• Rural Demographics o The demographic breakdown in rural Virginia is 64.1% White, 19.7% Black, 8.4% Hispanic, 6% Asian, and all other races make up the remainder.1 o Of these racial demographics 11.6% are 65 years and older living in Virginia.1 o On average 18% of people 65 years and older live in rural communities.1
• Socioeconomic conditions o According to the Virginia Department of Health a majority of low income families live in rural communities.1 o Southwest Virginia has the lowest median income of any location the state at an average family income of 28,000 per year.1 o Twenty four of Virginia’s 134 counties have 20% of their communities living in poverty.
Many of which are located in southwest Virginia, southern Virginia, and Virginia Beach. 1
• Culture o Independent community mentality. o Lack of education with less than 33% of people receiving education beyond high school.1 o Socioeconomic and spatial disparities keep the rural community to from accessing and affording neurological healthcare. o Mistrust in large medical facilities.
• The Disparity o Rural Virginia’s population has experienced a shortage of neurosurgeons at the level of 26%.3 o Strokes have been and are the third leading cause of death in Virginia and its rural community.4 o The mortality rate from cerebral cancer and cerebrovascular disease is on average of 50 per 100,000 and is highest in rural communities in Southwest Virginia reaching 72 per 100,000.4
II. Issues
• Accessibility o People living in remote communities may not have the ability to reach hospitals with neurosurgical care. o Lack of hospitals in the area.
Virginia defines rural areas has having only one hospital with 50 beds as having access to care.1
The Lynchburg Neurology Institute determined in a 50 mile radius around Lynchburg 80% of patients suffering from cerebral aneurysms had fatal results in route to UVA or Duke Medical Center. o Possibility of not being able to afford driving to a far reaching hospital. o Need for health care providers willing to stay in the rural locations to serve the underserved.
• Affordability o Neurosurgery, according to the Lynchburg Neurology Institute, can range anywhere between $50,000 and $200,000 depending on complications. o Virginia ranks 15th among all states for uninsured people.1
Over half of these people live in rural communities around the state. o Uninsured people receive only a 30% discount on their medical bills from neurosurgery.2 o Overall health status and length of required stay in the neurosurgical intensive care unit.
• Shortage Destinations o The Virginia Department of Health has determined that many hospitals that provide neurosurgical services are in shortages of surgeons.
A population to provider ration is 3,500 people to every surgeon.1 o Obtaining quality physicians that are willing to relocate to rural community hospitals is difficult. o Lack of loan repayment opportunities for practitioners in Virginia according to the AAMC.2 o Facilities with inadequate medical technology.
This results from a lack of governmental subsidies and grants.
• Government Hurdles o The American Association of Neurosurgeons, found in a survey that 67% of patients will have a difficult time being referred to a specialist and be covered by medicare.3 o 80% of neurosurgeons indicated in the AANS survey of 2010 that if Medicare repayments keep declining they will not accept Medicare patients.3 o Lack of grants pertaining to neurosurgical technology to provide advanced procedures.
Community hospitals are in need of new radiology devices, intensive care equipment, and respiratory care equipment and staff.
III. Recommendations
• Health Education for the Community o Teach the community through events how to care for themselves. o Emphasize education on how rural communities suffer from neurological illnesses. o Teach signs and symptoms of illnesses
