Availability and Accessibility of Rural Health Care*

Hicks, Lanis L.

doi:10.1111/j.1748-0361.1990.tb00684.x

Cited by 55 publications

(35 citation statements)

References 27 publications

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“…Compared with urban residents, rural residents are more likely to lack health insurance 1,2-4 and may travel long distances to obtain care. 1,[5][6][7] Rural residents tend to be older, poorer, and in worse health than urban residents, 8,9 and these characteristics may affect health care access and utilization. Supply-side issues, such as fewer physicians and hospitals in rural settings, may also play a role in limiting access or utilization of services.…”

mentioning

confidence: 98%

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

2003

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Results suggest that using rural and urban definitions that go beyond the traditional dichotomy of metropolitan and non-metropolitan may assist policymakers and researchers in identifying types of places where there is a disparity in access and subsequent utilization of health care. Rural residents, defined as totally rural in the urban influence coding scheme, may report having a health care provider but report fewer visits to health care providers during a year.

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confidence: 98%

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

2003

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“…18 Because of geographic (physical distance) and socio-organizational (who the person sees upon entry into the system) characteristics of the health care service system, entrance into the system for individuals with SCD who live in rural areas may not be "reachable, obtainable, or affordable." 19,20 An estimated 45% of adults with SCD in Alabama live in rural areas.…”

Section: Sickle Cell Client Experiencementioning

confidence: 99%

Rural/Urban Differences in Access to and Utilization of Services Among People in Alabama with Sickle Cell Disease

Telfair

Haque²,

Etienne³

et al. 2003

Public Health Reports

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Objective. This study examined relationships between socioeconomic factors and the geographic distribution of 662 cases of sickle cell disease in Alabama in 1999-2001.Methods. Measures of community distress, physical functioning, and medical problems were used in analyzing utilization differences between individuals with sickle cell disease living in urban and rural areas.Results. Utilization of comprehensive sickle cells disease services was lower for individuals with sickle cell disease living in rural areas than for those living in urban areas. Rural clients reported significantly more limitations than urban clients on several measures of physical functioning. The results also suggest that utilization of services was higher for those with more medical problems and those who lived in high distress areas, although these findings did not meet the criterion for statistical significance.Conclusions. Conclusions based on statistical evidence that geographic location and socioeconomic factors relate to significantly different health care service experience bear important implications for medical and health care support systems, especially on the community level.

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“…Numerous studies have shown that an adequate primary care physician supply correlates with a variety of positive population health outcomes including lower mortality rates (Farmer et al 1991; Shi and Starfield 2001; Shi et al 2003), earlier cancer detection (Roetzheim et al 2000), and better birth outcomes (Nesbitt et al 1997; Vogel and Ackermann 1998). It is widely assumed, but with much less evidence, that where there are more primary care physicians people's access to outpatient medical care also is better (Hicks 1990; Patrick et al 1988). The presumed link between an adequate primary care physician presence and access is a fundamental rationale for the many federal and state provider safety net programs, like the Title VII initiatives that support primary care physician training, the National Health Service Corps which entices physicians to needy areas with financial support for their training expenses, and Medicare's Incentive Payment Program for physicians in underserved areas (Berk, Bernstein, and Taylor 1983; GAO 1995; Grumbach, Vranizan, and Bindman 1997).…”

mentioning

confidence: 99%

How Adults' Access to Outpatient Physician Services Relates to the Local Supply of Primary Care Physicians in the Rural Southeast

Pathman¹,

Ricketts²,

Konrad³

2005

Health Services Research

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Objective. To examine how access to outpatient medical care varies with local primary care physician densities across primary care service areas (PCSAs) in the rural Southeast, for adults as a whole and separately for the elderly and poor. Data Sources. Access data from a 2002 to 2003 telephone survey of 4,311 adults living in 298 PCSAs within 150 rural counties in eight Southeastern states were linked geographically with physician practice location data from the American Medical and American Osteopathic Associations and population data from the U.S. Census. Study Design. In a cross‐sectional study design, we used a series of logistic regression models to assess how 26 measures of various aspects of access to outpatient physician services varied for subjects arranged into five groups based on the population‐per‐physician ratios of the PCSAs where they lived. Principal Findings. Among adults as a whole, more individuals reported traveling over 30 minutes for outpatient care in PCSAs with more than 3,500 people per physician than in PCSAs with fewer than 1,500 people per physician (39.1 versus 18.5 percent, p<.001) and more reported travel difficulties. Otherwise, PCSA density of primary care physicians was unrelated to reported barriers to care, unrelated to people's satisfaction with care, and unrelated to indicators of people's use of services. Use rates of six recommended preventive health services varied in no consistent direction with physician densities. Among the elderly, only the proportion traveling over 30 minutes for care was greater in areas with lowest physician densities. Among subjects covered under Medicaid or uninsured, lower local physician densities were associated with longer travel time, difficulties with travel and reaching one's physician by phone, and two areas of dissatisfaction with care. Conclusions. For adults as a whole in the rural South and for the elderly there, low local primary care physician densities are associated with travel inconvenience but not convincingly with other aspects of access to outpatient care. Access for those insured under Medicaid and the uninsured, however, is in more ways sensitive to local physician densities.

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Availability and Accessibility of Rural Health Care*

Cited by 55 publications

References 27 publications

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

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

Rural/Urban Differences in Access to and Utilization of Services Among People in Alabama with Sickle Cell Disease

How Adults' Access to Outpatient Physician Services Relates to the Local Supply of Primary Care Physicians in the Rural Southeast

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