How Missouri’s Healthcare Disparities Lead To Rural EMS Transportation Issues

Across rural Missouri, EMS providers and ambulance districts strive to provide prompt, reliable medical care and response to those in their service area. However, while urban and suburban EMS providers serve a more localized area, rural districts serve an expansive coverage territory. Rural EMS districts and providers must also navigate a larger problem leading to EMS transportation issues: healthcare disparity.

Vast coverage areas, a longer commute to hospitals, and other issues exacerbate the complications of rural EMS providers. However, the lack of local healthcare facilities drives many issues these providers face. Here’s how districts mitigate the challenges of healthcare access and rural emergency medical response.

Access to Healthcare in Rural America 

Many individuals living in rural Missouri lack access to healthcare, specifically hospitals. The Missouri Department of Health and Senior Services noted in its biennual 2022-2023 report that 19 hospitals closed over the period of a decade (2014-2023). Of these 19 hospitals, a dozen were located in rural areas; in addition, all the shuttered hospitals provided care to those living in health professional shortage areas (HPSAs).

Of the 115 counties in Missouri, 99 are considered rural. Statistics from the report note that 36 percent of rural counties lack a hospital, and, on average, those living in these areas must travel more than 29 miles to reach a hospital. However, some counties are nearly an hour’s drive from a hospital; Carter County and Benton County residents must travel 51.5 miles to reach their nearest hospital. Rural residents also are more likely to live in poverty and to be uninsured, and the inability to pay for medical costs is a devastating reality for many residents. 

For EMS districts and providers serving these areas, the lack of healthcare facilities combined with residents living in poverty and without access to insurance leads to numerous concerns. Many ambulance providers may need to travel many miles to transport a critical patient to a proper facility, and districts also may suffer the financial impact of uninsured patients who cannot pay their transport bills. 

EMS Districts Navigating A Rural Healthcare Shortage

As hospitals shuttered in rural counties, EMS transports suffered from geographically challenged healthcare access for their patients. When time is of the essence, distance to care greatly impacts health, wellbeing, and the survival of a patient. 

Distance to hospitals is only one of many issues that EMS districts face because of a rural healthcare shortage. Residents may rely on EMS teams for non-emergency care or treatment. When individuals lack access to doctors or providers, dialing 911 provides instant access to responders who can assess heart issues, wounds, or other issues. 

Some EMS teams offer residents in their service area crucial monitoring and healthcare assessments, saving drive time to hospitals and ensuring residents get the care they may otherwise delay because of issues with travel or cost burdens. Services offered by rural EMS districts/providers now include blood pressure and glucose checks. Cole Camp EMS (serving Benton County) offers these services to residents free of charge.

New Recruits: Rural EMS Assistance Staffing Issues

Many rural EMS districts cover a vast service area. Cole Camp EMS services more than 300 square miles. Unfortunately, this larger service area does not lead to more funding. In fact, many rural districts operate on tight margins. Rural communities have a higher percentage of residents living in poverty, which can lead to barriers in passing crucial tax increases for funding EMS equipment/transportation upgrades and improvements.

Districts with smaller fiscal budgets also may offer lower salaries than larger urban districts. The lower pay for EMTs, paramedics, and support staff create challenges for attracting new employees, leading to staffing issues and shortages. 

The National Rural Health Association (NRHA) reports that the main challenges for EMS teams operating in rural areas primarily focus on insurance reimbursement, financial support, workforce support, and training. However, all of these issues relate to financing in some capacity. Districts that fail to receive full reimbursement (or any reimbursement) for services must move the costs to the patient; in rural areas with high poverty, patients may be unable to afford their service costs, leading to write-offs. When rural EMS districts lose money because of reimbursement issues, they lack the funding for other necessary operational costs like training for their team and salary raises (or higher starting salaries for new team members).

For EMS districts located in rural western Missouri counties, grants through the Patterson Foundation may help offset training, gear, and/or other costs. This funding provides crucial financial support to districts that may struggle to remain operational and offer competitive salaries and better training.

Volunteer Districts Dominate Rural Areas

The NRHA also notes that about half of rural EMS districts are staffed by volunteers. Most concerning, the association explains that the volunteer pool for staffing these districts is growing smaller.

Rural districts relying on volunteers may need to move to hire a part-time or full-time crew. Again, hiring may be a continued challenge as operational costs become crunched. This is why it is imperative for districts to seek out additional sources of funding like grants offered by local foundations or through federal programs (if applicable). 

Rural districts that need financial assistance can visit the National Association of Emergency Medical Technicians (NAEMT) federal funding page, which includes a list of all available federal grants and other funding resources.

How the Future of Rural Healthcare Impacts EMS Districts

Over a decade, Missouri counties lost 19 hospitals. The changes and challenges of healthcare access will continue to plague rural areas and the EMS teams who serve these residents. 

The Missouri Ambulance Association advocates for the need for reimbursement changes that negatively impact the operational budgets of both small and large districts. Too many districts face rejected claims from insurers, losing any reimbursement for the care they provide. The MAA also understands that rural districts face unique challenges that impact their ability to deliver the care they provide to residents in their communities. 

Closed hospitals lead to longer transport times for EMS teams. Low reimbursement rates crunch budgets and pressure rural districts to pass care costs to residents who may live in poverty. Rural EMS districts may also struggle to pass crucial funding initiatives during elections, as residents may fear that even a small tax increase could be financially devastating.

While rural EMS districts may apply for grants and federal funding, their underlying issues are exacerbated by the ever-widening healthcare access disparity facing America’s rural communities. In response, these districts also take on a burden of care beyond their original scope. Many may offer free medical monitoring or screening for residents to minimize the need for emergency response related to residents neglecting chronic medical conditions and failing to seek care until it’s too late. Rural EMS teams have evolved from first responders to local medical providers.

Join MAA To Advocate for Change

The solution for decreasing the pressure on rural EMS providers and districts is not simple. Legislation and advocacy are necessary to implement change, close the healthcare access gap, and mitigate the pressure on EMS teams located in and servicing rural counties across the state. The Missouri Ambulance Association continues fighting for legislation and reform to increase funding and reimbursement for urban and rural EMS providers. Join us in our efforts and support a better future for emergency medical providers in Missouri.