Having a hospital nearby is important for many reasons. They have a positive economic impact in the communities where they are established. Hospitals also have services and equipment that clinics and doctors’ offices do not, and are usually where you go in the case of a health emergency. In Kentucky, however, rural hospitals are facing many financial pressures threatening to affect the lives and health of many Kentuckians by reducing the availability of hospital care in the areas where they serve.[i]
Based on that worrying thought, we decided to explore hospital access in Kentucky by asking: how far away is the nearest hospital? To answer this question we started by mapping all the general medical and surgical hospitals in Kentucky and in the surrounding states as shown below.
As you might expect, we found a higher presence of hospitals in the urban centers where there is a higher concentration of people. Other than that, it appears—at first glance—as if Kentucky hospitals are spread out evenly across the state. But does that mean these hospitals are easy to access over Kentucky’s winding rural roads?
To look closer, we wanted to find out if there are any areas farther than a 20 minute drive away from the mapped hospitals. We chose 20 minutes because, in an emergency, you don’t want to travel longer than that—a long ambulance ride is associated with increased risk of death.[ii] The map below shows shades all of the areas within a 20 minute drive. As you can see, there are many gaps in eastern and western Kentucky. We even looked at a 30 minute drive time—referred to by the US Department of Health and Human Services as “excessively distance”[iii]—and some gaps still remained.
However, perhaps those gaps above are unpopulated—if no one lives on that land, then no one is being denied access to a hospital. To test this, we decided to find out how far away is the nearest hospital from each Kentucky city. We define each city on the map by the location its city hall; while we recognize that some populated settlements do not have a city hall, we figured this was a good place to start. We discovered that unlike most metropolitan areas, some of the towns in the rural areas do not have hospital nearby. Although the average drive distance from city hall to the closest hospital is 1.6 miles, there are cases where the nearest hospital from city hall is located more than 20 miles away! The map below highlights all of the city halls that are more than 10 miles from the nearest hospital, many of which are located in far western Kentucky.
In many areas in rural Kentucky, accessing a hospital remains challenging. Ideally, rural residents should be able to conveniently and confidently use services such as primary care, dental, behavioral health, emergency, and public health services.[iv] This is something important to think about particularly because it has been shown that rural residents tend to be less healthy, older, lower-income and more likely to have a chronic illness than urban dwellers which may increase the need for health care services.[v]
So how do we improve access to healthcare in rural Kentucky, particularly to hospitals? In 2014, CEDIK completed a study where we estimated willingness-to-pay for attributes of rural healthcare facilities.[vi] We found that Kentucky residents were willing to pay $225 more annually to support a hospital relative to a rural health clinic. While acceptance of Medicaid/Medicare was the most valued attribute, we also saw that having full diagnostic services, an emergency room, and 24-hour/7-day-per-week access were also highly valued. If we can no longer afford to keep our rural hospitals open, maybe we should consider equipping our rural health clinics with some of these attributes (e.g., longer hours, diagnostic services) as a way to extend care to those in need.
Correction: Maps were updated on February 12, 2016 to with a revised list of hospitals after crosschecking with the American Hospital Directory. We apologize for any inconvenience and thank our readers for pointing out our mistake!
[i] Kentucky Hospital Association. Code Blue: Many Kentucky Hospitals Struggling Financially Due to Health System Changes. April 2015.
[ii] Nicholl J, West J, Goodacre S, Turner J. The relationship between distance to hospital and patient mortality in emergencies: an observational study. Emerg Med J 2007 Sep; 24(9): 665-8.
[iii] “Guidelines for Primary Medical Care/Dental HPSA Designation.” Health Resources and Services Administration. U.S. Department of Health and Human Services. Available at: http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/medicaldentalhpsaguidelines.html.
[iv] Rural Health Information Hub. Healthcare Access in Rural Communities. Available at: https://www.ruralhealthinfo.org/topics/healthcare-access.
[v] Glasgow N, Morton LW, Johnson NE, eds. Critical Issues in Rural Health. Ames, IA: Blackwell Publishing Professional. 2004.
[vi] Allen IV, J., Davis, A., Hu W., Owusu-Amankwah, E. (2014)Residents’ Willingness-to-pay for attributes of rural health care facilities in Kentucky. The Journal of Rural Health 00(2014) 1-12.