Rural Minnesotans Must Travel Long Distances for Hospital-Based Health Care

As the Minnesota legislature considers enacting paid family and medical leave legislation in 2023, it is clear that rural Minnesotans — more than one-quarter of the state's population — have a particularly acute need for paid leave. Rural people, communities, and economies will be stronger with a comprehensive, inclusive paid family and medical leave program in place.

Access to Paid Leave

Overall, less than one-quarter of private-sector workers nationwide (24 percent) — and just one-fifth of private-sector workers in the Midwest (20 percent) — have paid family leave through their jobs, according to the Bureau of Labor Statistics. In Minnesota, even job-protected unpaid leave is available and accessible to only an estimated 40 percent of workers, according to researchers from Brandeis University.

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 Minnesotans must travel an average of three to six times further than Minnesotans in metropolitan areas to seek six essential types of hospital-based health care services. Rural census tracts are an average of 20-30 miles away from hospital-based obstetrics care, pediatric care, cardiology/cardiac care, cancer screening and cancer treatment, and a whopping 60 miles away, on average, from NICU/neonatal services. In contrast, urban census tracts are typically less than 10 miles away from each of these types of hospital-based health care services.

Native Americans and people in areas of high persistent poverty in Minnesota's rural communities are at particular disadvantages: The rural census tracts in which Native American Minnesotans are concentrated and the census tracts with high concentrations of persistent poverty are 20 percent further than other rural areas to hospital-based cancer screening, cancer treatment, and obstetrics services. Native American Minnesotans tend to be in census tracts that are also further from cardiology services. [2] Nationally, people who live in poverty and Native people are among those with less access to paid leave of any kind that can be used for personal or family health needs or to care for a new child.

Implications: Paid Leave Will Strengthen Rural Minnesota

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 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 Minnesota considers joining 11 states and the District of Columbia in passing a comprehensive, inclusive statewide paid leave program, there is a rural economic and health 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 Minnesota 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.

[2] Census tracts in this subgroup analysis are those that fall into the top 10 percent of census tracts nationwide with concentrations of Native American/Pacific Islanders and, separately, into the top 10 percent of census tracts that are considered "persistently poor" (those with 20 percent of the population in poverty in four decennial censuses in 1980, 1990, 2000 and 2010). For more information, please see the methodology in Health, Work, and Care in Rural America.