Rural Virginians Must Travel Long Distances to Hospital-Based Health Care Services

As the Virginia legislature considers enacting paid family and medical leave legislation in 2023, it is clear that rural Virginians — about 12 percent of the commonwealth's population inhabiting about 46 percent of its land — have a particularly acute need for paid leave. The legislative action Virginia took in 2022, which authorized the State Corporation Commission to approve private insurers' sale of private, voluntary paid leave insurance products to employers that choose to purchase it, has not resulted in new access to paid family and medical leave for Virginia's workers and families. The option for employers to buy insurance is not a substitute for guaranteed access to this essential support for workers and businesses alike.

The most rural parts of Virginia, including much of the Eastern part of the commonwealth and parts of Southside, tend to have higher shares of residents of color. Rural communities also have households with lower median incomes and higher poverty rates, and residents with lower levels of education, than other parts of the commonwealth, which means more hardships when family and medical needs arise. Virginia's rural people, communities, and economies will be stronger and more competitive — both within the state and with neighboring states that have adopted paid leave programs — if the commonwealth adopts a comprehensive, inclusive paid family and medical leave program.

Access to Paid Leave

Overall, less than one-quarter of private-sector workers nationwide (24 percent) — and just 22 percent of workers in the South Atlantic region, which includes Virginia — have paid family leave through their jobs, according to the Bureau of Labor Statistics. In Virginia, even job-protected unpaid leave is available and accessible to only an estimated 45 percent of workers and just 40 percent of parents with children under 18, according to researchers from Brandeis University; Black workers and parents (43 percent and 36 percent, respectively) and Latine workers (33 percent and 25 percent, respectively) in Virginia are even less likely than workers overall to have available, accessible unpaid leave.

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.

Lack of access to paid leave can force 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 specific types of hospital-based health care services. We found that people in rural communities must travel three to five times as far as people in urban areas to hospital-based care. [1]

New state data analysis augments our national findings: Rural Virginians must travel an average of two-and-a-half to nearly five times further than Virginians in metropolitan areas to seek six essential types of hospital-based health care services. Rural census tracts are an average of 52 miles from NICU/neonatal services, 35 miles from hospital-based pediatric services, and 20 to 28 miles away from hospital-based obstetrics care, cardiology/cardiac care, cancer screening and cancer treatment. In contrast, urban census tracts are an average of 11 miles from a NICU, 13 miles from hospital-based pediatric care, and nine miles or less from obstetrics, cancer screening and treatment and cardiac care.

Interestingly, median distances from urban areas to hospital-based care are even shorter, just six to seven miles to obstetrics, NICU, cancer screening and treatment and cardiac care, and 10 miles to pediatric care. The difference between median and average distances reflect variations in urban-dwellers' proximity, with residents in outlying urban areas facing atypically long distances.

All rural Virginians, regardless of race or poverty status, face equally long distances to hospital-based care. Within rural Virginia, there are no significant distance disparities between all census tracts and those that have high shares of Black, Latine, AAPI, Native, or persistently poor residents.

Implications: Paid Leave Will Strengthen Rural Virginia

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 and unemployment higher than in other communities, where health disparities are significant, and where caregiving needs are higher due to the aging of the population and higher rates of people with disabilities.

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.

As Virginia considers joining a dozen other jurisdictions — including regional competitors Maryland, Delaware and the District of Columbia — in passing a comprehensive, inclusive statewide paid family and medical leave program, this analysis provides further evidence that there is a rural economic, health, business and competitiveness imperative for paid leave.

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 Virginia hospital-distance data analysis used in this blog.

[1] 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.