Access to Health Care: Urban‐Rural Comparisons from a Midwestern Agricultural State

Abstract

Lack of access to quality health care for a large number of Americans, particularly those living in rural areas, is a major health care problem. Differences in access between rural and urban areas are caused by obstacles to providing adequate care, such as hospital closures and physician shortages, and low income and/or employment that does not provide health insurance as an employee benefit. This study, based on a random sample of 6,000 households in Nebraska, finds that access to health care is better for residents of rural than urban areas. The relationship holds with controls for health status and health insurance. The pattern in Nebraska reflects an absence of differences in income, health insurance, and health status that produce differences in access between rural and urban areas nationwide. The findings suggest that any serious proposal to reform health care delivery should involve the states and use established patterns of seeking care among state residents.

Rural-Urban Differences in Usual Source of Care and Ambulatory Service Use

“…15, 16 Among nonelderly adults in Nebraska, rural residents were more likely than MSA residents to have a personal physician and made a greater number of physician visits. 17 In contrast, studies of the elderly found that the likelihood of having any outpatient event was greater in non-metropolitan than metropolitan places, 9 and the mean number of ambulatory visits was lower among residents of nonmetropolitan counties than large metropolitan core and fringe counties 16 or central city residents. 18 Rural-urban location is often measured dichotomously, by comparing residents of MSAs to those who live outside an MSA.…”

Profiles of Hospital, Physician, and Home Health Service Use by Older Persons in Rural Areas

“…Norton and McManus (1989) and Moscovice (1989) reported that Medicare beneficiaries in rural areas had more discharges per capita than urban residents, but recent studies show no significant differences in hospital use between urban and rural residents (Himes & Rutrough, 1994;Comer & Mueller, 1995). Rural hospitals, as compared to urban hospitals, have fewer beds (Moscovice, 1989), lower occupancy rates (Mick & Morlock, 1990) and shorter lengths of stay (Mick & Morlock, 1990).…”

“…Despite considerable improvements in health service delivery to rural communities, this question remains unanswered, in part due to conflicting reports on differences in health service use by rural and urban elderly persons (Comer & Mueller, 1995;Dubay, 1993;Himes & Rutrough, 1994;Kenney, 1993).…”

Stroke in Rural Areas and Small Communities

“…Similarly a study in Nebraska comparing urban and rural settings showed that access to health care in rural Nebraska was as good, if not better, than access to health care in urban parts of the same state. 48 …”