Why is there a lack of access to health care in urban and rural areas of extreme poverty?

For many high-poverty rural and urban areas, healthcare resources are sparse. A listener in Columbus wondered why this problem was so common.

Nir Manashimi is the executive assistant dean at Indiana University’s Fairbanks School of Public Health at IUPUI. The problem, he said, relied heavily on doctors not maintaining these areas.

“They are positioning themselves in areas that have more resources,” he said. “And that creates a kind of lack of access to medical services or dental services in a lot of areas.”

Menachemi said many doctors tend to settle in areas with more facilities — such as places with more schools and shopping options.

He said there has historically been a lack of rational ways to attract doctors to these areas.

“The strategies that usually work best is to recruit someone who grew up in a rural area to practice medicine in a rural area, because they are less likely to leave because they are used to the lifestyle, they like the kind of benefits that rural communities offer,” he said.

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Furthermore, Menachemi said there are sometimes loan forgiveness programs that waive a percentage of the loans as long as the doctor agrees to stay and practice in certain areas of need.

“But once the loan forgiveness ended, they kind of moved on,” he said. “And that can be a double whammy, because society has now, in some cases, lost its only doctor. Separately, if another doctor is appointed at the end, everyone has to get to know their doctor, and their doctor has to get to know everyone from the start.”

These small, short-term solutions may help some communities, Menahimi said, but leave many others struggling.

“We still haven’t done it on a large scale, and most communities are still struggling with recruitment [physicians],” He said.

This problem has taken years to make, he said, and will require more collaboration between many communities and more long-term solutions to enact changes.


Contact reporter Violet at vcomberwilen@wfyi.org or follow her on Twitter at @employee.

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