Understanding shortages of sufficient health care in rural areas

Background and purpose: Despite efforts to provide comprehensive health care services and reduce inequalities, most developed countries face serious challenges in achieving comprehensive health care delivery in rural areas. The purpose of this study is to characterize health care shortages in the rural areas of developed countries and to comprehensively explore the underlying reasons for these shortages. Methods and sample: To answer the research questions, we conducted a systematic literature review. The content analysis included 176 papers on the topic of rural health care. The thematic-analysis approach revealed key aspects of health care shortages in rural areas and evidence regarding the reasons for these shortages. Findings and conclusion: Shortages of sufficient health care in rural areas were clustered into the following five categories: provider shortages, maldistribution, quality deficiencies, access limitations and the inefficient utilization of health care services. The reasons for the occurrence of these shortage problems are manifold and are related to physical/infrastructural, professional, educational, social cultural, economic and political issues. This paper contributes to a comprehensive understanding of the health care problems in rural areas by creating an integrated framework that examines several aspects of shortages in sufficient health care in rural areas as well as their underlying reasons. The results provide directions for future research and specific advice for policy makers. (C) 2014 Elsevier Ireland Ltd. All rights reserved.