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Urban and Rural Differences in Health Insurance and Access to Care |
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| Authors: | David Hartley PhD MHA Lois Quam MA Nicole Lurie MD MSPH |
| Affiliation: | Hartley is a research associate at the University of Minnesota Rural Health Research Center in Minneapolis, MN. His research interests include the role of medical technology in rural health delivery, and the impact of national and state health care reform on rural communities and rural American Indian populations.;Pirani is a research associate with the WAMI Rural Health Research Center and a doctoral candidate in the University of Washington Department of Geography in Seattle, WA.;Lurie is an associate professor with appointments in the Institute for Health Services Research and the Department of Internal Medicine at the University of Minnesota in Minneapolis, MN. She divides her time between teaching, clinical practice at the Hennepin County Medical Center, and research. Her research interests include access to and quality of care, preventive care, and medical education. |
| Abstract: | This study considers differences in access to health care and insurance characteristics between residents of urban and rural areas. Data were collected from a telephone survey of 10,310 randomly selected households in Minnesota. Sub-samples of 400 group-insured, individually insured, intermittently insured, and uninsured people, were asked about access to health care. Those with group or individual insurance were also asked about the costs and characteristics of their insurance policies. Rural areas had a higher proportion of uninsured and individually insured respondents than urban areas. Among those who purchased insurance through an employer, rural residents had fewer covered benefits than urban residents (5.1 vs 5.7, P < 0.01) and were more likely to have a deductible (80% versus 40%, P < 0.01). In spite of this, rural uninsured residents were more likely to have a regular source of care than urban residents (69% versus 51%, P < 0.01), and were less likely to have delayed care when they thought it was necessary (21% versus 32%, P<0.01). These differences were confirmed by multivariate analysis. Rural residents with group insurance have higher out-of-pocket costs and fewer benefits. Uninsured rural residents may have better access to health care than their urban counterparts. Attempts to expand access to health care need to consider how the current structure of employment-based insurance creates inequities for individuals in rural areas as well as the burdens this structure may place on rural providers. |
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