Rural‐Urban Differences in Access to Preventive Health Care Among Publicly Insured Minnesotans

John Loftus · Elizabeth M. Allen · Kathleen Thiede Call · Susan A. Everson‐Rose

80 citations0/0 files storedThe Journal of Rural Health

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Healthcare Policy and Management Healthcare Quality and Satisfaction Public Health and Social Inequalities

Abstract

PURPOSE: Reduced access to care and barriers have been shown in rural populations and in publicly insured populations. Barriers limiting health care access in publicly insured populations living in rural areas are not understood. This study investigates rural-urban differences in system-, provider-, and individual-level barriers and access to preventive care among adults and children enrolled in a public insurance program in Minnesota. METHODS: This was a secondary analysis of a 2008 statewide, cross-sectional survey of publicly insured adults and children (n = 4,388) investigating barriers associated with low utilization of preventive care. Sampling was stratified with oversampling of racial/ethnic minorities. RESULTS: Rural enrollees were more likely to report no past year preventive care compared to urban enrollees. However, this difference was no longer statistically significant after controlling for demographic and socioeconomic factors (OR: 1.37, 95% CI: 1.00-1.88). Provider- and system-level barriers associated with low use of preventive care among rural enrollees included discrimination based on public insurance status (OR: 2.26, 95% CI: 1.34-2.38), cost of care concerns (OR: 1.72, 95% CI: 1.03-2.89) and uncertainty about care being covered by insurance (OR: 1.70, 95% CI: 1.01-2.85). These and additional provider-level barriers were also identified among urban enrollees. CONCLUSIONS: Discrimination, cost of care, and uncertainty about insurance coverage inhibit access in both the rural and urban samples. These barriers are worthy targets of interventions for publicly insured populations regardless of residence. Future studies should investigate additional factors associated with access disparities based on rural-urban residence.

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References

2004Rural Health Disparities, Population Health, and Rural Culture 1993Access to Health Care in America 2012In 2011 Nearly One-Third Of Physicians Said They Would Not Accept New Medicaid Patients, But Rising Fees May Help 2006Perceived discrimination and use of preventive health services 2005Perceived discrimination and reported delay of pharmacy prescriptions and medical tests 2004Delays and Unmet Need for Health Care Among Adult Primary Care Patients in a Restructured Urban Public Health System 2001Barriers to healthcare access in a non-elderly urban poor American population 2010Practicing Preventive Health: The Underlying Culture Among Low-Income Rural Populations

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