US Health Care Reform and Rural America: Results From the ACA's Medicaid Expansions

Benitez, Joseph; Seiber, Eric E.

doi:10.1111/jrh.12284

Cited by 33 publications

(31 citation statements)

References 41 publications

(46 reference statements)

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“…While expansion decreased the percentage of infants without health insurance overall in both rural and urban areas, it did so by a much smaller margin for rural infants. Despite resources from the ACA to address the needs of rural communities, rural/urban disparities in the percentages of households without health insurance persisted [13]. Differences in the percentage of rural/ urban households with insurance have been previously attributed to the fact that fewer rural than urban states had expanded Medicaid [12].…”

Section: Discussionmentioning

confidence: 99%

“…As such, rural residents stood to benefit significantly from the Medicaid expansion. Also, because of the long-standing disadvantages in access to care, coverage, and generally poorer health status among rural populations, the US Government-funded outreach programs that specifically targeted rural enrollment [13,14].…”

Section: The Medicaid Expansion and Barriers To Health Insurance Covementioning

confidence: 99%

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Infants without health insurance: Racial/ethnic and rural/urban disparities in infant households’ insurance coverage

Sanders¹,

Cope²,

Park³

et al. 2020

PLoS ONE

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Section: Discussionmentioning

confidence: 99%

Section: The Medicaid Expansion and Barriers To Health Insurance Covementioning

confidence: 99%

Infants without health insurance: Racial/ethnic and rural/urban disparities in infant households’ insurance coverage

Sanders¹,

Cope²,

Park³

et al. 2020

PLoS ONE

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“…Furthermore, increases in the percentage of people covered were found to be much greater in rural, compared to urban, settings [42]. Conceivably, rural Black residents of the Delta Region may have benefitted particularly strongly from the ACA, thereby resulting in decreased CRC mortality.…”

Section: Discussionmentioning

confidence: 98%

Racial Residential Segregation and Colorectal Cancer Mortality in the Mississippi Delta Region

Kruse-Diehr

McDaniel

Lewis‐Thames³

et al. 2020

Preprint

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Background Few studies have examined the effects of segregation on colorectal cancer (CRC) outcomes, and none has determined if rurality moderates the effect of segregation on CRC mortality. We examined whether the effect of segregation on CRC mortality was moderated by rurality in the Mississippi Delta Region, an economically distressed and historically segregated region of the United States. Methods Using data from the US Census Bureau and the Surveillance, Epidemiology, and End Results (SEER) program, we estimated linear mixed-effects models with state-level random effects in which Black and White CRC mortality rates in Delta Region counties (N = 252) were regressed on county rurality, White-Black residential segregation indices, an interaction term for these two variables, and a vector of socioeconomic control variables. Missing data were replaced with values generated via random forest imputation. Results Segregation was a risk factor for Black CRC mortality in urban Delta counties but was associated with lower Black CRC mortality in rural counties (B = − 23.30 [95% CI = − 38.51, − 7.92]). For Whites, living in a rural area did not moderate the relationship between segregation and CRC mortality, though White CRC mortality was inversely associated with White population proportion (B = − 7.12 [95% CI = − 10.66, − 3.43]). Conclusions Health outcomes related to segregation vary by racial, contextual and community factors. We give possible explanations for our findings and provide implications for practice and recommendations for further research to better understand the CRC mortality burden in segregated communities.

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“…Changes in the US financing and delivery system due to the Affordable Care Act (ACA) insurance expansion and delivery system changes and innovations have differentially impacted rural areas. Understanding differences in referral patterns between rural and urban areas over time is important.…”

Section: Introductionmentioning

confidence: 99%

Differences in referral patterns for rural primary care physicians from 2005 to 2016

Geissler

2019

Health Services Research

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| INTRODUC TI ONReferrals from primary care physicians (PCP) to specialists and among different specialists and subspecialists are important contributors to medical care costs and quality. 1,2 Referrals have increased over time, potentially due to the increased complexity of medical care 1 ;research shows PCP referral rates are stable within physician over time, but have significant variation across physicians. 4-6 Referrals contribute to appropriate medical care 1,4 ; better understanding current determinants of referrals and appropriate use is important for improving care delivery, particularly in medically underserved rural areas. 7,8 Access to care and availability of specialists are concerns in rural areas due to distance to providers and the nonrural location of many specialists. 7-10 This results in decreased specialist visits and an increased reliance on PCPs in rural areas. 11The ideal PCP referral rate within and across conditions to optimize patient care to provide the highest quality at the lowest cost is unknown. Referrals may be both over-and under-used by PCPs 12 ; referrals may generate excess spending and increase care fragmentation, but specialists have been shown to be more likely to Abstract Objective: To examine differences in referral patterns in a nationally representative sample between primary care physicians (PCP) practicing in rural vs nonrural areas and changes over time. Study Design: Using the 2005-2016 National Ambulatory Medical Care Survey and multivariate logit regression models, I compare referral patterns of PCPs in rural vs nonrural areas. Data Collection: Multiple years of data were combined.Principal Findings: A PCP visit was 1.9 percentage points (95% confidence interval: 0.1 pp, 3.8 pp) more likely to result in a referral in nonrural areas than rural areas, controlling for physician and patient characteristics, a 17 percent increase. This difference is driven by a widening gap in referral rates between nonrural and rural areas over time, with large differences in later periods. The regression-adjusted predicted probability of a PCP visit resulting in a referral was 71 percent higher in nonrural than rural areas in 2013-2014 and 92 percent higher in 2015-2016. Conclusions:Recognizing that the optimal PCP referral rate is unknown, referrals are less common in rural areas with a widening gap in recent years. This difference may reflect specialist availability, distance to care, or patient preferences. As changes occur to health care financing and delivery, continuing to monitor practice patterns is important to ensure patients are receiving appropriate levels of care across geographic regions. K E Y W O R D S ambulatory care, physician practice patterns, referrals, rural S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Geissler KH. Differences in referral patterns for rural primary care physicians from 2005 to 2016.Health Serv Res. 2020;55:94-102. https ://doi.

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US Health Care Reform and Rural America: Results From the ACA's Medicaid Expansions

Abstract: The ACA Medicaid expansions produced larger gains in coverage for rural residents than urban residents; however, it appears there remain opportunities to improve access to care among potentially vulnerable rural residents.

Cited by 33 publications

References 41 publications

Infants without health insurance: Racial/ethnic and rural/urban disparities in infant households’ insurance coverage

Infants without health insurance: Racial/ethnic and rural/urban disparities in infant households’ insurance coverage

Racial Residential Segregation and Colorectal Cancer Mortality in the Mississippi Delta Region

Differences in referral patterns for rural primary care physicians from 2005 to 2016

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