Definitions
Population
Access to Healthcare
Health Insurance
Education
Income/Employment
Miscellaneous


Definitions

Broadband:The California Broadband Task Force has defined that broadband is the ability to perform online applications at a sufficient speed and level. The minimum speed is 512 kbps. This figure is expected to increase with time.1

Rural: The US Census has defined rural as an area (city, town, village or borough) with a population density less than 2,500. Rural farms consist of all rural farms or households. Rural nonfarms consist of the remaining rural areas. 2

Medical Service Study Area (MSSA): MSSAs are sub county designations defined by the California Health Manpower Commission. Rural MSSAs have 250 persons or less per square mile and no township of more than 50,000. Frontier MSSAs have less than 11 persons per square mile. California has a total of 541 MSSAs (Rural: 186, Frontier: 56). 3

Rural-Urban Communiting Area Codes (RUCAs): Under the RUCA definition, degrees of rurality are coded from 1-10 by their proximity to urban areas and the portion of the population that commutes from rural to urban areas. There are 85 MSSA communities eligible for the Offie of Rural Health Policy funding via the RUCA definition. 4

Primary Care Health Professional Shortage Areas (HPSA): HPSAs may be designated as having a shortage of primary medical care, dental or mental health providers. They may be urban or rural areas, population groups or medical or other public facilities. 5

Federal Poverty Area: To view specific guidelines please visit http://aspe.hhs.gov/poverty/05poverty.shtml.

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Population

There are 304 million residents in the United States. 37 million Americans live in California. There are 50.1 million residents in rural areas throughout the entire United States, 5.1 million of which are in California .6 Of CA's 58 counties, 44 are rural counties and approximately 13% of CA's population resides in rural areas. 80% of California's landmass is designated rural. 7

 

California

United States

Rural

5.1 million

50.1 million

Total Population

37 million

304 million

8,9

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Access to Healthcare

Workforce

There are 935 residents per doctor in rural California compared to 460 per doctor in urban areas of the state. Approximately 45 percent of rural Californians live in regions designated as Primary Care Health Professional Shortage areas. 10

In 2007 the American Medical Association (AMA) reported that 75% of physicians in patient care worked in metropolitan areas and only 25% of physicians worked in rural areas. 11

Distance Barriers

Rural residents have a much farther distance to travel to receive access to healthcare. 75% of or urban residents live between 1 and 78 miles of a hospital, with an average of 10 miles away from a hospital. 75% of rural residents live between 1 and 259 miles of a hospital, with an average of 14 miles away from a hospital. 90% or rural residents live between 1 and 283 miles away from a hospital, averaging 25 miles away. 12

Internet Access

Many rural communities lack access to healthcare. Broadband internet access and the adoption of telehealth are eliminating distance as a barrier to receive healthcare.

  1. 96% of Californians have access to broadband
  2. 20% (over 1 million) of rural Californians do not have access to broadband
  3. 96% of non-rural households have broadband, but only 57% of rural households have broadband 13

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Health Insurance

Medi-Cal

Since 2005 there has been a steady increase in the percentage of Medi-Cal enrollees in rural communities. Respectively, there has been a decrease in the percentage of Medi-Cal enrollees in urban communities. In 2005 30.12% of Medi-Cal enrollees were in rural communities and 69.88% were in urban communities. In 2009 31.58% of Medi-Cal enrollees were in rural communities and 68.42% were in urban communities. 14

Medicaid

There is a higher percentage of Medicaid recipients in rural California and rural United States overall. From 2006-2007, 15.2% of the United States Medicaid recipients were in rural America and 12.6% of the population’s Medicaid recipients were in urban America.  

From 2006-2007, 17.3% of California Medicaid recipients were in rural California, while only 16% were in urban California. 15


Uninsured

There has been a rise in the percentage of uninsured Californians in rural counties. In 2002, 11.10% of rural Californians reported having no health insurance. By 2008 13.37% of rural Californians reported having no health insurance. From 2002 to 2008, 12.8% of urban Californians reported having no health insurance. 16

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Education

While more residents in rural counties have completed high school than in urban counties, less rural residents have completed higher levels of education.

  1. 23.3% of residents in rural counties have completed high school; 19.25% in urban
  2. 18.64% of residents in rural counties have completed college; 24.87% in urban
  3. 11.72% of residents in rural counties have post-graduate degrees; 16.86 in urban 17

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Income/Employment

2008 Household Income Levels 18

 

<$10k

$10k-19,999

$20k-34,999

$35k-49,000

$50k-74,999

$75k+

Urban

8.17%

12.99%

14.76%

11.87%

13.95%

38.27%

Rural

9.01%

15.59%

17.84%

11.97%

16.22%

29.38%

2008 Employment Status 19

 

Employed for Wages

Retired

Unable to Work

Self-employed

Homemaker

Student

Urban

44.15%

18.94%

11.04%

10.83%

10.64%

4.4%

Rural

42.86%

19.79%

13.98%

9.28%

11.05%

3.04%

Income/Poverty

Rural counties have a higher percentage of residents that fall below the Federal Poverty Level. 19.35% of rural residents fall in below the Federal Poverty Level. 17.1% of urban residents fall below the Federal Poverty Level.

Rural counties have a higher percentage of residents that fall between 100% and 200% of the Federal Poverty Level; 10.38% in rural counties and 8.11% in urban counties. 20

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Miscellaneous

Disease

Rural Californians are 25% more likely than their urban counterparts to dies of cancer, and about 16% more likely to die of heart disease. 21

4.2% of rural Californians had heart attaches in 2007 vs. 2.9% in urban residents. 22

6.3% of rural Californians are at risk for chronic alcoholism compared to 5% urban. 23


Disabled in Rural Communities

Nationally, 21.8% of disabled individuals reside in rural communities. 5.7% of CA's disabled population lives in rural communities. 24

Birth Rates

Rural counties have a higher live birth rate than in urban counties: Rural 15.55 vs. Urban 14.20. 25

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Resources

1. The California Broadband Task Force, The State of Connectivity: Building Innovation Through Connectivity, January 2008, viewed January 20, 2010, http://www.calink.ca.gov/pdf/CBTF_FINAL_Report.pdf.
2.US Census Bureau, Urban and Rural Definitions, October 1995, viewed January 20, 2010, http://www.census.gov/population/censusdata/urdef.txt.
3. California Office of Statewide Health Planning and Development GIS Census 2000.
4. California Office of Statewide Health Planning and Development, http://www.oshpd.ca.gov/RHPC/Resources/Demographics.html.
5. HRSA, Shortage Designation: HPSAs, MUAs & MUPs, April 20, 2009, viewed January 20, 2010, http://bhpr.hrsa.gov/shortage/.
6. The California Broadband Task Force
7. Sam Willburn, Department of Health Care Services, State Affairs Update, The California State Rural Health Association 9th Annual Rural Health Conference, Sacramento, CA, November 19, 2009. Presentation available at http://www.csrha.org/conference/2009/presentations/samwillburn.ppt.
8. The California Broadband Taskforce
9. USDA: Economic Research Service, State Fact Sheets, December 9, 2009, viewed January 20, 2010, http://www.ers.usda.gov/StateFacts/US.htm.
10. California Health Interview Survey, Diabetes and Heart Disease search; rural/urbancomparison, 2007,http://askchis.com/main/DQ2/geographic.asp.
11. United States Department of Labor, Occupational Outlook Handbook, 2010-11 Edition : Physicians and Surgeons, December 17, 2009, viewed January 20, 2010, http://www.bls.gov/oco/ocos074.htm.
12. Health Services Research, Updated Variable-Radius Measure of Hospital Competition, April 2004, viewed January 20, 2010, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361015/.
13. The California Broadband Taskforce
14. Sam Willburn
15. North Carolina Rural Health Research and Policy Analysis, State Medicaid Profiles, 2009, viewed January 19, 2010,  http://www.shepscenter.unc.edu/medicaidprofiles/AllStateProfiles.pdf.
16. Sam Willburn
17. Sam Willburn
18. Sam Willburn
19. Sam Willburn
20. Sam Willburn
21. California Health Interview Survey (2007). Diabetes and Heart Disease search; rural/urban comparison, http://askchis.com/main/DQ2/geographic/asp.
22. 2007 Behavorial Risk Factor Study
23. 2007 Behavorial Risk Factor Study
24. Research and Training Center on Disability in Rural, Rural Facts: State by State Comparison, March 2007, viewed January 19, 2010,http://rtc.ruralinstitute.umt.edu/RuDis/Comparison.htm.
25. Sam Willburn

 

 

 


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