Rural Residents More Likely To Have Usual Source of Care, Less Likely To Get Care From Physician

While their health is poorer, rural Americans are more likely to have a usual source of care than people living in metropolitan areas, according to an AHRQ-funded study in the American Journal of Preventive Medicine. However, usual sources of care in rural areas are less likely to be physicians and are less likely to be available at night and on weekends. Researchers examined MEPS data on about 52,000 rural and metropolitan patients. Respondents in rural areas were 5 percentage points more likely to have a usual source of care than residents in metropolitan areas, but were 13 percentage points less likely to have a usual source of care who was a physician and 11 percentage points less likely to have an individual provider as a usual source of care, relying instead on a clinic or other facility. Usual sources of care in rural areas were 18 percentage points less likely to offer night and weekend hours. Researchers concluded future studies should look beyond having a usual source of care as the sole indicator of primary care access. Access the abstract.

2020 Jan;58(1):89-96. doi: 10.1016/j.amepre.2019.08.026.

Rural-Urban Differences in Access to Primary Care: Beyond the Usual Source of Care Provider.

Kirby JB1, Yabroff KR2.

Author information

1: Agency for Healthcare Research and Quality, Center for Financing, Access, and Cost Trends, Rockville, Maryland. Electronic address: james.kirby@ahrq.hhs.gov.
2: American Cancer Society, Atlanta, Georgia.

Abstract

INTRODUCTION:

In the U.S., rural residents have poorer health than urban residents and this disadvantage is growing. Therefore, it is important to understand rural-urban differences in access to medical care. This study compared the percentage of individuals with a usual source of care and characteristics of usual source of care providers across 3 urban-rural categories.

METHODS:

This study identified 51,920 adults from the 2014-2016 Medical Expenditure Panel Survey and estimated the percentage with a usual source of care across the rural-urban categories. Then, differences in a variety of provider characteristics were examined. Estimates were weighted to be representative of the U.S. non-institutionalized population and adjusted for age, race/ethnicity, self-rated health, and presence of chronic conditions. Analysis was conducted in 2018 and 2019.

RESULTS:

Compared with metropolitan county residents, residents of the most rural counties were 7 percentage points more likely to have a usual source of care (81% vs 74%), but their providers were 13 percentage points less likely to be physicians (22% vs 35%). Despite having to travel longer to reach their usual source of care providers, residents of the most rural counties were 18 percentage points less likely than metropolitan residents to have usual source of care providers with office hours on nights and weekends (27% vs 39%).

CONCLUSIONS:

Rural-urban differences in access to care are complex; there is a rural disadvantage on some dimensions of access but not others. To understand rural-urban disparities in healthcare access, research should move beyond the usual source of care provider as an overall indicator and instead investigate disparities using multiple indicators of access based on theoretically distinct domains.

Published by Elsevier Inc.