Part 4 of a special report

Echols County in Georgia, which borders Florida, could be called a health desert.

There is no hospital, no local ambulances. A medical provider comes to treat patients at a clinic for migrant farm workers but, aside from a small public health department with two full-time employees, that’s roughly the extent of medical care in rural county 4. 000 people.

In an emergency, a patient must wait for an ambulance from Valdosta and be taken to a hospital there, or call in a medical helicopter. Ambulances from Valdosta can take up to 20 minutes to arrive, said Bobby Walker, chairman of the county committee. “It’s a pretty good wait for an ambulance,” he added.

Walker tried to establish an ambulance service based in Statenville, the county seat of one-stop fire in Echols, but the cost of providing the service was estimated at $ 280,000 per year. Without the industry to support the tax base, the county could not find that kind of money.

In many ways, Echols reflects the healthcare challenges faced in rural areas nationwide, such as limited insurance coverage among residents, gaps in medical services, and provider shortages.

Dr Jacqueline Fincher, an internal medicine doctor who practices in rural Thomson, eastern Georgia, said these communities have a higher proportion of people 65 and over who need medical services. comprehensive, and a much higher incidence of poverty, including extreme poverty, than the rest of the country.

For example, about 1 in 4 Echols residents do not have health insurance, and nearly a third of children live in poverty, according to the County Health Rankings and Roadmaps program of the Population Health Institute at the University of Wisconsin.

Like Echols, several counties in Georgia do not have a doctor at all.

It is difficult to recruit doctors in a rural area if they have never lived in such an environment before, said Dr Tom Fausett, a family doctor who grew up and still lives in Adel, a town in the south of. Georgia.

About 20% of the nation lives in rural America, but only about 10% of American physicians practice in these areas, according to the National Conference of State Legislatures. And 77% of the country’s rural counties are designated as areas of health worker shortage. About 4,000 additional primary care practitioners are needed to meet current rural health care needs, the Health Resources and Services Administration has estimated.

“A lot of doctors haven’t lived in a rural area,” said Dr Samuel Church, a family doctor who helps train medical students and residents in the town of Hiawassee in northern Georgia, in the mountains. “Some of them thought we were in Alaska or something. I assure them that Amazon delivers here.

Rural hospitals are also struggling to recruit nurses and other medical staff to fill vacant positions. “We are all competing for the same nurses,” said Jay Carmichael, COO of Southwell Medical, which operates Adel Hospital.

MORE: Georgia Health News

Even in rural areas that have doctors and hospitals, it can be difficult to put a patient in contact with a specialist.

“When you have a trauma or cardiac patient, you don’t have a trauma or cardiology team to take care of that patient,” said Rose Keller, chief nurse at Appling Healthcare in Baxley, South East. from Georgia.

Access to mental health care is also a major problem, said Dr Zita Magloire, a family doctor in Cairo, a city in southern Georgia with a population of around 10,000. “It’s almost non-existent here.”

A map created at Georgia Tech shows vast swathes of rural counties without access to autism services, for example.

One of the factors behind this shortage of health care providers is what rural hospital officials call the “payers mix”.

Many patients cannot pay their medical bills. Swainsboro Medical Center CEO Damien Scott said 37% of hospital emergency room patients did not have insurance.

And a large portion of rural hospital patients are enrolled in Medicaid or Medicare. Medicaid generally pays less than the cost of care, and although Medicare reimbursements are a bit higher, they are lower than private insurance.

“The problem with rural hospitals is the reimbursement mechanisms,” said Kirk Olsen, managing partner of ERH Healthcare, a company that operates four hospitals in rural Georgia.

Georgia is one of 12 states that have not expanded their Medicaid programs under the Affordable Care Act. This would make other low-income people eligible for the public insurance program. Would that help? “Absolutely,” Olsen said, echoing comments from nearly everyone interviewed during a months-long survey by Georgia Health News.

“If Medicaid were expanded, hospitals could become more viable,” said Dr. Joe Stubbs, internist in Albany, Georgia. “So many people go to the hospital without being able to pay.”

Echols County isn’t the only place where ambulance service is spotty.

Ambulance teams in some rural areas have ceased to function, leaving the remaining providers to cover greater distances with limited resources, said Brock Slabach, director of operations for the National Rural Health Association. It is difficult for a local government to pay the cost of the service when patient volumes in sparsely populated rural areas are very low, he said.

“If people are not careful they will wake up and there will be no rural health care,” said Richard Stokes, financial director of Taylor Regional Hospital in Hawkinsville, Georgia. “This is my great concern.”

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The Arthur M. Blank Family Foundation provided funding for the writing of this article.