When Distance Becomes Risk

Access to hospital care remains inconsistent across the United States and around the world, despite improvements in healthcare systems and infrastructure. Approximately 35% of U.S. adults (about 91 million people) reported they cannot access or afford quality healthcare in 2024 [1]. Within the United States, limited access to hospitals disproportionately affects underserved rural communities and low-income neighborhoods, primarily due to hospital closures, workforce shortages, and long travel distances. These barriers are critical in emergencies, where they can lead to life-or-death situations.
In this analysis, a variety of datasets have been employed to analyze the risk of hospital access on a national level.

Geographic accessibility is represented using U.S. county rurality classifications from the Department of Agriculture Rural-Urban Continuum Codes [11], which capture long-term geographic isolation and barriers to hospital access.

Healthcare system capacity is analyzed using county-level data on the number and location of acute care hospitals from the Centers for Medicare & Medicaid Services Provider of Services dataset [35] and the American Hospital Association Annual Survey [37].

Population vulnerability is represented using U.S. demographic data, with a focus on the proportion of residents aged 65 and older, derived from the Health Resources and Services Administration’s Area Health Resources Files.

Risk analysis is conducted by constructing a composite index that identifies U.S. counties facing elevated structural risk of limited hospital access, rather than directly modeling disease-specific mortality or hospitalization outcomes.

This report provides a framework for analyzing healthcare access as a structural risk. Risk is the likelihood of limited access to healthcare, calculated based on structural geographic accessibility. The modeling approach emphasizes transparency and broad applicability by treating hospital access risk as a structural condition shaped by infrastructure and socioeconomic factors, rather than as a fluctuating variable. While this report focuses on quantifying structural access risks, existing research consistently links increased travel distance and delayed hospital access to higher mortality rates, worse outcomes for time-sensitive conditions, and increased healthcare costs due to delayed treatment, healthcare system capacity, and population vulnerability indicators. This design allows the framework to be used across various regions without relying on overly complex or data-intensive methods.
The results from this model confirm that limited hospital access presents an ongoing and disproportionately distributed hazard across populations. Rural and poor populations experience higher levels of exposure to barriers to access, increasing the probability of delayed or forgone care and raising the risk of adverse health consequences. The severity of these outcomes is magnified by socioeconomic status—situations like poverty, uninsurance, and unstable housing conditions. Since the access limitation involved is structural, the health risks associated with it are likely to prevail over time without targeted intervention.

To reduce the likelihood of hospitalizations and mitigate financial risk for rural and low-income families, we have implemented multiple strategies. These measures aim to decrease the chances of developing certain health conditions, improve access to healthcare, and minimize the risk of financial crises in the event of a health issue. From a policy perspective, mitigating hospital access risks can reduce costly emergency interventions and preventable hospitalizations, allowing targeted investments in access infrastructure and mitigation strategies to yield long-term economic and public health benefits. We can establish health workshops and programs in rural areas to raise awareness about health and promote healthy lifestyles, which significantly lowers the risk of disease when followed. Additionally, to alleviate hospital overcrowding and ensure proper care, we can introduce a hospital-at-home program specifically for rural residents facing overwhelmed healthcare facilities. This program offers the same safety as traditional hospital care and often leads to improved mental health and increased physical activity. Finally, if a health condition does arise, having insurance and financial safety nets is crucial in avoiding a financial crisis. It is particularly important to focus on disseminating information about health insurance and how low-income families can apply for medical coverage.

This project offers a data-driven framework to understand and compare the risks associated with limited access to hospitals. The model and analysis aim to aid policymakers, healthcare administrators, providers, and public health officials in making informed decisions. This will help prioritize interventions and enhance healthcare access in underserved communities.