Rural patients avoid medical bills – and treatment

Bill Knight column for Mon., Tues. or Wed., Oct. 14, 15 or 16

Months before the October health insurance signups, implemented provisions of the Affordable Care Act started helping Americans with medical bills, but costs continue to hit patients – especially in rural areas, where skepticism also contributes to inadequate care.

A fifth of families struggle with paying medical bills, according to a study by the National Center for Health Statistics, which said that 20.3 percent of families headed by someone younger than 65 – 54.2 million Americans – had difficulty covering medical expenses last year.

That’s actually an improvement, the center found, largely due to parts of the Affordable Care Act that took effect last year, such as young-adult children staying on parents’ health insurance, eliminating lifetime caps on benefits, and phasing out annual maximum coverage.

However, another factor could be that people aren’t seeking treatment, filling prescriptions or following doctors’ advice to just avoid the expense altogether.

Seniors in rural areas dealing with cancer, for instance, are more likely to forgo medical and dental care because of financial concerns compared with older cancer survivors living in urban areas, according to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal from the American Association for Cancer Research.

Data showed cancer survivors in rural areas who were aged 65 or older were 66 percent more likely to skip medical care and 54 percent more likely to do without dental care because of cost, compared with their urban counterparts.

“This is the first population-based study to examine whether cancer survivors in rural and urban areas are equally likely to forgo health care as a result of concerns about cost,” said Nynikka Palmer, a Doctor of Public Health at Wake Forest School of Medicine in Winston-Salem, N.C.

“We found a disparity among older survivors, for whom health insurance coverage through Medicare is almost universal,” he said.

Palmer and colleagues analyzed data from 7,804 cancer survivors who participated in the National Health Interview Surveys conducted by the the Centers for Disease Control and Prevention (CDC).

“Health care providers and public health officials should be aware of this rural-urban disparity so that they can help rural cancer survivors access the resources they need to get care,”
Palmer added.

The researchers noted that older cancer survivors in rural areas may have to travel farther to reach a medical provider, causing them to incur out-of-pocket travel costs and lost wages. They may also face challenges with social support and transportation issues if relatives no longer live nearby, and out-of-pocket expenses can be daunting for patients who have Medicare but no other health insurance.

“While insurance coverage may not have fully explained rural-urban disparities in older survivors, we did observe strong associations between health insurance and forgoing care,” Palmer said. “With the expected changes in health care policies, it will be important to assess the impact on rural and urban cancer survivors.”

Meanwhile, another study seems to show that rural seniors prefer self-care over doctors, but it doesn’t address the costs.

A survey of older rural adults found considerable medical skepticism – the belief that one knows and can control their own health better than medical professionals – according to research reported in the Journal of Health Care for the Poor and Underserved.

People were asked whether they believed they could overcome illness without the help of a medical professional, whether they thought home remedies were better than prescribed drugs, and if they felt they understood their health better than most doctors.

They were also asked about their use of various home remedies, including honey, vinegar, baking soda, olive oil, whiskey, or petroleum jelly; vitamin or mineral supplements; herbal remedies such as garlic or ginseng; supplements such as fish oil; or of alternative medical practitioners such as chiropractors, physical therapists, or massage therapists.

“Older people in rural areas often live where their parents and grandparents lived and complementary treatments and folk remedies are handed down in the family," said Leigh F. Callahan, Ph.D., professor of social medicine at the University of North Carolina at Chapel Hill.

Such self-diagnosis, home remedies and patient self-care also can be dramatically cheaper than doctor visits, tests, prescription drugs, etc.

Even if treating oneself with herbs, honey and herbs can be less effective, if not downright suspect, it cuts down on medical bills – at least, until conditions deteriorate to the point that an ambulance trip to a hospital emergency room is required.

Soon – if the bottleneck from the overwhelming demand for an Affordable Care Act subsidized insurance policies eases and lets technology catch up to the need – people may be able to stop worrying about the financial burden and start to seek help from medical professionals, too.

[PICTURED: Graphic from paworld.us (Physicians Assistants).]