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Differences in access to health care services among adults in rural America by rural classification categories and age.

Australian Journal of Rural Health 2003; 11(2):64-72.

Zhang P, Tao G, Anderson LA.

Abstract
OBJECTIVE: To study differences in excess to health care services between different population groups in rural areas of the United States. DESIGN: Using data from the 1994 National Health Interview Survey and the 1991 Area Resource File, we examined the differences in excess with seven measures: having a regular source of care, having a usual place of care, having health insurance coverage, delaying medical care because of cost for all rural residents; number of doctor visits, number of hospital discharges and length of hospital stay per discharge for those who reported their health as being either poor or fair. Rural residents were classified by ages and grouped into four rural classification categories that were characterised along two dimensions: adjacent to a metropolitan statistical area (MSA) (yes/no) and inclusion of a city of at least 10,000 people (yes/no). SETTING: Rural areas. SUBJECTS: Rural populations. RESULTS: Residents aged 18-24 years had the worst access to services and the residents aged 65 years and over had the best access to services when measured by regular source of care, a usual place of care and health insurance status. Compared to those aged 50-64 years, residents aged 25-49 years were less likely to report having health insurance and more likely to report delaying seeking medical care because of costs. Rural residents who lived in a county adjacent to an MSA generally were less limited in access than those who lived in a county not adjacent to an MSA. CONCLUSIONS: Rural America is not a homogeneous entity in many aspects of the access to health care services.