• Socioeconomic conditions o According to the Virginia Department of Health a majority of low income families live in rural communities.1 o Southwest Virginia has the lowest median income of any location the state at an average family income of 28,000 per year.1 o Twenty four of Virginia’s 134 counties have 20% of their communities living in poverty.
Many of which are located in southwest Virginia, southern Virginia, and Virginia Beach. 1
• Culture o Independent community mentality. o Lack of education with less than 33% of people receiving education beyond high school.1 o Socioeconomic and spatial disparities keep the rural community to from accessing and affording neurological healthcare. o Mistrust in large medical facilities.
• The Disparity o Rural Virginia’s population has experienced a shortage of neurosurgeons at the level of 26%.3 o Strokes have been and are the third leading cause of death in Virginia and its rural community.4 o The mortality rate from cerebral cancer and cerebrovascular disease is on average of 50 per 100,000 and is highest in rural communities in Southwest Virginia reaching 72 per 100,000.4
• Accessibility o People living in remote communities may not have the ability to reach hospitals with neurosurgical care. o Lack of hospitals in the area.
Virginia defines rural areas has having only one hospital with 50 beds as having access to care.1
The Lynchburg Neurology Institute determined in a 50 mile radius around Lynchburg 80% of patients suffering from cerebral aneurysms had fatal results in route to UVA or Duke Medical Center. o Possibility of not being able to afford driving to a far reaching hospital. o Need for health care providers willing to stay in the rural locations to serve the underserved.
• Affordability o Neurosurgery, according to the Lynchburg Neurology Institute, can range anywhere between $50,000 and $200,000 depending on complications. o Virginia ranks 15th among all states for uninsured people.1
Over half of these people live in rural communities around the state. o Uninsured people receive only a 30% discount on their medical bills from neurosurgery.2 o Overall health status and length of required stay in the neurosurgical intensive care unit.
• Shortage Destinations o The Virginia Department of Health has determined that many hospitals that provide neurosurgical services are in shortages of surgeons.
A population to provider ration is 3,500 people to every surgeon.1 o Obtaining quality physicians that are willing to relocate to rural community hospitals is difficult. o Lack of loan repayment opportunities for practitioners in Virginia according to the AAMC.2 o Facilities with inadequate medical technology.
This results from a lack of governmental subsidies and grants.
• Government Hurdles o The American Association of Neurosurgeons, found in a survey that 67% of patients will have a difficult time being referred to a specialist and be covered by medicare.3 o 80% of neurosurgeons indicated in the AANS survey of 2010 that if Medicare repayments keep declining they will not accept Medicare patients.3 o Lack of grants pertaining to neurosurgical technology to provide advanced procedures.
Community hospitals are in need of new radiology devices, intensive care equipment, and respiratory care equipment and staff.
• Health Education for the Community o Teach the community through events how to care for themselves. o Emphasize education on how rural communities suffer from neurological illnesses. o Teach signs and symptoms of illnesses