Rural Healthcare at a Crucial Point: Inclusive Design Can’t Wait
By Mats Delsing, MSc, Consulting Account Manager — September 23, 2025
Across the United States, rural communities are facing a growing crisis: mounting strain on local health systems and the steady loss of clinics. With Medicaid policy changes scheduled for 2027 and many providers already stretched thin by workforce shortages and tight reimbursement margins, rural healthcare access is becoming increasingly fragile.
For rural populations—often older, lower-income, and already managing higher rates of chronic illness—the stakes could not be higher. Besides Medicaid and Medicare being essential sources of health coverage for these communities, they also represent a vital share of income for rural hospitals and healthcare systems. With this revenue stream in jeopardy, rural clinics and other parts of the healthcare infrastructure are at risk of shutting down, endangering access to care for entire communities, regardless of insurance status.
The Costs of Short-Term Savings
Clinic closures exemplify how reduced access to healthcare due to short-term savings can create long-term consequences:
- Worsening health outcomes, as patients delay or go without essential care.
- Damage to local healthcare infrastructure, which is far harder to rebuild once lost.
- Widening disparities, particularly in communities already operating with little margin for loss.
The ripple effects extend well beyond individual patients. Entire communities feel the strain when access to care erodes, creating downstream costs for families, health systems, and society at large.
The Need for Inclusive Healthcare Design
Healthcare will always be in progress and never “finished.” From the design and implementation of exciting new initiatives to improve health and well-being, to coping with Medicaid and Medicare funding challenges: meeting the mark is complex and requires more than just technical expertise.
Periods of strain and urgency in healthcare expose and often exacerbate this truth: top-down decision-making lacks the input of those most directly affected. As we saw during the pandemic, when communities lack a seat at the table, policies risk being disconnected from lived realities, appearing sound on paper but missing the mark in practice.
Developing sustainable healthcare systems goes beyond financial models and professional expertise. It requires an inclusive approach. That means involving communities in shaping the solutions that affect their lives. Not only when drafting new policies, but also when making tough decisions to mitigate the damage of changes beyond our control.
As we are once again entering a time in which systems will face pressure, we need a broad array of perspectives to help communities and institutions weather difficult times as strongly as possible.
To protect, strengthen, and build systems that sustainably support equity in healthcare, rural community voices—as well as other voices whose health is most negatively affected by social determinants of health—must be part of the process. Policymakers, healthcare professionals, and advocates all have a responsibility to protect long-term health, despite short-term savings.
Looking Ahead
At Advancing Health Equity, we recognize sustainable, equitable progress requires co-creation: building policies and practices alongside communities, not just for them. Our health equity consulting centers around community-centered healthcare strategy, involving community engagement and co-ownership, ensuring that solutions are both effective and sustainable. As the saying goes, ‘Nothing about us, without us.’
Author note: Mats Delsing, MSc (he/him) serves as Consultant Account Manager at Advancing Health Equity. He is passionate about translating complex health concepts into clear, actionable insights that promote fairness in healthcare.