Is rural healthcare as bad as you hear? Actually, it’s like another thing that requires smart decisions. Yup, rural healthcare is kind of like airplane food.

Healthcare is different out here

Are you considering a move to rural America? Top of mind is healthcare.

You’ve heard the negative stories. Or, they’re easy to find. To sum it up: rural healthcare is a disaster.

OK, short post. See ‘ya next time! Seriously, there’s more to this story. Rural healthcare is challenging for many reasons. And yet, people swear by their rural communities. They raise families, grow old. They make it work.

… most people aren’t leaving over this issue

To put it for another way: except for the chronically ill, most people aren’t leaving a small town over this issue.

Our urban audience

Here, we consider the rural bargain, which is urban people contemplating a move to rural life. As an urban person, you can ignore some negative data about rural healthcare. It’s not always applicable to an incoming person. You’ll have options and a different lifestyle than many people included in the data.

Yes, it’s unfair to some degree. You’ll have means the locals don’t. We care about the plight of indigenous rural communities. It’s an important topic. If anything, we advocate helping rural communities by moving to them.

Many communities are a long way from worrying about gentrification.

You bring resources to rural America. Starting with your taxes. Many communities are a long way from worrying about gentrification. They could use your dollars. When you go rural, your presence helps where you live.

Can you make good choices

A comparison between rural healthcare and airplane food. Pretty unflattering. Really, though?

Airplane food isn’t automatically bad anymore. It’s more edible these days, even nourishing (depending on where you sit). At the very least, it tides you over. The point isn’t to knock rural healthcare. It’s to say: airplane food is naturally a compromise.

At 35,000 feet, your favorite food isn’t always being served. Or, being served correctly. When the airplane food cart appears, you know what to expect. You’ve trained yourself in advance to be practical.

You’ve trained yourself in advance to be practical.

On a plane, usually boredom and hunger go hand in hand. Still, you listen and weigh what they have. It could be good, or good enough. Or, you might pass on it and make plans for that restaurant when you land. Choices, choices.

You decide whether you take what’s being offered.

How is rural healthcare like airplane food?

We’ll look at what’s being offered in rural healthcare. For many, healthcare is a priority, especially for the elderly and parents with young children.

It just so happens that I, the author, have two young children. One with special needs. You’ll hear from a parent who’s a heavy user of healthcare.

Instead of dismissing a rural community, try to manage expectations. Because rural healthcare and airplane food really do have a few things in common:

1. The menu is limited

You don’t expect an airline menu to have whatever you want. It has the basics. Same here. Rural hospitals offer useful services, but fewer. Which means, fewer patients use rural hospitals. Only 12% of hospitalizations are in rural hospitals (using data from 2010) even though 16% of the population lives in rural areas. Rural hospitals account for only 1% of ICU beds.

I live in a town with a third-tier hospital. It means a) it’s a hospital, yay b) it draws people throughout the county c) it has surgical services. What our hospital lacks is the ability to serve special cases.

What our hospital lacks is the ability to serve special cases.

For example, we have need for specialized infant care. Our hospital can give oxygen and antibiotics. Insert a feeding tube (usually). However, the hospital doesn’t care for infants with greater issues. It sends them to a first-tier hospital. In our case, Oregon Heath & Sciences University in Portland, Oregon.

We find the hospital to be wise in knowing what it can and can’t do well. It works with larger hospitals to transfer patients. In many cases, you have time to make the decision: can this hospital serve my needs. Which is something that patients all over the world have to consider. There may be a hospital in another city that has a better specialist than your hospital.

2. You pay less for getting less

Airline food might not be your favorite. Still, you pay relatively little for it. According to, the airlines charge between $4-12 for snacks to light meals.

… rural hospitals charge less for procedures

In a similar way, rural hospitals charge less for procedures. A study in 2014 showed, rural hospitals had a 63.48 out of 100 ranking on a scale of costs. Urban hospitals were at 35.84 out of 100 (which is worse).

Few of us bargain hunt for hospitals. But if you’re going into a rural hospital for flu-like symptoms, you might find your costs lower. Not a bad thing.

3. Jump on it because they can run out

You turn up your nose at the terrible airplane food. Later, you change your mind. But there’s none left!

It happens. Something that’s seen as “second-best” can still have high demand. People in rural areas find this out with doctors. There’s a shortage. A big shortage. Your fellow residents will jump on healthcare service fast.

As stated a 2016 article in the Atlantic, “about a fifth of Americans live in rural areas, but barely a tenth of physicians practice there.”

On a personal note, I still don’t have a primary care doctor.

On a personal note, I still don’t have a primary care doctor. I arrived to town when a shortage began. I was told, “three doctors just left town.” The remaining ones weren’t accepting new patients. Fortunately, an immediate care facility nearby takes our insurance. They’re real doctors. It works for now.

4. You’ll have some depending on what it is

An apple that’s on an airplane is airplane food, technically. It’s also just an apple. There are times when a thing is the same everywhere. A prescription for antibiotics, for example. No different from a rural doctor or an urban one. There are times when rural healthcare will be the same, and a lot closer.

There are times when rural healthcare will be the same, and a lot closer.

Still, there’s evidence that rural patients will drive to an urban hospital for something they could’ve had done at home. One health institute found, 7 in 10 rural patients drove past the closest healthcare facility to receive care. However, the reason was understandable. The procedures were more specialized, like coronary bypass surgery.

Patients having surgeries in rural hospitals tend to be older. If you’re younger, you’ll maybe search out a better fit. Which goes along with the idea, rural patients do have choices. Many choose to use the local hospital.

5. Everyone around you seems fine with it.

You’re on an airplane. You see food service coming. Immediately, people around you lower their tray tables. You think, “how do you know you’ll want what they’re serving?”

It could be for drinks, sure. And yet, a lot of people eat airplane food. You know this. It’s just something they’ve gotten used to. And watching them take it might make you more open to taking it. Same with rural healthcare. A lot of people get comfortable with the convenience of it. They don’t quiz their doctors on what medical school they went to. Frankly, many of us can’t tell which is a good medical school.

Frankly, many of us can’t tell which is a good medical school.

The urban person is used to choices. The best of everything. It might seem strange to pick from a limited pool of rural doctors. But when you see other people doing it, and doing fine, you might settle down a bit.

6. It’s brought to you by legit professionals (don’t forget)

If you’ve ever wondered why airplane food is bad, there are legitimate reasons. What you find is, the problem is situational. For example, having to work in an airplane kitchen the size of a closet. Making food that reheats well. The challenge between long and short flights. The complexities go on.

The reason isn’t that the people who make airplane food are amateurs. They’re professional chefs. They’re not bad at their jobs. They have hard jobs.

You can find a qualified doctor.

Rural doctors face a similar challenge. They’re trained by the same medical schools as urban doctors. Yet they work with equipment and resources a grade below. They care for a rural population that is in poor health, often due to lifestyle choices. They have a tough job.

As an urban person, you’re likely to be in much better health. Your rural doctor will have a lot more to work with. You can find a qualified doctor. The rural healthcare crisis is an issue of environment, not the doctor’s skill.

7. A bad reputation doesn’t mean it’ll be bad

“I had a great meal on an airplane yesterday.” You don’t hear that very often. (I’ve never heard it.) It doesn’t mean it’s impossible. The reputation of something can be hard to overcome. “Airplane food is a joke.” Or, “Rural healthcare is terrible.” It’s hard to hear anything to the contrary.

Personal note, I met with our hospital’s head of pediatric nursing. My son with special needs had respiratory issues. I was looking for what level of care the hospital could provide. At the close of our meeting, the head nurse told me she’d be out of the office for a few weeks. Hip replacement. I noted where she was getting it done. At the very same hospital. She could’ve driven a couple of hours to a larger one. She was confident in the surgeons there for her own care. It told me something.

She was confident in the surgeons there for her own care.

A bad reputation isn’t always relevant to the situation. Also, a good reputation isn’t always good. This study found that the biggest, most famous hospitals aren’t always the best at surgical care. Go figure.

8. It’s amazing what they can do with limited resources

We can stick to the safest places. Or we can live life. People in rural communities aren’t blind to their limited choices. They make alliances and plans. For instance, many rural families have airlift insurance. In the event that a medical emergency requires quick transport to a larger hospital.

When you study what goes into pulling off either of the feats mentioned in this post, you gain a new understanding of both. Making safe, re-heatable meals or millions of airline passengers? Big undertaking. Providing quality, affordable healthcare for rural communities? Harder than it looks.

If you want to live in an outdoor-focused community, don’t let rural healthcare stop you. It’s there. It’s not perfect, but, at least, it’ll tide you over until you need to get the city version.

Leave a comment

What’s your view on rural healthcare? Or, on urban healthcare? Do you need regular access to the best hospitals? Can you see yourself getting by with more limited options? What’s the airplane food you never turn down?

This blog post first appeared at Recently Rural.

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