title: Exposing some important barriers to health care access in the rural USA.
abstract: OBJECTIVE
  To review research published before and after the passage of the Patient Protection and Affordable Care Act (2010) examining barriers in seeking or accessing health care in rural populations in the USA.
  
  
  METHODS
  This literature review was based on a comprehensive search for all literature researching rural health care provision and access in the USA.
  
  
  METHODS
  Pubmed, Proquest Allied Nursing and Health Literature, National Rural Health Association (NRHA) Resource Center and Google Scholar databases were searched using the Medical Subject Headings (MeSH) 'Rural Health Services' and 'Rural Health.' MeSH subtitle headings used were 'USA,' 'utilization,' 'trends' and 'supply and distribution.' Keywords added to the search parameters were 'access,' 'rural' and 'health care.' Searches in Google Scholar employed the phrases 'health care disparities in the USA,' inequalities in 'health care in the USA,' 'health care in rural USA' and 'access to health care in rural USA.' After eliminating non-relevant articles, 34 articles were included.
  
  
  RESULTS
  Significant differences in health care access between rural and urban areas exist. Reluctance to seek health care in rural areas was based on cultural and financial constraints, often compounded by a scarcity of services, a lack of trained physicians, insufficient public transport, and poor availability of broadband internet services. Rural residents were found to have poorer health, with rural areas having difficulty in attracting and retaining physicians, and maintaining health services on a par with their urban counterparts.
  
  
  CONCLUSIONS
  Rural and urban health care disparities require an ongoing program of reform with the aim to improve the provision of services, promote recruitment, training and career development of rural health care professionals, increase comprehensive health insurance coverage and engage rural residents and healthcare providers in health promotion.
authors.affiliation: Medical School for International Health, Ben Gurion University, Beer Sheva, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Douthit
authors.affiliation: Medical School for International Health, Ben Gurion University, Beer Sheva, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Kiv
authors.affiliation: Medical School for International Health, Ben Gurion University, Beer Sheva, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Dwolatzky
authors.affiliation: Ben Gurion University, Beer Sheva, Israel. Electronic address: seemabiswas@msn.com.
authors.forename: S
authors.initials: S
authors.lastname: Biswas
mesh_terms: D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D058991:Patient Protection and Affordable Care Act; D012424:Rural Population; D014481:United States
keywords: Access; Disparities; Health; Health care; Inequalities; Rural; Services; Supply; USA; Utilization