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Maine Rural Health Research Center

Research & Policy Brief June 2009

Fast Facts

Rural residents are morelikely than urban residentsto have a usual sourceof health care (USC),particularly the rural versusurban uninsured.

Rural residents aresomewhat more likely toreport long travel times to

reach their USC and havegreater dif culty gettingcare after hours.

While rural access tocare is not uniformly worsethan urban access, theburden on rural providersin delivering this care maybe high, especially sincerural physicians are twiceas likely to work in solopractices.

Authors

Erika Ziller, MSJennifer Lenardson, MHS

For more information about thisstudy, contact Erika Ziller at(207) 780-4615 oreziller@usm.maine.edu

Rural-Urban Differences in Health Care AccessVary Across Measures

Introduction

R a n n d at a g t an an,1 and t n n d t n a d ty ta n ng n d d a .2 D t t ng and ta n ng a t a p d

a t d n ng tand ng d pa t n a and an p y an pp y.3 Tm nat n a t gg t t at a d nt may a g at a t a nga t a t an t an nt pa t . Ana y data m t 2006 M d a

Exp nd t Pan S y (MEPS) n n- d y a and an d nt pa t y pp t t p m , y t a d nt a tt n m m a a .

Rural Residents More Likely to Have Usual Source of Care

Ha ng a g a p d ( a a , USC) m w m n a ta a mm n m a a t a a . R a nd at t at a ng

a USC n t many a t t at n a t p ntat a andd a a ng nm t a t n d .5

A wn n F g 1, 83% a d nt nd ag 65 a a USC and tp p t n g t an n an a a (79%). T USC m t mm n y ap y an a t g a ma p ntag t a and an nd d a d nt y

p ta and/ m g n y m a t USC (data n t wn). In p ng w t pa ,6 t n n d a m y t a a USC y t n n d a d nt

a gn ant y m y t p t a ng a USC t an an (57% 47%).

83

57

79

47

0%

20%

40%

60%

80%

100%

All, Has a Usual Source of Care Uninsured, Has a Usual Source of Care

Rural Urban

Figure 1: Usual Source of CareUnder Age 65

USC differences by residence significant at p

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Rural Residents More Likely to Have Dif cultyAccessing Usual Source of Care

E d n gg t t at t t a t m t a a t ap d an ad y af t a p n a ty t at at p d , p a y am ng t n d ng p a ty

a .7 A F g 2 d m n t at , a d nt am w at m y t t a m t an 30 m n t t

t USC (13% a n n- d y d nt mpa dt 10%).

T n a - an d f n n t p ntag nd d a t at p t d ty a ng t USC

p d y t p n (a t 16%). H w , ad nt a m m y t a t a ng

t USC p d t d n ma (37% 29% an). T y at d t t a t t at

a p y an a tw a y t w n p a ta t an nt pa t (29% 15%),8 wma p d ng 24- ag a ng ng.

Some Preventive Care Services are LessCommonly Used by Rural Residents

U p nt a n nd at at a t a and a mp n nt d n H a t aEf t n Data & In mat n S t (HEDIS) m a

a .9 D p t ng m y t a a USC, aad t a m w at y t ta n p nt

a t an a an ad t . F xamp , n y 80% a ad t nd ag 65 a ad a p y a xam

n t pa t y a mpa d t 84% an d nt

(F g 3). S m a y, n y 69% ad t n a a ap t d ng a t w t n t pa t y a , 74% n an a a .

F t p nt a , a d nt a a y a t an nt pa t t a . In pa t a ,

a w m n nd ag 65 p t ng pap m a , a txam and mamm g am w t t am p d ty a an

w m n. It n a w y a d nt a m p y m typ p nt a and n t t .

Policy Implications

A t g a a a a w p y an t p p at n att an an a a ,10 a d nt a m y t a a

a a t a (USC). T may a n t n a d nt a ng m m t d a t a pt n and

t ng m y t a n a p d .

W a ng a USC a n t t a d nt , t d n p d ng a may g a p d , p a y

w n t y a w pt n a ng t nan a andg t a t t at ng t n/ nd n d. R a

p y an w ng and m pat nt t an

an p y an11 and t t xt nt t at t nt td at a t n w t t p a t , may xa

a p y an tm nt and t nt n.12

T d mand n a p y an , m n d w t td ng n p a t , may xp a

d nt a m m d ty a ng ta t . It a t at t mp tan

a t a , a C t a A

a a a t p d g nt a t p n t.

A t g t a t a USC m w at ng t d f n wa ma t an m g t xp t d

mp tant t n t t at w d a ng m an mpa a a a a , and t m t a

d f n am ng a mm n t t at a and ap and p d a a a ty.13 T , m y m

a a a may a w n t m a (a wnn - ty an a a ). F na y, w a a

n t at g a y w t an an a a

1316

37

10

17

29

0%

10%

20%

30%

40%

Travel Time Exceeds 30Minutes

Phone Access isVery/Somewhat Difficult

After Hours Access isVery/Somewhat Difficult

Rural Urban

Figure 2: Access Barriers to Usual Source of CareUnder Age 65

Access differences by residence significant for travel time and after hours at p

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data, t nd n t a a t a w gg t t att d ang . F xamp , nt d n nd att at a g at p p t n a t an an p ma y ap y an a n a ng t m nt ag , pa t a y n m

m t a mm n t .14 C m n d w t t a ng tm nt and t nt n n t a a t a

w , t gg t t at a a t p d w wa ant a m n t ng n t t .

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S t n Ma n , M S P S , Ma n R a H a tR a C nt ; 2009.

2) Ayan an JZ, W man JS, S n d EC, G n g JA, Za a y AM.Unm t H a t N d Un n d Ad t n t Un t d Stat . JAMA. 2000;284:2061-2069.

3) G n a A nt ng OPhysician Work orce: Physician Supply Increased in Metropolitan and Nonmetropolitan Areas but Geographic Disparities Persisted.Wa ngt n, DC: G n a A nt ng O ; 2003.

4) D V JE, F y GE, P p R, G n L. R pt P nt Ca Am ng Ad t : In an Stat and U a S Ca . American Journal o Public Health.2003;93:786-791.

5) N wa PW, H g DC, H ng Y-Y, W ng S, St dda d JJ. TUnm t H a t N d Am a C d n.Pediatrics.2000;105:989-997.

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146.

8) G man P. In mat n n d n p ma y a : a y n n a p ma y a p y an (C apt 5). Pat VL, RHa x R Medin o 2001: Proceedings o the 10th World Congress on 2001:338-349.

9) Nat na C mm tt Q a ty A an .HEDIS 2008: HealthcareE ectiveness Data & In ormation Set. Vol. 2, echnical Speci cation

Wa ngt n, DC: Nat na C mm tt Q a ty A an

10) R n att RA, Ha t LG. P y an and a Am a. I, Ed. Rural Health in the United States.N w Y , NY: Ox d Un

P ; 1999:38-51.

11) W WB, Wa a AE. R a -U an D f n n PP y an P a t Patt n , C a a t t , and In m Journal o Rural Health.2008, Sp ng; 24:161-170.

12) B , M, F dman, J, S C., and G pta J.Satis action WithPractice and Decision to Relocate: an Examination o Rural Physicia B t da, MD: Wa C nt R a H a t Ana y ; Ma

13) Ha t GL, La n, EH, and L n , DM R a d n t n p y and a . American Journal o Public Health2005;95(7):1149-55.

14) D MP, F dy MA, S man SM.Te Aging o the PrimaryCare Physician Work orce: Are Rural Locations Vulnerable? P y BS att , WA: WWAMI R a H a t R a C nt , Un

Wa ngt n; J n 2009.

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