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Saturday, September 15, 2018

Texas A&M welcomes national center to improve rural health care - Vital Record

In operationalizing this grant, I would hope the A&M Rural and Community Health Institute keeps in mind the lessons we have learned since the 1990s regarding health services utilization--that of psychological distance. The natural assumption is that more brick and mortar locations directly correlates to better health care; that is, proximate geographic access effects better health care. However, this assumption was proven false in the mid-1990s by the near financial devastation of the Kaiser system which practically placed a clinic in everyone's backyards, yet utilization did not increase. Subsequently, in the decades since Kaiser's experience this assumption has been proven false over and over. The true barrier appears to be not that of geographical access but that of "psychological distance." Psychological distance is the new sexy term that has replaced psychological aversion in the health care utilization literature. What it means is that people have a natural bias to avoid health care contact. Health care contact is seen as a tax on time which may be more joyfully spent. Would you rather spend an afternoon in a clinic's waiting room or have that time as relaxation time, family time or time with a book on the back patio? The argument of downstream benefit--the preventative clinic visit means better health and quality of life rewards down the road--appears to be insufficient to narrow this psychological distance. Thus, a clinic in one's backyard might as well be on Mars. Until the psychological distance is narrowed, effective health care utilization may be poor.
from Rajesh Harrykissoon, MD

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