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We must heal our rural health care system

By Emily Briggs, MD, MPH, TAFP President, and Christy Francis, TORCH Board Chair
Texas’ rural health care system is in serious trouble. The numerous problems plaguing rural health are well-documented and have been described as a succession of bad situations that are getting worse. They demand the Legislature’s immediate attention.

Rural Texans are older, sicker, poorer, and less likely to be insured than the average Texan. Rural hospitals, physician practices, and community clinics face significant financial distress and a constant risk of closure due to high uncompensated care costs and unsustainably low reimbursement rates.

Rural communities struggle to recruit and retain doctors, nurses, dentists, mental health providers, and other important health care workers, forcing patients to travel long distances to receive care. This lack of access to care results in higher rates of preventable poor health conditions among our neighbors, leading to increased rates of heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke.

According to the March of Dimes, most rural Texas communities qualify as maternity care deserts, with limited or no access to obstetrical care. Today, only 40% of rural hospitals provide obstetrical services, down from 60% just a few years ago. Is it any wonder that Texas ranks last in the nation in access to high-quality prenatal and maternal care?

When rural Texans can’t access the care they need, it’s not only their health that suffers, but the entire state economy. Rural Texas is the foundation for much of our state’s economic activity. More than 3 million Texans currently live and work in rural communities and are responsible for a sizable chunk of the Texas economy. Rural small businesses make up 24% of all business in the state, contributing more than 20% of the state’s economic output and generating more than $21.2 billion for the state’s economy.

The continued neglect of Texas’ rural health care system has implications not just for the health of rural residents, but the competitiveness of the entire state’s economy. If our rural health care system deteriorates further, the consequences for all of Texas, rural and urban, will be dire.

Rural communities’ ability to attract new industries and employers will stall, hobbling business and economic development. Job losses will mount, creating a ripple effect through rural communities, negatively impacting local tax bases, and shrinking available resources for schools and other public services. More patients will be transferred to distant communities, potentially delaying life-saving care, but also straining resources of urban health care safety net systems that are already stretched thin.

Is this the future our leaders want or rural Texans deserve? We have known about the problems for decades, but effective policy solutions have been largely ignored, underutilized, and underfunded. The time to act and invest in our rural health infrastructure is long overdue.

A long-term, multi-pronged strategy is required to 1) address our rural health care workforce shortage, 2) improve health care coverage options, thereby reducing uncompensated care and strengthening the viability of physician practices and hospitals, and 3) create a stable financial environment by targeting Medicaid payment increases to incentivize and reward rural practice, in particular preventive care, maternal care and behavioral health services.

With an historic budget surplus, the Texas Legislature has a once-in-a-lifetime opportunity to ameliorate many of our persistent rural health care challenges. Let’s not waste this opportunity to stabilize, heal, and revitalize our rural health care infrastructure.


The Texas Academy of Family Physicians is the premier membership organization dedicated to uniting the family doctors of Texas through advocacy, education, and member services, and empowering them to provide a medical home for patients of all ages. It has 32 local chapters and is a chapter of the American Academy of Family Physicians. Visit for more information.

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