U.S. cities are home to 62.7% of the American population, according to the U.S. Census Bureau. This number is expected to grow to 87.4% by 2050, according to data and projections by the United Nations Department of Economic and Social Affairs.
Justin Brasell, BBA, MBA, executive vice president, Transwestern, a real estate services firm, cites a variety of reasons for the influx to urban areas. Cities often have higher-paying jobs, public transportation, and top-notch entertainment, food, higher education, and healthcare. Additionally, specialized workforces are emerging in large, urban populations as demand grows for top expertise in specific fields. For example, Houston attracts specialization related to the energy sector, while San Francisco talent is focused on technology.
“As the population ages, there is not only a desire but also a necessity to be in closer proximity to people and resources,” says Andrew Renda, MD, MPH, director, office of the chief medical officer, Humana.
Furthermore, Henry W. Osowski, managing partner, Strategic Health Group LLC, which advises health plans and system leaderships, says increasing mechanization, automation, and innovation in the agriculture sector is decreasing the number of workers required to sustain agricultural production in rural areas.
Positive effects on healthcare
Healthcare organizations in urban environments have several advantages over those based in rural areas. High volume in healthcare for certain services is correlated to greater quality, says L. Allen Dobson Jr, MD, president and CEO, Community Care of North Carolina, Inc., an organization dedicated to improving community-based primary care delivery systems. “The more times a specialist performs a specific procedure, the better the expert becomes in providing it,” he says. Having a greater volume of potential patients is especially important for services that require expensive equipment and overhead, (e.g., diagnostic imaging, operating rooms, and laboratories).
Because urban areas have a more diverse population, they also have a higher representation of younger, healthier, and more affluent residents, Dobson says. “This population has a higher percentage of private sector insurance coverage, which pays higher rates than public programs such as Medicare and Medicaid. A broader payer mix coupled with the basic economic and lifestyle advantages of an urban area is attractive to many physicians and other healthcare professionals.”
Along these lines, Osowski says, “The benefits of an urban environment will likely provide a continuing source of trained professional employees at a time when manpower shortages threaten the efficient delivery of healthcare in some communities.”
From a patient perspective, access to primary care, preventive care, and community resources tends to be better in urban areas, which increases the likelihood of completing annual wellness visits, receiving regular care, and monitoring chronic conditions. “This, in turn, likely leads to better health outcomes and a lower total cost of care,” Renda says.
Movement to urban areas means more people are accounted for when healthcare systems complete community needs assessments. This enables more social determinant needs, such as food insecurity and public transportation, to be addressed for more people, says Renda.
As the population shift continues to increase demand in cities, urban health systems and providers will have both the opportunity and challenge of winning patient business and loyalty by decreasing wait times, increasing price transparency, optimizing patient scheduling, and providing convenient access, Brasell says.