The United States has many regions which have been described as medical deserts, with those locations featuring inadequate access to one or more kinds of medical services. An estimated thirty million Americans, many in rural regions of the country, live at least a sixty-minute drive from a hospital with trauma care services. Nearly half of Americans live over 25 miles from one of the nation's top-ranked hospitals, limiting their access to specialized and high-quality medical care. This geographic barrier significantly affects health outcomes, particularly for those in rural areas. Regions with higher rates of Medicaid and Medicare patients, as well those who lack any health insurance coverage, are less likely to live within an hour of a hospital emergency room. Although concentrated in rural regions, health care deserts also exist in urban and suburban areas, particularly in predominantly Black communities in Chicago, Los Angeles and New York City. Racial demographic disparities in healthcare access are also present in rural areas, particularly in Native American communities which experience worse health outcomes and barriers to accessing quality medical care. Limited access to emergency room services, as well as medical specialists, leads to increases in mortality rates and long-term health problems, such as heart disease and diabetes.
Between 2010-2021, 136 hospitals in rural regions closed their doors, unable to bear worker shortages, low patient volume, and financial burdens of the COVID-19 pandemic. In addition to the immediate financial problems facing rural healthcare providers, inequities in rural healthcare are further aggravated by the disproportionately low amount of newly graduated doctors that are willing to work in rural areas. Addressing the doctor shortage in the U.S. remains a challenge in terms of improving healthcare in America. In the 2010s, a study released by the Association of American Medical Colleges (AAMC) projected a shortage of between 37,800 and 124,000 physicians, which impact rural and underserved communities the most directly.
Proposed solutions to US health care deserts include the enactment of a national single payer health care system; adoption of a public option under the Affordable Care Act (ACA); the approval of higher Medicare reimbursements and tax credits for struggling hospitals; the establishment of strategically placed free-standing emergency centers; the expansion of telehealth and telemedicine to remote areas; and increased incentives to recruit doctors to practice in rural and underserved areas.
In rural areas In 2019, the federal government identified nearly 80 percent of rural America as “medically underserved,” lacking in skilled nursing facilities, as well as rehabilitation, psychiatric and intensive care units. Access to rural healthcare is limited, as there are approximately 5.1 primary care doctors per 10,000 people, whereas there are 8.0 doctors per 10,000 in urban centers. About 8% of rural counties had no doctors in 2019. Rural communities face lower life expectancy and increased rates of diabetes, chronic disease, and obesity. Fewer than half of rural women live within a thirty-minute drive of the nearest hospital able to provide obstetric services, and 12% do not live within a sixty-minute drive of the nearest such hospital, resulting in increased maternal and infant mortality rates.
Rural residents may live on farms, ranches and Indian reservations far from a hospital, forcing residents to take several hours or an entire day off work to drive to a doctor's appointment or follow up care, making rural residents less likely to seek treatment. The Centers for Disease Control and Prevention (CDC) reports that during 1999–2014 rural counties experienced increased mortality rates from the five leading causes of death (1-heart disease, 2-cancer, 3-unintentional injury, 4-chronic lower respiratory disease (CLRD), 5-stroke) compared with metropolitan counties. Unintentional injuries (high speed car accidents; opioid and drug abuse and traumatic brain injuries) mortality rates, were "approximately 50% higher in rural areas than urban areas", with lack of access to adequately staffed healthcare facilities listed as one among several factors leading to this disparity.
There is a disproportionately higher population of older adults over 65 who live in rural areas, with 17.5% of rural populations being over 65 versus 13.8% in urban areas. This means that medical deserts in rural areas have a more significant impact on the older adult population in rural areas since there is a higher ratio than in urban areas. Those over 65 years old are also more likely to require medical services for chronic conditions such as hypertension and heart disease. Living in a rural medical desert for older adults, then, could mean less of a chance to be able to receive treatment for such chronic conditions.
In states that chose not to expand Medicaid programs under the Affordable Care Act–Alabama, Georgia, Missouri, Oklahoma, Texas and Tennessee–rural Americans face limited options as hospitals close their doors. A 2019 study found that participation in Medicaid expansion reduced the likelihood of rural hospital closures by 62% and that of the hospitals deemed most at-risk for closure, 75% were in states that did not expand Medicare.
In 2016, the Kaiser Commission on Medicaid and the Uninsured, in conjunction with the Urban Institute, conducted a case study analysis of three privately owned Southern hospitals to determine the causes and effects of their closures in Kansas, Kentucky and South Carolina. In addition to the challenges of graying, declining and poverty-stricken populations, as well as the preference of privately insured patients to seek treatment at newer hospitals further away, the report said corporate profit-driven decisions, as opposed to local community needs, shuttered the doors of rural hospitals in underserved areas. In a "shift from mission to margin," health systems that owned multiple hospitals, some more profitable than others, closed less-profitable hospitals in Kentucky and South Carolina to concentrate resources on other hospitals in the chain, resulting in communities without acute care and emergency facilities to serve as a safety-net for patients facing challenges with mental health and drug use. The case studies report also notes that decreases in Medicare and Medicaid reimbursements, some the result of federal budget sequestration or across the board cuts, others the result of the Affordable Care Act's lower hospital Medicare readmission reimbursement rates, negatively impacted the finances of the rural hospitals.
Physician shortages
While approximately 20% of Americans live in rural regions, only 9% of the country's doctors practice in rural areas. The average age of doctors in rural areas has increased, with over 50% of rural physicians over the age of 50. In 2019, it was predicted that the number of rural doctors would decline by 23% by 2030 due to these physicians retiring. The Association of American Medical Colleges (AAMC) projects a shortage of 13,500 to 86,000 physicians by 2036, with non-primary care specialties facing the largest gaps. Rural areas, already experiencing limited healthcare access, are expected to be disproportionately affected. An additional contributing factor to this decline is newly graduated doctors' reluctance to move to rural areas. Doctors originally from rural areas are more likely to practice in rural regions, however, a study from the Association of American Medical Colleges found that the percentage of rural Americans enrolling in medical school is declining. A 2023 survey of physicians found that 68% of newly graduated doctors wanted to work in hospitals, rather than jobs in family practices that are more common in rural areas. Additionally, only 4% of resident physicians wanted to work in a community of 25,000 or less, highlighting the difficulty in recruiting new physicians to rural areas.
The lack of entertainment or food diversity, fear of prejudice, and reduced financial prospects associated with rural regions have been cited as factors leading to medical students' reluctance to practice in rural regions, as well as the unique difficulties associated with practice rural healthcare. For example, in parts of rural Alaska, transferring patients to hospital emergency rooms can "depend on the schedules of rickety charter planes" which are often prevented from flying due to the weather. In some states, such as Oklahoma, a lack of available residency programs for prospective doctors directly contributes to a shortage.
Impact on Native Americans and Alaskan Natives
Native American and Alaska Native populations often face even greater healthcare disparities. Many live in remote regions where limited healthcare facilities and insufficient funding for Indian Health Service programs restrict access to essential medical care, resulting in poorer health outcomes. The federal government is legally obligated under treaties to provide medical care to American Indian and Alaska Native Americans through the Indian Health Service (IHS), part of the United States Department of Health and Human Services. Advocates for the Native American community have argued, however, that the government chronically under funds the IHS, resulting in a lack of accessible health care facilities, particularly emergency room departments for those living on reservations. The IHS provides services to 573 tribes and 2.56 million Native Americans primarily living on or near reservations and in rural areas concentrated in Alaska and the western United States. In 2011, the IHS reported that life expectancy for Native Americans was 73, compared to 78 for all other races in the US, as Native Americans and Alaskan natives were dying at higher rates due to chronic liver disease, diabetes, intentional self-harm and suicide, as well as respiratory diseases. In 2016, the Office of Inspector General (OIG) issued reports criticizing the IHS's hospital care for tribal members, citing lack of oversight, outdated equipment and difficulty in recruiting and retaining skilled staff. Administrators at one hospital interviewed by the OIG complained of aging hospital infrastructure with corroded pipes causing sewage to spill into an operating room.
Dissatisfied with the IHS's management of health clinics and hospitals closest to reservations, tribes have demanded greater control over hospital administration. In July, 2019, the Great Plains Tribal Chairman's Health Board representing 18 tribal communities in South Dakota, North Dakota, Nebraska and Iowa, took over the Rapid City's Sioux San Hospital, where, according to government investigators, patients died as a result of misdiagnoses and treatment by staff members not screened for hepatitis and tuberculosis.
In New Mexico, where Native Americans, in 2020, made up six percent of the population but 25% of positive COVID-19 cases, members of the Navajo Nation live without access to running water to frequently wash their hands, as recommended by the CDC.
In urban areas According to research conducted in 2019 by University of Chicago Medicine, African American census tracts in large US cities—Chicago, Los Angeles, New York City—are more likely than white majority neighborhoods to be located in trauma care deserts that are greater than five miles from a trauma center offering emergency medical services and specialists: neurosurgeons, cardiac doctors, respiratory therapists.