Health care access from the rural perspective: A narrative review

Health care access has been described using several definitions and frameworks, but none are specific to rural populations. We describe ways access to care is measured using the model of access developed by Fortney et al., with a focus on the differential impact on rural populations.

We describe patient-centered access metrics in rural and urban populations using the Fortney model's five access dimensions: geographic, temporal, financial, cultural, and virtual. Patient-level access is put into context of the broader environment in which they live (i.e., their community, health care providers, and health care system).

Rural populations face similar access challenges as urban residents but are disproportionally impacted by four interrelated challenges: (1) geographic access barriers of distance and available transportation, (2) virtual access care barriers manifested by broadband internet access and digital literacy, (3) health care workforce shortages, and (4) differential impact of social determinants of health. Key facilitators to overcome these include: (1) integrated public transportation services when in-person care is required; (2) expanded broadband coverage, affordability, and education to ensure access to telemedicine services; and (3) training, incentives, and support for the rural workforce.

Health care systems should incorporate access metrics into routine data collection to drive improvement and ensure equitable access to quality health care. Rural systems of care may be disproportionally impacted by access challenges which require unique approaches for improvement.