions,” he said.
Some trends that restrict patient access are linked to policies intended to improve care. For example, the push to centralize surgeries at fewer, higher-quality hospitals across the U.S. has reduced the number of available surgical centers.
However, Mullens believes that routine surgeries like gallbladder removals, hernia repairs, and joint replacements can be safely performed at smaller rural hospitals.
“It’s not acceptable for patients to drive so far for low-risk surgeries that could be safely done at smaller hospitals,” he said.
In many cases, Mullens suggests considering telehealth sessions for pre-surgery consultations to reduce the burden of travel.
Regarding the rising costs of surgery, Mullens and his team advise that patients pay attention to more than just the premium when choosing health insurance. High-deductible plans can be a major obstacle.
“Choosing a plan with a lower deductible, contributing to a tax-free health savings account, and confirming which hospitals are in-network for surgery can make a big difference,” the team said.
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