A triple disaster: Uninsured, living far from a hospital, and sick with COVID-19

 

This is a disturbing scenario: The 274,000 North Carolinians who live in a county without a state-licensed hospital. Of them, the 37,700 who are uninsured. And an unknown number of these rural, uninsured residents who have COVID-19.

Seventeen counties in North Carolina lack a state-licensed hospital, which means those residents with acute symptoms of the virus must drive — or, if they are poor, elderly or have a disability, be transported, if that’s even possible — 10, 15, even 30 miles to the nearest facility. Or out of options, they might ride out the disease at home.

For routine medical care, residents in these counties rely on urgent care centers, rural health clinics and county health departments, none of which is equipped to deal with serious cases of the virus.

Ten of the 17 hospital-less counties have reported positive cases of COVID-19, although the number of cases is likely an undercount because of testing limitations. As of April 7, that total was 88, according to the state Department of Health and Human Services. (Most of Northampton County’s total originated at a nursing home.) No deaths have been reported in these 17 counties from the virus.

According to state health department statistics, 354 of the state’s 3,220-plus known cases are hospitalized. However, that data is incomplete because only two-thirds of hospitals have reported their totals. Forty-six people have died.

Although most people with the virus don’t require hospitalization, those who do often have underlying medical conditions that put them at risk of dying. And rural residents, who tend to be older, poorer and geographically isolated, are also more likely to be in poor health than their urban and suburban counterparts.

Unable to financially survive, seven rural hospitals have closed in North Carolina since 2010, according to the NC Rural Health Research Program at UNC Chapel Hill. In some cases, rural hospitals are shutting down as a result of mergers; in other instances, declines in rural population mean there are fewer patients and fewer dollars. And the lack of Medicaid expansion also cuts into hospital revenue because the facilities aren’t reimbursed for services for uninsured patients.

Without Medicaid expansion, many of these rural residents have no insurance at all. According to census data, in 12 of the 17 counties without state-licensed hospitals, the percentage of uninsured residents is higher than the state average of 12.7%.

CountyPopulation (2019)Percentage under 65 without health insurance    
Clay11,23115.6
Graham8,44118.6
Madison21,75512.6
Yancey18,06914.7
Yadkin37,66714.1
Caswell22,60412.9
Warren19,73116.4
Greene21,06918.8
Jones9,41915.6
Pamlico12,72612.7
Tyrrell4,01617.0
Hyde4,93715.7
Perquimans13,46312.4
Northampton19,48311.5
Currituck27,76312.8
Camden10,86711.9
Gates11,56211.7

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