2017 Healthcare Delivery Sites in Rural Missouri The Office of Primary Care and Rural Health WHAT DEFINES RURAL? There are many different definitions for what defines rural and urban populations. For the purpose of this report, rural is defined as any county that does not have a population density over 150 persons per square mile.1 All counties in the map below that are green or purple are considered rural. Some maps will narrow the rural population down further by selecting counties that are classified as 75% or more rural. This measure is determined simply by the amount of the population per county that lives in rural areas. There are 49 counties in Missouri that would be classified as 75% or more rural. In the map below, the pink counties are considered the rural most counties in Missouri; 75% or more rural. HOSPITALS: Missouri has 167 hospitals. However, 94 of those hospitals are located in urban counties, accounting for 56% of all hospitals in Missouri. Of the 73 hospitals located in rural areas, 5 are Trauma Level III hospitals, and 1 is a Trauma Level II. Of the 94 urban hospitals, 12 are Trauma Level I hospitals, 9 are Trauma Level II hospitals, and 5 are Trauma Level III hospitals. The table below shows the percentage of Trauma Hospitals in Missouri by the geographic designation of the counties. Trauma Level: Rural: Urban: I 0% 100% II 10% 90% III 50% 50% CRITICAL ACCESS HOSPITALS: One particular type of hospital that almost exclusively caters to rural populations are Critical Access Hospitals. Critical Access Hospitals (CAHs) are hospitals in rural settings that receive a cost based Medicare reimbursement in order reduce financial vulnerability and increase access to healthcare.3 To be designated a CAH, a hospital must meet the following eligibility requirements: 4  No more than 25 acute inpatient care beds  Must be located 35 miles or more from another hospital  Average length of stay must be 96 hours or less for acute care patients annually  Must provide 24/7 emergency care services In Missouri, there are 36 Critical Access Hospitals. The hospitals are located within 35 counties; 4 urban, and 31 rural. Only 22% of all Missouri hospitals are categorized as Critical Access Hospitals. Type of Number of County: Hospitals Rural 32 Urban 4 RURAL HEALTH CLINICS: To qualify as a Rural Health Clinics, the clinic must be : located in a non-urbanized area and in a federally designated or certified shortage area. 15 RHCs cannot be a Federally Qualified Health Center. 15 There are 365 Rural Health Clinics (RHCs) located in Missouri. Of the 101 rural counties in Mis- souri, 9 do not have a Rural Health Clinic: Atchison, Bollinger, Carter, Holt, Moniteau, Osage, Pettis, Reynolds, and Worth. Approximately 9% of rural Missouri does not have a Rural Health Clinic accessible within the county. This does not necessarily mean that there are no clinics lo- cated n those counties, it simply means there are no Rural Health Clinics in those counties. FEDERALLY QUALIFIED HEALTH CENTERS: A Federally Qualified Health Center, also called a Community Health Center (CHCs), are care centers that are community-based and patient-driven. 16 FQHCs are designed to help people who have limited access to care.16 Payment at these facilities is based on a persons income and ability to pay.16 Lack of insurance and income are not a barrier in receiving health or dental care from a FQHC.16 There are approximately 193 FQHCs located in Missouri. There are 27 counties that do not have a FQHC located within them. All 27 counties are classified as rural. Approximately 27% of the rural Missouri counties do not have a FQHC located within them. TRANSPORTATION Many people in rural counties do not have access to vehicle. Lack of transportation makes receiving adequate medical care difficult. People who live in rural counties are more likely to have to travel long distances to receive medical care, in particular specialty services.2 In rural Missouri, the average percent of the population that do not have access to a vehicle is 6.3%. This leaves an estimated 140,300 people in rural Missouri without access to a vehicle. When put into perspective, the population of rural Missourians that do not have access to a vehicle is roughly half of the total population in St. Louis City. HOSPITALS: Only 73 (43.7%) hospitals in Missouri are located in rural counties. Of the 73 hospitals in rural counties, 14 (19%) are located in counties where less than 5% of the population does not have a car; 44 (60%) are located in counties where 5%-7% of the population does not have a car; 13 (18%) are in counties where 8%-10% of the population does not have a car; and 2 (3%) are in counties where over 10% of the population does not have a car. County: Nearest Hospital Distance: (county): There are 42 counties in Missouri that do not have a general access hospital. For some counties, access to neighboring county hospitals is Andrew Buchanan 14.0 miles easier than others. However, the average driving time is around Benton St. Clair 51.5 miles 30-45 minutes. Of the 42 counties with no hospitals, 16 counties have Bollinger Cape Girardeau 41.7 miles populations with less than 5% without vehicles, 21 have 5%-7% of their populations without vehicles, 2 have 8%-10% of their Caldwell Clinton 18.8 miles populations without vehicles, and 3 have over 10% of their Carter Howell, Ripley, 51.5 miles populations without vehicles. Approximately 36.5% of counties have Butler no hospital access. Approximately 650,991 people live in a county Chariton Linn 20.7 miles with no hospital, or 11% of Missouri’s population total. Christian Greene 17.5 miles Clark Scotland 26.4 miles Dade Barton 20.1 miles Dallas Laclede 29.0 miles Daviess Harrison 20.2 miles DeKalb Buchanan 26.3 miles Douglas Texas 49.9 miles Hickory Cedar 46.1 miles The average driving distance is similar to the distance Holt Atchison 26.2 miles between Columbia, MO and Jefferson City, MO Howard Cooper 23.4 miles Knox Scotland 27.1 miles Lewis Marion 34.8 miles Maries Phelps 23.9 miles McDonald Barry 36.2 miles Mercer Harrison 33.5 miles Percent Number of Number of Miller Camden 24.0 miles without a Hospitals: Counties: Mississippi Scott 21.2 miles car: Moniteau Cole 24.1 miles Less than 5% 14 28 Monroe Macon 33.6 miles 5%-7% 43 57 Montgomery Gasconade 20.8 miles Morgan Camden 37.5 miles 8%-10% 14 11 New Madrid Pemiscot 31.8 miles Over 10% 2 5 Oregon Howell 29.0 miles TOTAL: 73 101 Osage Cole 24.9 miles Ozark Howell 35.9 miles Figure 4: Counties with 10% or more of the population with no access to a vehicle Pulaski Phelps 31.7 miles Ralls Marion 19.8 miles County: No Hospital: Reynolds Iron 31.6 miles Vehicle: Schuyler Scotland 20.3 miles Pemiscot 12.8% Yes Shannon Texas 37.7 miles Shelby Macon 27.8 miles Mississippi 11.7% No Stone Taney 22.4 miles Warren Franklin 17.9 miles Carter 11.7% No Wayne Butler 27.4 miles New Madrid 10.5% No Webster Laclede 30.3 miles Worth Gentry 19.4 miles Dunklin 10.2% Yes Wright Laclede 27.8 miles Average distance= 29.4 miles CRITICAL ACCESS HOSPITALS: The goal of Critical Access Hospitals is to provide healthcare to underserved rural populations. However, in the counties where over 10% of the population has no access to a vehicle, there are 0 critical access hospitals. Of the 36 Critical Access Hospitals, 32 are located in rural counties. Of those 32, 12 are located in 75% or more rural counties. Ultimately, only 33% of Critical Access Hospitals are located in rural most Missouri.