As I get ready to speak to a group of rural health care advocates and interested parties about the problems of health care access, I’m afraid that I will have to address the problem of bypass. This is a concept that is easy to grasp but is but tends to get a “so what” response. To make a long story short, up to 32% of folks who live in rural areas drive past their local health care facility to reach another, “better” facility. Even Canadians will drive 2 hours to get to a different hospital.  This is not just for urgent care. 53% of folks needing colonoscopy will bypass their local colonoscopist for someone “better”. In Alabama, nearly 50% of women did not deliver babies in the nearest maternity hospital but drove to another with almost 1/3 of rural Alabamians delivering in an urban area (Healthy People 2010).  

Bypass leads to poorly performing health systems in rural communities. If only those with transportation difficulties use local services, the services tend to be of poor quality. Communities with less bypass have better care. The addition of patients with private insurance will help local health care remain viable. Care providers need to assess bypass and figure out why it occurs. Policy makers need to measure bypass (it is surprising how difficult the numbers are to come by) and suggest solutions. Communities need to confront percieved poor care instead of voting with their feet.

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