Health care resources distributed unevenly in Kansas

May 8 2005

At least a third of the state of Kansas resembles an inner city when it comes to local availability of doctors, hospitals, medical personnel and nursing homes. Basically, there's not a lot of medical help to be had in either south Chicago, for example, or Sharon Springs, Kan.

Recent research by a Kansas State University geography graduate student determined there is extremely uneven distribution across the state of the essential health care resources, specifically, medical practitioners and health care facilities.

Residents of western or southeastern Kansas are on their own if they get sick in the middle of the night. And, the situation doesn't get better when the sun comes up. A rural resident is likely to drive three hours or more to reach the nearest medical facility. An urban resident likewise will travel hours to the nearest doctor or clinic, albeit by public transportation.

Debarchana "Debs" Ghosh is studying with K-State geography professor Bimal Paul, who is very interested in health-related issues. Using a variety of statistical and geographic tools, she analyzed county-level health care availability data for all 105 Kansas counties in order to derive a health care resource distribution pattern for the state. She presented a poster of the findings for Kansas state legislators in March at the second Graduate Student Research Summit in Topeka.

Ghosh was able to designate "health care resource regions" for the state on the basis of the spatial variation of health resources. She correlated resource availability with population density, distribution of the elderly population in the state, and income and other economic variables.

According to her analysis, three counties -- Sedgwick, Shawnee and Johnson -- are what Ghosh calls "very high health care resource regions." There's a positive correlation between population density, income and health care resource availability.

Almost all counties of western Kansas and southeastern Kansas would be classified as "low or very low health care resource regions." These regions characteristically have fewer people, a higher percentage of elderly in the population, and a higher percentage of people living below the poverty line.

"This inequity in health care resource distribution is really a problem in Kansas," Ghosh said.

For the project, she assessed the distribution of practitioners and facilities. Practitioners included primary care physicians, general physicians, full-time equivalent medical doctors, full-time equivalent physical assistants, and nurses. Health care facilities included hospitals, clinics, mental health clinics, nursing homes, adult care homes and home health aids. She pointed out that other researchers might elect to use other study parameters.

In urban counties, the ratio of doctors to population is one doctor to 500 people. In rural counties, the ratio is one doctor to 1,500 people. "This relates to the acute shortage of medical personnel in the rural areas," Ghosh said.

Frontier and rural counties are defined as having fewer than 20 people per square mile, and they make up about one-third of the state. These counties rely on nurses almost exclusively to provide health care services. In many such counties, there are no doctors or hospitals. Elk, Kiowa and Chase counties had no general practitioners in 2002.

There's scarcity of hospital beds in rural areas: in 2003, there were 378 available hospital beds per 100,000 people in certain rural counties. In the decade 1993-2003, hospitals in many rural counties shut their doors.

"When we looked at availability of adult care homes -- which are really important for the older people -- we found a very high spatial inequality between urban and rural counties," she explained. Exacerbating the problems, in many frontier and rural counties, the elderly make up as much as one-fourth of an already sparse population, which means that those areas actually could use a greater supply of health resources, she noted.

"The frontier and rural counties, the category having high percentages of elderly, are the counties that really need the health care resources, and they do not have them," she said.

Ghosh hopes Kansas policy-makers can incorporate statistical patterns like the study findings as they work to develop strategies for improving the delivery of health care statewide.

"I would like policy makers, legislators and others to be aware of how deep and how acute the shortages are," the health geographer said. "It is important. I hope that pointing out these aspects in a statistical manner will help them."