Rural Health

What constitutes rural in healthcare depends on the definition being used for rurality, and that is sometimes dependent on the type of healthcare being delivered. There currently is no consensus definition of what rural is in the United States, either for health or for other policy domains. Since 1910, the U.S. Census Bureau has used a threshold of 2,500 people living in an incorporated place as its definition of rural; that definition remains in place today, but it is seldom used except for classification purposes in the census. A more widely used and recognized definition is the “metropolitan” designation process developed by the U.S. Office of Management and Budget (OMB), the White House office responsible for devising and submitting the president's annual budget proposal to Congress. The OMB classifies counties as metropolitan if they include a central city of at least 50,000 people or contain an urban cluster of that size or if they are closely tied to central metropolitan counties by commuting or economic trade patterns. The OMB originally identified only metropolitan counties but later designated core and other metro counties. In 2000, the nonmetropolitan counties with small urban centers were classified as “micropolitan.” The U.S. Department of Agriculture (USDA) has created several different classifications of nonmetropolitan counties (non-Core Based Statistical Areas, functional regions based around an urban center of at least 10,000 people) that are often used to scale the degree of rurality of counties. These include the Rural Continuum Code and the Urban Influence Codes. An alternative, fine-grained classification system based largely on commuting patterns, the Rural Urban Commuting Areas (RUCA) codes, is based on clusters of census blocks or block groups; it has been adapted to apply to U.S. Postal Service ZIP [Page 1055]code areas. Federal and state policies that apply to health programs and regulations often specify one or more of these classification systems to guide the allocation of funds or application of rules to rural communities and populations.