Medical
Service Study Area (MSSA) MSSAs are sub-county designations defined by
the California Health Manpower Policy Commission. Total California MSSAs
541. Rural MSSAs have 250 persons or less per square mile and no township
of more than 50,000. Total Rural MSSAs 186. Frontier MSSAs have less than
11 persons per square mile. Total Frontier MSSAs 56. - OSHPD GIS Census
2000
Rural California includes approximately 80% of the total California land mass of 156,000 square miles.
Rural California counties range in size from 601 square miles (AMADOR) to 20,164 square miles (SAN BERNARDINO) - 2003 BRFS
Rural California climates are severe. Winter temperatures in the mountain elevations frequently drop below freezing. Summer temperatures in most regions throughout the state reach 100 F and above. Harsh climates make travel difficult. - 2003 BRFS
California
covers 175,000 square miles. It is the fourth largest state in the union.
California
has 58 counties; only three are entirely urban. Fifty-five of California’s
counties have substantial rural areas. Twenty-nine
of California’s counties are considered totally rural.
Map of California by rural designation coming soon.
Rural California includes approximately 75 percent of the total California land mass of 156,000 square miles. - Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002
Rural California Counties range in size from 20,164 square miles (San Bernardino) to 601 square miles (Amador). - Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002.
Proportionately
there are more white non-Hispanic residents in rural counties than in
non-rural counties (67.8% vs. 58.8% respectively). - 2003 Behavioral Risk
Factors Survey (BRFS)
There are proportionately fewer black non-Hispanic and Asian/ Pacific
Islander residents in rural counties than in non-rural counties (4.0%
vs. 7.4% and 4.6% vs. 10.4% respectively). - 2003 Behavioral Risk Factors
Survey (BRFS)
Proportionately there is a greater number of American Indian, Eskimo or
Aleut residents in rural counties than in non-rural counties (2.3% vs.
1.0% respectively). - 2003 Behavioral Risk Factors Survey (BRFS)
Approximately 18% of rural residents are of Latino/Hispanic origin compared
to the the urban population of 20.2%. - 2003 Behavioral Risk Factors Survey
(BRFS)
A greater percentage of rural residents do not speak English (18.2%) compared
to the urban population (11.5%). - 2003 Behavioral Risk Factors Survey
(BRFS)
There are a greater proportion of residents of rural counties that are 55 years of age and over compared to residents of non-rural counties (27.5% vs. 24.3% respectively). -2003 BRFS
Almost
three of ten (27.5%) residents of rural counties are age 55 and over.
The bureau
defines urbanized areas as continuously populated areas of 50,000 persons
or more. U.S. Census Bureau -Census 2000 Urban and Rural Classification
Urban areas are then defined as all territory, population, and housing
units in urbanized areas and in places of 2,500 or more persons outside
urbanized areas. U.S. Census Bureau -Census 2000 Urban and Rural Classification
Rural is then defined as not being urban or urban area. - U.S. Census
Bureau -Census 2000 Urban and Rural Classification
Rural California includes 5 million residents, 14.8 percent of the total population, and 75 percent of the land mass in California. - 2000 Census data
1.1 million California residents live in rural areas of Southern California, 2.3 million live in Central, and 1.5 million live in Northern. - 2000 Census data
California's
rural population is increasing: According to the 1990 Census, 3,232,000
people lived in rural MSSAs in California. The 2000 Census reports there
are now 5,018,189 rural residents, an increase of 1,786,189 people or
35.5 percent.- Sam Wilburn, State Office of Rural Health, Primary and
Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December
4, 2002.
3.9 million people moved into rural communities between 1990 and 2000. 2.2 million more Americans moved from the city to the country than from the country to the city during this time frame. Nearly 65 million people live in rural communities. - US 2000 Census
Much of the rural population growth was concentrated in only 40 percent of rural counties. - USDA Economic Research Service. "Rural Population and Migration: Rural Population Change" 2000
In general rural areas have a higher proportion of elderly residents. - US Census Bureau (1990-1998)
Exacerbating the age differences between rural and metropolitan areas is that many of the youngest and most highly educated people are moving away from rural areas. - Fluharty, Charles "Rural America: Challenges and Opportunities" 2001
14 percent of rural populations in California are over the age of 65 as compared to 11 percent of urban. (2000) - Department of Health Services
18 percent of rural populations in California are Medi-Cal eligible as compared to 15 percent of urban. (2000) - Department of Finance
18 percent of rural populations in California are below the poverty level as compared to 14 percent of urban. (1997) - Department of Finance
9.3 percent of rural populations in California are unemployed as compared to 6.8 percent of urban. (2002) - Fed Stats.gov
214,000 rural residents in California die due to cancer as compared to 171,000 urban residents. - Department of Health Services
Currently, children account for 31 percent of the rural population. More than 15 percent of these children are uninsured, making them more likely to experience problems with access to medical care, delays in necessary treatment and inadequate immunizations. - National Rural Health Association, October, 2002
The percent of Asians and African Americans in rural areas is 2.5 percent and 1.7 percent. - Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002 (California Health Interview Survey 2001)
The percent of American Indian/Alaska Natives in rural areas is twice that in urban areas (.8 percent to .4 percent). - Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002 (California Health Interview Survey 2001)
More than one in four (26.9 percent) of rural residents are Latino/Hispanic in origin. This is comparable to urban residents. (28.4 percent) - Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002 (California Health Interview Survey 2001)
12.1 percent of rural residents completed a BA/BS degree compared to 19.8 percent of urban residents. - Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002 (California Health Interview Survey 2001)
Rural
Definition
Rural, as defined by the Federal Office of Management and budget, is anything
that is not urban. Urban is metropolitan counties having one or more central
cities with at least 50,000 people or an urbanized area and a total population
of at least 100,000 and two adjacent communities with a high degree of
social integration with the core county. - Sam Wilburn, State Office of
Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA
Annual Conference, December 4, 2002.
Rural, as defined by the California Health Policy Council, is less than 250 people per square mile that does not contain an incorporated are with a population greater than 5000.
Nationally, 32% of hospitals had a negative operating margin last year. - American Hospital Association, Fall, 2002
In 2001 there were 3.9 taxpaying workers for every person who benefits from a subsidized healthcare program. In 2002, that number was down to 2.9. - National Association of Public Hospitals, 2002
41.4 million US residents are uninsured in 2001. - National Association of Public Hospitals, 2002
Rural
Industry One in four rural
children lives in a house without a phone. - W. O'Hare - "Disconnected
Kids: Children Without a Phone at Home", Annie Casey Foundation,
September 2001(America's Forgotten Children: Child Poverty in Rural America,
Save the Children, June 2002)
Rural California is
home to a $17 billion agriculture, fishing, mining and forestry economy.
Of the 200 persistently poor counties (those with a 20 percent poverty rate or higher), 195 are rural. - US Bureau of the Census, Small Area Income and Poverty Estimates Program, 1997 (America's Forgotten Children: Child Poverty in Rural America, Save the Children, June 2002)
2.5 million children in rural America live in poverty. (America's Forgotten Children: Child Poverty in Rural America, Save the Children, June 2002)
The rural poor have greater long-term health problems and less access to health care than the poor in urban America - National Center for Health Statistics, Health, United States, 2001, with Urban and Rural Chartbook, 2001 (America's Forgotten Children: Child Poverty in Rural America, Save the Children, June 2002)
Fewer than 10 percent of rural Americans live on a farm and only 7.6 percent of the rural workforce is employed in farming. (America's Forgotten Children: Child Poverty in Rural America, Save the Children, June 2002)
Health care can represent up to 20 percent of a communities' employment and income. In some lower income communities federal support may account for as much as 50 percent of income in the community through funding for social and health services. - HHS Rural Task Force Report to the Secretary "One Department Serving Rural America" 2002
National: Agriculture is a small segment of rural economies, accounting for only 7.6 percent of employment. - Fluharty, Charles "Rural America: Challenges and Opportunities" 2001
California: California Agricultural ranks among the state's most important industries. In 1999, the state's farm business received more than $26 billion from their sales of crops, livestock and livestock purchases. Today more than 50 percent of all US major vegetable production, and 40 percent of major fruit production comes from California's filed and orchards. - "Suffering in Silence: A Report on the Health of California's Agricultural Workers," California Institute for Rural Studies, November 2002
The West is characterized as having vast frontier areas in which much of the land is federal park and Forest Service land. Consequently, the tax base is extremely limited. - Rural Policy Research Institute Center for Rural Health Policy Analysis, Operation Rural Health Works Project Briefing Vol 1, 1.1999
Health care provides and generates up to 15 to 20 percent of jobs in many rural communities. - Rural Policy Research Institute Center for Rural Health Policy Analysis, Operation Rural Health Works Project Briefing Vol 1, 1.1999
More than half of all rural seniors have family incomes below 200 percent of poverty, compared to roughly 40 percent of urban seniors. - Fluharty, Charles "Rural America: Challenges and Opportunities" 2001
40 percent of rural areas are not serviced by public transportation. - G. Rucker "Status Report on public Transportation in Rural America" Rural Transit Assistance Program, Federal Transit Administration 1994 (America's Forgotten Children: Child Poverty in Rural America, Save the Children, June 2002)
Rural Health Service Providers / Workforce
Licensed
Health Care Facilities in Rural/Frontier Areas 2003 and 2004. There are
208 and 227 licensed community clinics:
Rural - 180 and 195 Frontier - 28 and 32, Acute Care Hospitals: Rural
- 72 - 72, Home Health Agency: Rural 97 Frontier 7. - Source: OSHPD Licensed
Healthcare database (GIS) 2004
Licensed Health Care Facilities in Rural/Frontier Areas 2003 - 2004. Other Licensed Health Care Facilities Include: Chronic Dialysis Clinics 40 46 Rural, Surgical Clinics 34 42 Rural, Hospice Facilities 16 - 18 Rural 2 - 3 Frontier, Acute Psychiatric Hospitals 2 Rural 1 Rural, Psychiatric Facilities 7 Rural (2 suspended licenses), 8 Rural (2 suspended licenses). - Source: OSHPD Licensed Healthcare Database (GIS), 2004
The Federal,
State and local governments provide grant support for health services
in California. California DHS administers programs
designed to strengthen the rural infrastructure. Clinic Programs include:
Seasonal Agricultural Migratory, Workers Program (SAMW)- $6.8 million,
Indian Health Program (IHP) $6.4 mil, Rural Health Services Development
, Program (RHSD) - $8.2 mil, Expanded, Access to Primary Care , and Program
(EAPC) - $30.2 million. - CDHS-Primary and Rural Health Care Systems
Federal,
State and Local Government Support. DHS County Medical Services Program
provides reimbursement for medical services to non-Medicaid eligible and
low-income patients in 34 small counties: 2002-03 Average monthly eligible
caseload was 38,889, 2003-04 Average monthly eligible caseload was 41,443,
2004-05 Projected monthly eligible case load is 41,805, Program payments
for 2002-03 - $223,060,434, Program payments for 2003-04 - $222,235,000,
and Projected program payments for 2004-05 - $224,158,000. - CDHS County
Medical Services Program, CMSP Unit, December 2004
California's small and rural hospitals provide primary and acute services to the state's 2.6 million rural residents and cover a service area that geographically includes approximately 75 percent of the state. - California Healthcare Association Special Report, "Rural Health Care at Risk: California Small and Rural Hospitals", Sharon Avery, Executive Director, Rural Healthcare Center.
California's rural hospitals provided outpatient services to almost 1.7 million patients in 1988. This number doubled to more than 3.4 million in 2000. - California Healthcare Association Special Report, "Rural Health Care at Risk: California Small and Rural Hospitals", Sharon Avery, Executive Director, Rural Healthcare Center.
There are 69 rural hospitals in California. Twenty-six are eligible for certification as Critical Access Hospitals (CAHs) which entitles them to enhanced Medicare reimbursement. Thirteen have been certified as CAHs during the past five years. - Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002
Rural Health Clinics (RHCs) are a designated Medical provider type that receives a set reimbursement rate for providing primary care services in rural areas. 205 RHCs billed the DHS Medical program in 2000. This compares to 39 RHCs that billed the program in 1990. It represents a 526 percent increase in ten years. - Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002
California rural hospitals are averaging approximately $650,000 shortfall between payments and expenses. - California Healthcare Association Special Report, "Rural Health Care at Risk: California Small and Rural Hospitals", Sharon Avery, Executive Director, Rural Healthcare Center.
In 2000, California rural hospitals averaged a -3.9 percent patient operating margin. Seventy-six percent of rural hospitals lost money on operations in 2000. As a group they carried $70 million in bad debts in 1999. - California Healthcare Association Special Report, "Rural Health Care at Risk: California Small and Rural Hospitals", Sharon Avery, Executive Director, Rural Healthcare Center.
Between 1997 and 2000, nine California rural hospitals closed or entered into bankruptcy. - California Healthcare Association Special Report, "Rural Health Care at Risk: California Small and Rural Hospitals", Sharon Avery, Executive Director, Rural Healthcare Center.
The supply of dentists is as low as 29 per 100,000 in the most rural counties compared to 61 per 100,000 in metropolitan counties. - Health Resources and Services Administration, Area File. 1998 and Eberhardt MS, Ingram DD, Makuc Dm, et al. Urban and Rural Health Chartbook. Health, United States, 2001. National Center for Health Statistics. 2001
Rural Americans make up 20 percent of the nation's population, but only 9 percent of the nation's physicians practice in rural counties. Rural patients also see doctors less frequently and usually later in the course of an illness than their urban and suburban counterparts. Rural Americans do not have the same access to quality care as their friends and family living in metropolitan and suburban areas according to the CDC. - National Advisory Committee on Rural Health "Medicare Reform: A Rural Perspective". 2001
The American Academy of Family Physicians reports a 28 percent jump in the number of family physicians no longer taking new Medicare patients. About 21.7 percent of family physicians do not take new Medicare patients, up from 17 percent last year. - (survey by AAFP in June, 2002) CPAC "Improving Recruitment and Retention of Primary Care Practitioners in Rural CA), July 2002
There are 935 residents per doctor in rural California as compared to 460 in urban California.- Department of Health Services
There are 2.8 community clinics per county in rural California as compared to 20.4 in urban California. - Department of Health Services
Most rural areas of California have inadequate supplies of primary care physicians, physician's assistants and nurse practitioners.
Approximately 45 percent
of rural Californians live in areas designated as Primary Care Health
Professional Shortage Areas.
Farmworkers
Today an estimated 700,000 agricultural workers toil in the state's fields and livestock facilities. - "Suffering in Silence: A Report on the Health of California's Agricultural Workers," California Institute for Rural Studies, November 2002
Nearly one in five male subjects (18 percent) had at least two of three risk factors for chronic disease: high serum cholesterol, high blood pressure or obesity. - "Suffering in Silence: A Report on the Health of California's Agricultural Workers," California Institute for Rural Studies, November 2002
More than one-third of male farmworkers have at least one decayed tooth. And nearly four out of ten of female farmworkers have at least one broken or missing tooth. - "Suffering in Silence: A Report on the Health of California's Agricultural Workers," California Institute for Rural Studies, November 2002
Seventy percent of farmworkers lack any kind of medical insurance. - "Suffering in Silence: A Report on the Health of California's Agricultural Workers," California Institute for Rural Studies, November 2002
Government programs covered only seven percent of farmworkers. - "Suffering in Silence: A Report on the Health of California's Agricultural Workers," California Institute for Rural Studies, November 2002
Sixteen and a half percent of farmworkers were offered coverage by employers, one third of those declined coverage because they either could not afford the premiums or the required co-pay for treatments. - "Suffering in Silence: A Report on the Health of California's Agricultural Workers," California Institute for Rural Studies, November 2002
Thirty-two percent of males surveyed in farmwork had never been to a doctor in their lives. - "Suffering in Silence: A Report on the Health of California's Agricultural Workers," California Institute for Rural Studies, November 2002
Medical
Insurance Coverage for Rural Regions
Of rural residents who have health insurance, approximately 40% is derived from employers, either from their own employer (24.8%), or someone else's employer (15.5%). -2003 BRFS
Of those residents who have health care insurance, the proportion of those with Medicare is much greater in rural counties than in urban counties (30.2% vs. 20.8%). -2003 BRFS
About the same percentage of rural as urban residents buy health insurance on their own (21.6% and 21.9% respectively). -2003 BRFS
There is a greater proportion of rural residents covered by Medi-Cal compared to urban residents (12.5% vs. 9.0% respectively). -2003 BRFS
Rural residents utilize military health insurance proportionately more than urban residents in paying for most of their medical care (8.3% vs. 6.6% respectively). -2003 BRFS
Of those people who have health insurance, rural residents indicate that Medicare is the single most frequently used source to pay for most of their medical care (30.2%); the most frequent source for urban residents is their employer provided health insurance (29.4%). -2003 BRFS
According to data from the DHS/Medical Care Statistics Section, 19.5% of residents in rural counties were beneficiaries of Medi-Cal services in fiscal year 2003-04 compared to 17.5% in non-rural counties. -DHS-Medical Care Status Section, 2004
Of the 6.5 million residents of California who were beneficiaries of Medi-Cal services in fiscal year 2003-04, 1.9 million, or 29.0% live in rural areas. -DHS-Medical Care Status Section, 2004
Although
approximately 27% of California's population live in rural areas, they
represent 29% are Medi-Cal beneficiaries.
-DHS-Medical Care Status Section, 2004
Expanded Access to Primary Care Program (EAPC) reimburses clinics for providing care to patients whose incomes are at or below 200% of the Federal poverty level and have and have no means to pay for care. - OSHPD Annual Clinic Report, 2004
Uncompensated Care Visits Reported By Community Clinics in the Expanded Access to Primary Care Program in rural and frontier MSSAs increased by 15% and 21% respectively between fiscal year 2003-04 and 2004-05 compared to an increase of 22% in urban clinics.
Medicare patient expenses in 1998 accounted for 47 percent of total patient care expenses for rural hospitals, compared to 36 percent for urban hospitals - Medicare Payment Advisory Commission. Report to the Congress: Medicare in Rural America. 2001
In 1995, 46 percent of rural elders lacked prescription coverage, compared to only 31 percent in urban areas. - Fluharty, Charles "Rural America: Challenges and Opportunities" 2001
37 percent of California's rural counties (11) do not have any HMO that provides services to the county on a countywide basis. - Department of Managed Health Care 2002
Four of these 11 counties in California have one HMO providing services to select areas within the county. - Department of Managed Health Care 2002
40 percent of rural counties (12) in California have only one HMO operating on a countywide basis. - Department of Managed Health Care 2002
About 72 percent of rural counties in California no longer have a Medicare+Choice HMO. - Department of Managed Health Care 2002
A greater proportion of rural residents under 65 are eligible for the Medical Program (17.6 percent vs 12.1 percent). Similarly, a greater percent of rural residents are eligible for the Healthy Families Program (8.5 percent Vs 5.4 percent). - Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002
A greater proportion of rural residents under 65 are covered by the Medical program (15.7 percent Vs 9.9 percent). Fewer rural residents under 65, compared to urban residents, are covered by employer-sponsored health care insurance (58 percent Vs 64.1 percent). - Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002
About one in five (18.8 percent) of older rural residents (65 and older) are covered by Medicare and Medical- Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002 (California Health Interview Survey 2001)
A greater proportion of rural residents regardless of age are covered by the Medical program (16.2 percent Vs 11.2 percent). - Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002 (California Health Interview Survey 2001)
One in six (16.5 percent) rural residents currently do not have health insurance, another 5.4 percent have been uninsured at some time during the last year. - Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002 (California Health Interview Survey 2001)
Among those adults living in rural areas who currently have healthcare coverage, but did not have coverage for all of the past twelve months, the main reason for not having coverage was a change in employment or a loss of employment. - Sam Wilburn, State Office of Rural Health, Primary and Rural Health Care Systems Branch, DHS at CSRHA Annual Conference, December 4, 2002 (California Health Interview Survey 2001)
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