WEDNESDAY, Feb. 12, 2025 (HealthDay News) — As closures of rural hospitals across the United States continue, more Americans are facing hour-plus drives to reach surgical centers, two new reports find.
By 2020, data show, 99 million Americans already had trouble finding “timely, high-quality and affordable surgical care,” according to a news release from the University of Michigan.
The situation is most dire for people living in rural areas.
“One of the big factors creating this situation is hospitals closing in rural areas, with more than 150 lost in the last 14 years, but we can also see indications of other factors related to the health policy environment,” said Dr. Cody Mullens, lead author of both studies.
It’s not just distance that’s an issue: Out-of-pocket costs for surgeries are also soaring, even for insured patients.
“The number [of patients] who lacked access due to not having insurance shrunk a lot, likely due to the Affordable Care Act, but the number who are underinsured, likely due to the growth in high-deductible health insurance plans and other factors, grew,” noted Mullens, a resident physician in surgery at Michigan Medicine.
The two studies were published in the February issue of Annals of Surgery and Feb. 12 in the Journal of the American Medical Association.
In the Annals study, Mullens’ team looked at data on surgical care across the United States for 2011 through 2020. The researchers combed through data supplied by Medicare, Medicaid, the American Hospital Association and elsewhere.
Besides finding that by 2020 almost 100 million Americans lacked local access to affordable surgeries, the study also found rural Americans to be especially hard-hit.
The researchers defined good access to surgery as “living within an hour’s drive of a hospital that offers surgical care and earned at least three stars from the Medicare quality rating system, and being able to afford the out-of-pocket costs of that operation after any insurance coverage.”
Using this metric, nearly 7% of rural patients were deemed to have “insufficient access to [surgical] care,” Mullens’ team found, compared to 2% of those living in cities.
The second study, published in JAMA, focused on rural Americans who underwent one of 16 types of surgery between 2010 and 2020. These included both low- and high-risk operations.
By 2020, 44% of these rural Americans had to drive and hour or more to get to their surgeries, a rise from the 37% noted for 2010. On average, rural patients drove 55 minutes to get to a surgical center, the study found.
The combined logistics of long drives and higher costs can have real-world implications for patients’ health, Mullens noted.
“When we can look at these factors in concert, we can have a better understanding of the net effect of our complex policy environment on patients, who may delay getting surgery and see their condition worsen and become more complex,” he said.
As the researchers explained, some trends that limit patient access are tied to policies meant to help patients.
For example, in an effort to boost quality and safety, there’s been a gradual “centralization” of surgeries at fewer and fewer high-quality hospitals in the United States, the team noted.
However, routine, low-risk surgeries — operations such as gall bladder or appendix removal, hernia repair or joint replacements — can just as safely be done at rural centers, Mullens believes.
“It’s not acceptable for that large a proportion of patients to drive that far for low-risk surgery that can be performed safely and with high quality at smaller hospitals,” he said.
In many such cases, doctors may want to consider the inconvenience of driving time when considering appointments leading up to the actual surgery, substituting telehealth sessions instead.
As for out-of-pocket surgical costs, there’s more to consider when choosing health insurance than just the monthly premium, Mullens and team said.
“When someone knows that surgery may be in their future, choosing a Medicare, ACA Marketplace or employer-sponsored plan that does not have a high deductible, starting and adding funds to a tax-free health savings account or flexible spending account, and checking on which hospitals are considered in-network for surgery, can be very important,” the team said in a university news release.
More information
There’s help on figuring out your out-of-pocket cost for health care at Healthcare.gov.
SOURCE: University of Michigan, news release, Feb. 12, 2025
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