Characteristics of High-Resource Health System Users in Rural and Remote Regions: A Scoping Review

Abstract

A small proportion of health care users are recognized to use a significantly higher proportion of health system resources, largely due to systemic, inequitable access and disproportionate health burdens. These high-resource health system users are routinely characterized as older, with multiple comorbidities, and reduced access to adequate health care. Geographic trends also emerge, with more rural and isolated regions demonstrating higher rates of high-resource use than others. Despite known geographical discrepancies in health care access and outcomes, health policy and research initiatives remain focused on urban population centers. To alleviate mounting health system pressure from high-resource users, their characteristics must be better understood within the context in which i arises. To examine this, a scoping review was conducted to provide an overview of characteristics of high-resource users in rural and remote communities in Canada and Australia. In total, 21 papers were included in the review. Using qualitative thematic coding, primary findings characterized rural high-resource users as those of an older age; with increased comorbid conditions and condition severity; lower socioeconomic status; and elevated risk behaviors.

Double Disparity of Sexual Minority Status and Rurality in Cardiometabolic Hospitalization Risk: A Secondary Analysis Using Linked Population-Based Data

“…Widespread rural barriers to healthcare, due to factors such as lack of medical practitioners and transportation problems, could worsen stigma-related health disparities among those who identify as a sexual minority; however, the evidence base is mixed, as LGB persons living in rural areas may also be more likely to report a greater sense of belonging than their urban peers [35]. Much of the existing literature on rural-urban differences in health outcomes is singularly limited to geographic barriers to healthcare access [26]; our analysis highlighted rural heterogeneity in access across socially marginalized groups. Results showed that LGB persons more often exhibited behaviors associated with chronic stress, including tobacco smoking and regular alcohol consumption, compared with heterosexual persons.…”

“…Although we did not find a significant association between degree of residential remoteness and hospitalization risk among those with an underlying cardiometabolic condition, statistical power was reduced when limiting the analysis to a small subgroup and for a relatively rare outcome. Moreover, the analysis was conducted for Canada, a high-income country characterized by universal healthcare coverage, considerable legal protections with regard to sexual minority populations [39], and a vast sparsely populated rural geography [26]. In countries with mixed healthcare payment systems, insurance status has been found to contribute significantly to health disparities among sexual minority groups, notably in the United States where the uninsured are numerous [31].…”

“…It has been advanced that socioeconomic deprivation associated with rural residence may syndemically reinforce prolonged stress and, in turn, preventable and treatable chronic morbidity among minority populations [19,22,23]. Yet, many existing studies on rural health rely on small subsets of rural settings, limited accounting for individual socioeconomic status or socially entrenched gender norms, and approaches that fail to consider the heterogeneity of rural and remote communities [24][25][26][27]. The need for more research efforts focusing on long-term healthcare needs within diverse and evolving rural populations is increasingly recognized [21,28].…”