Definition and categorization of “rural” and evaluation of access to care

This article was originally published here

Health Serv Res. 2022 Feb 11. doi: 10.1111/1475-6773.13951. Online ahead of print.


OBJECTIVE: To examine how three measures of actual access to care vary across definitions and categorizations of ‘rural’.

DATA SOURCES: Data from the National Health Information Trends Survey (HINTS), a nationally representative survey assessing knowledge of health information, were used. Participants were categorized by county-based Urban Influence Codes (UIC), Rural-Urban Continuum Codes (RUCC) and Rural-Urban Commuting Areas (RUCA) based on census tracts.

STUDY DESIGN: Three approaches were used in the categories of UIC, RUCC and RUCA: 1) non-metropolitan/metropolitan, 2) categorization into 3 groups based on population size and 3) categorization into 3 groups based on the contiguity of metropolitan areas. Wald’s chi-square tests assessed differences in sociodemographic variables and three measures of achieved access across 3 of the ‘As of Access’ and Penchansky’s approaches. The three outcome measures included: having a regular provider (availability realized), self-reported “excellent” quality of care (acceptability realized), and a self-reported provider who “always” spends enough time with you (provider attention – accommodation made). ). Average marginal effects corresponding to each outcome were calculated.

DATA COLLECTION AND EXTRACTION METHODS: N/A KEY FINDINGS: All approaches indicated comparable variation in socio-demographic characteristics. Across all approaches, RUCA-based categorizations showed differences in having a regular provider (e.g., 68.9% of non-metropolitan participants and 64.4% of metropolitan participants had a regular provider). This association was attenuated in multivariate analyses. No rural-urban differences in quality of care were observed in unadjusted or adjusted analyzes regardless of approach. After adjusting for covariates, rural respondents reported greater provider attention in some categorizations of rural compared to urban (e.g., non-metropolitan respondents reported a 6.03 percentage point increase in the likelihood of have an attentive supplier [CI = 0.76-11.31%] compared to metropolitan).

CONCLUSIONS: Our findings underscore the importance of considering multiple definitions of rural to understand access disparities and suggest that continued research is needed to examine the interplay between potential access and realized access. These findings have implications for federal funding, resource allocation, and the identification of health disparities. This article is protected by copyright. All rights reserved.

PMID:35146771 | DOI:10.1111/1475-6773.13951

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