Health care access from the rural perspective: A narrative review

Peter Kaboli; Adam Blaine; Jasmine Mares; John Fortney; Sarah Ono; Amy M J O'Shea

doi:10.1111/jrh.70119

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Health care access from the rural perspective: A narrative review

Journal article

Open access

Peer reviewed

Health care access from the rural perspective: A narrative review

Peter Kaboli, Adam Blaine, Jasmine Mares, John Fortney, Sarah Ono and Amy M J O'Shea

The Journal of rural health, Vol.42(1), e70119

01/2026

DOI: 10.1111/jrh.70119

PMID: 41685945

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Abstract

Health care access has been described using several definitions and frameworks, but none are specific to rural populations. We describe ways access to care is measured using the model of access developed by Fortney et al., with a focus on the differential impact on rural populations. We describe patient-centered access metrics in rural and urban populations using the Fortney model's five access dimensions: geographic, temporal, financial, cultural, and virtual. Patient-level access is put into context of the broader environment in which they live (i.e., their community, health care providers, and health care system). Rural populations face similar access challenges as urban residents but are disproportionally impacted by four interrelated challenges: (1) geographic access barriers of distance and available transportation, (2) virtual access care barriers manifested by broadband internet access and digital literacy, (3) health care workforce shortages, and (4) differential impact of social determinants of health. Key facilitators to overcome these include: (1) integrated public transportation services when in-person care is required; (2) expanded broadband coverage, affordability, and education to ensure access to telemedicine services; and (3) training, incentives, and support for the rural workforce. Health care systems should incorporate access metrics into routine data collection to drive improvement and ensure equitable access to quality health care. Rural systems of care may be disproportionally impacted by access challenges which require unique approaches for improvement.

Health Services Accessibility - standards

Health Services Accessibility - statistics & numerical data

Health Services Accessibility - trends

Humans

Rural Health Services

Rural Population - statistics & numerical data

Rural Population - trends

Details

Title: Subtitle: Health care access from the rural perspective: A narrative review
Creators: Peter Kaboli - University of Iowa
Adam Blaine - University of Iowa
Jasmine Mares - Iowa City VA Health Care System
John Fortney - University of Washington
Sarah Ono - VA Portland Health Care System
Amy M J O'Shea - University of Iowa
Resource Type: Journal article
Publication Details: The Journal of rural health, Vol.42(1), e70119
DOI: 10.1111/jrh.70119
PMID: 41685945
NLM abbreviation: J Rural Health
ISSN: 0890-765X
eISSN: 1748-0361
Publisher: Wiley
Grant note: CIN 13-412 / HSRD VA Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Iowa City
Language: English
Date published: 01/2026
Academic Unit: Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9985139313802771

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