System- and Individual-Level Barriers to Accessing Medical Care Services Across the Rural-Urban Spectrum, Washington State

Background: Residents of rural areas face barriers beyond geography and distance when accessing medical care services. The purpose of this study was to characterize medical care access barriers across several commonly used classifications of rurality. Methods: Washington State household residents completed a mixed-mode (paper/online) health care access survey between June 2018 and December 2019 administered to a stratified random sample of ZIP codes classified as urban, suburban, large rural, and small rural (4-tier scheme). For analyses, rurality was also classified into 2-tier schemes (rural/urban) based on ZIP code and county. Respondents reported availability of medical care services and system- and individual-level barriers to accessing services. Logistic regression models estimated the odds of reporting system- or individual-level barriers in accessing medical care services across rurality (4- and 2-tier schemes), adjusting for respondent characteristics, and weighted to account for survey design. Results: About 617 households completed the survey (25.7% response rate). Compared to urban residents (across all 3 schemes), more rural residents reported traveling to a distant city or town for medical care (P < .001). Rurality was significantly associated with increased odds of facing system-level barriers. Respondents from small rural areas had greater odds access barriers for primary care (OR 7.31, 95% CI 1.84-29.09) and having no primary care provider (OR 11.37, 95% CI 3.03-42.75) compared to urban respondents. Individual-level barriers were not associated with rurality. Conclusions: To improve healthcare access across the rural-urban spectrum, policymakers must consider system-level barriers facing rural populations.

[1]  N. McDonald,et al.  Addressing transportation barriers to health care during the COVID-19 pandemic: Perspectives of care coordinators , 2022, Transportation Research Part A: Policy and Practice.

[2]  L. Bierut,et al.  Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system , 2022, PloS one.

[3]  N. Bell,et al.  Geographic, racial/ethnic, and socioeconomic inequities in broadband access. , 2021, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[4]  Yendelela L. Cuffee,et al.  Telehealth Interventions and Outcomes Across Rural Communities in the United States: Narrative Review , 2021, Journal of medical Internet research.

[5]  E. Hawes,et al.  Rural Residency Training as a Strategy to Address Rural Health Disparities: Barriers to Expansion and Possible Solutions. , 2021, Journal of graduate medical education.

[6]  J. Graves,et al.  Disparities in Technology and Broadband Internet Access Across Rurality , 2021, Family & community health.

[7]  M. Zimmerman,et al.  Patient satisfaction with partial hospital telehealth treatment during the COVID-19 pandemic: Comparison to in-person treatment , 2021, Psychiatry Research.

[8]  Daniel Davis,et al.  Urban-rural Differences in Visits to Office-based Physicians by Adults With Hypertension: United States, 2014-2016. , 2020, National health statistics reports.

[9]  R. Vasan,et al.  The southern rural health and mortality penalty: A review of regional health inequities in the United States. , 2020, Social science & medicine.

[10]  R. Griffin,et al.  Impact of Rural Hospital Closures on Health-Care Access. , 2020, The Journal of surgical research.

[11]  P. Groeneveld,et al.  Income Disparities In Access To Critical Care Services. , 2020, Health affairs.

[12]  J. Graves,et al.  Barriers to Telemedicine Implementation in Southwest Tribal Communities During COVID‐19 , 2020, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[13]  G. Anderson,et al.  Varying Trends In The Financial Viability Of US Rural Hospitals, 2011-17. , 2020, Health affairs.

[14]  K. R. Yabroff,et al.  Rural-Urban Differences in Access to Primary Care: Beyond the Usual Source of Care Provider. , 2020, American journal of preventive medicine.

[15]  N. Mohr,et al.  Perceptions and Perceived Utility of Rural Emergency Department Telemedicine Services: A Needs Assessment. , 2020, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[16]  K. Bennett,et al.  What Is Rural? Challenges And Implications Of Definitions That Inadequately Encompass Rural People And Places. , 2019, Health affairs.

[17]  J. Benneyan,et al.  Access to specialty healthcare in urban versus rural US populations: a systematic literature review , 2019, BMC health services research.

[18]  Esther M. Friedman,et al.  Rural-Urban Disparities in Access to Home- and Community-Based Services and Supports: Stakeholder Perspectives From 14 States. , 2019, Journal of the American Medical Directors Association.

[19]  A. Coburn,et al.  Patterns of Telehealth Use Among Rural Medicaid Beneficiaries. , 2018, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[20]  R. Lindrooth,et al.  Understanding The Relationship Between Medicaid Expansions And Hospital Closures. , 2018, Health affairs.

[21]  K. Call,et al.  Rural‐Urban Differences in Access to Preventive Health Care Among Publicly Insured Minnesotans , 2017, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[22]  I. Moscovice,et al.  Geographic variation in transportation concerns and adaptations to travel-limiting health conditions in the United States , 2017 .

[23]  V. Amelung,et al.  Patients’ preferences for primary health care – a systematic literature review of discrete choice experiments , 2017, BMC Health Services Research.

[24]  Steven A. Cohen,et al.  A Closer Look at Rural‐Urban Health Disparities: Associations Between Obesity and Rurality Vary by Geospatial and Sociodemographic Factors , 2017, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[25]  J. Munson,et al.  Residence in Rural Areas of the United States and Lung Cancer Mortality. Disease Incidence, Treatment Disparities, and Stage‐Specific Survival , 2017, Annals of the American Thoracic Society.

[26]  C. Ford,et al.  Intersection of Living in a Rural Versus Urban Area and Race/Ethnicity in Explaining Access to Health Care in the United States. , 2016, American journal of public health.

[27]  M. Haas,et al.  Community preferences in general practice: important factors for choosing a general practitioner , 2016, Health expectations : an international journal of public participation in health care and health policy.

[28]  Daniel M. Saman,et al.  A cross-sectional study on health differences between rural and non-rural U.S. counties using the County Health Rankings , 2015, BMC Health Services Research.

[29]  J. Bolin,et al.  Rural Healthy People 2020: New Decade, Same Challenges. , 2015, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[30]  T. Dwolatzky,et al.  Exposing some important barriers to health care access in the rural USA. , 2015, Public health.

[31]  W. James.  All rural places are not created equal: revisiting the rural mortality penalty in the United States. , 2014, American journal of public health.

[32]  A. Hayanga,et al.  Rural-Urban Differences in Access to Specialist Providers of Colorectal Cancer Care in the United States: A Physician Workforce Issue. , 2014, JAMA surgery.

[33]  A. Bazemore,et al.  Migration after family medicine residency: 56% of graduates practice within 100 miles of training. , 2013, American family physician.

[34]  G. Wellenius,et al.  Rural-urban disparities in the prevalence of diabetes and coronary heart disease. , 2012, Public health.

[35]  J. Bolin,et al.  Rural Healthy People 2010, 2020, and beyond: the need goes on. , 2011, Family & community health.

[36]  M. MacDowell,et al.  A national view of rural health workforce issues in the USA. , 2010, Rural and remote health.

[37]  S. Krishna,et al.  Diabetes burden and access to preventive care in the rural United States. , 2010, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[38]  P. Bower,et al.  What are the key attributes of primary care for patients? Building a conceptual ‘map’ of patient preferences , 2006, Health expectations : an international journal of public participation in health care and health policy.

[39]  L. Chan,et al.  Geographic access to health care for rural Medicare beneficiaries. , 2006, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[40]  John Spencer,et al.  The effects of geography and spatial behavior on health care utilization among the residents of a rural region. , 2005, Health services research.

[41]  J. Fleishman,et al.  Rural‐Urban Differences in Usual Source of Care and Ambulatory Service Use: Analyses of National Data Using Urban Influence Codes , 2003, Medical care.

[42]  L. Wyszewiański,et al.  Access to care: remembering old lessons. , 2002, Health services research.

[43]  M. Casey,et al.  Are rural residents less likely to obtain recommended preventive healthcare services? , 2001, American journal of preventive medicine.