Rural Pennsylvanians Must Travel Long Distances to Hospital-Based Health Care

For several years, Pennsylvania policymakers have contemplated creating a statewide paid family and medical leave program. Research released in 2017 by the Pennsylvania Department of Labor and Industry found broad public support and strong employer support for a paid leave program in the commonwealth; a cost analysis concluded that a statewide program could be implemented in a cost-effective and business-friendly way and would promote the health, economic security, and well-being of Pennsylvania's workers and families. The need for — and evidence to support the value of — paid leave has only grown since then.

For Pennsylvanians in rural areas — 26 percent of the commonwealth's population, or nearly 3.4 million people — there is a unique need for paid leave. Demographic and economic factors, including lower rural per capita household incomes relative to urban areas, and higher rural poverty rates, mean that rural households are more likely to struggle if a worker must take leave without pay or loses their job. Pennsylvania is the nation's ninth oldest state, and rural Pennsylvania is even older overall than the rest of the commonwealth. An aging population means rural communities must simultaneously attract enough workers to fill jobs and ensure that older adults are able to get the family-provided care they need. Lower fertility rates suggest the need to attract younger people to maintain vibrant, thriving community economies.

The longer distances that people in Pennsylvania's rural communities must travel to get to hospital-based care, relative to people in metropolitan areas, exacerbate the challenges that rural Pennsylvanians have accessing care. For rural communities, where long distances to hospitals and lack of paid leave together have significant implications, guaranteed access to comprehensive paid family and medical leave is a necessary intervention.

Access to Paid Leave

Overall, less than one-quarter of private-sector workers nationwide (24 percent) have paid family leave through their jobs, according to the Bureau of Labor Statistics. Access is higher in the Middle Atlantic region (New Jersey, New York and Pennsylvania) at 35 percent, and this is very likely affected by employer-provided leave options available through the paid family and medical leave programs in New Jersey and New York. [1]

In Pennsylvania, even job-protected unpaid leave is available and estimated to be affordable for 12 weeks to 38 percent of workers, according to researchers from Brandeis University; even smaller shares of Black workers (28 percent), Latine non-immigrant workers (22 percent), and Latine immigrants (18 percent) in Pennsylvania have both job protection and the ability to afford an unpaid leave for 12 weeks.

Rural workers have even less access to both employer-provided paid family leave and paid sick leave than workers in metropolitan areas because the types of jobs that are most prevalent in rural communities are less likely than others to offer paid leave benefits. Rural workers also have reduced access to job-protected, unpaid leave through the Family and Medical Leave Act of 1993 (FMLA) because they tend to work for smaller employers and are more likely to work part-time. In Pennsylvania, the industries that are growing, including manufacturing, leisure and hospitality, and health and educational services, are unlikely to provide paid leave.

Lack of access to paid leave can force working people into impossible choices between keeping a job, feeding a family, and getting or helping a loved one to get the health care they need.

Distances to Hospital-Based Health Care Services

In 2022, the Better Life Lab at New America released a report, Health, Work, and Care in Rural America, tying together new analysis of rural disparities in access to paid leave and new calculations demonstrating the long and disparate distances that rural people must travel to seek six specific types of hospital-based health care services: obstetrics care, NICU care, pediatric care, cardiac care, cancer screening, and cancer treatment. [2]

New state data analysis augments our national findings: Rural Pennsylvanians must travel up to 3.8 times further, on average, than people in urban areas to get to hospital-based health care. The distance disparities are greatest for parents and caregivers of babies in the NICU or receiving pediatric: Rural NICU services are an average of 38 miles from rural census tracts but only 10 miles from urban areas. Similarly, hospital-based pediatrics care is 26 miles from rural census tracts, but just 9 miles from urban ones, on average.

Hospital-based obstetrics services, cardiac care, cancer treatment, and cancer screening are each more than twice as far from rural communities than from urban ones in Pennsylvania— 15 to 18 miles, on average, compared to 7 to 9 miles. Windy roads in many of the commonwealth's rural areas exacerbate mileage disparities and make travel times even longer.

In addition, rural census tracts with high shares of Latine people are even further than rural census tracts overall from hospital-based obstetrics services (22 miles), cardiac care (19 miles), cancer treatment (19 miles), and cancer screening (19 miles). [3] This is significant because Latine workers have lower access to paid family and medical leave and paid sick days than workers as a whole do, and our main report found that Latine workers in rural areas have even less access than workers in urban ones.

Implications: Comprehensive Paid Leave Will Strengthen Rural Pennsylvania

Hospital distances and lack of paid leave together have significant implications, especially for people in rural communities where labor force participation rates are already lower than in other communities, where measures of good health are lower, and where caregiving needs are higher. For example, research cited in our main national report shows that rural cancer patients are better able to return to work when they have paid leave and workplace flexibility, that hospitalized children recover more quickly when a parent can be at the hospital with them, and that cancer treatment recommendations are followed more closely when patients and caregivers have and use paid leave. Additional research shows that paid leave contributes to workforce retention for new parents and caregivers and higher earnings for mothers; positive impacts for businesses; and, as a result, improves the potential for economic growth.

Pennsylvania's policymakers should evaluate the evidence, the needs of all geographic areas of the state, and key demographic, business and economic trends, and they should consider joining 11 states and the District of Columbia in passing a comprehensive, inclusive statewide paid leave program. Paid leave is a family, health and labor force issue, and for rural communities in particular, it's a factor to consider in economic development as well.

Hannah Friedman, a doctoral candidate in the Department of Health Policy and Management at the Gillings School of Global Public Health and The Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, provided the Pennsylvania hospital-distance data used in this blog.

[1] New York requires employers to provide temporary disability insurance and paid family leave to workers either through a private insurance product or through the state insurance fund; New Jersey has state temporary disability and paid family leave programs that offer employers the opportunity to privately insure workers or through a state fund. Bureau of Labor Statistics data does not capture coverage through New Jersey's state fund and might not capture all New York coverage, but it should capture self-insured or privately-insured workers who receive benefits through their employers. For more information on state paid leave programs, see our explainer, Paid and Unpaid Leave Policies in the United States.

[2] Distances to hospital-based health care services are measured from the middle of each census tract. Census tracts are classified as rural or metropolitan using RUCA codes. Data on hospital services is from the American Hospital Association Survey. Files used for mapping are from the National Historical Geographic Information System. For more information on our methodology, please see descriptions in Health, Work, and Care in Rural America.

[3] Census tracts in this subgroup analysis are those that fall into the top 10 percent of census tracts nationwide with concentrations of Latine people. For more information, please see the methodology in Health, Work, and Care in Rural America.