Rural Health Policy Project

Research Update: Health Care in Rural and Urban America

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CCF is starting a new series on research in health policy. I will regularly highlight some of the new research that I have been reading. This week, I am reading studies comparing health care and poverty in rural and urban parts of the country.

AHRQ’s National Healthcare Quality and Disparities Report: Chartbook on Rural Health Care

The report shows trends and snapshots of health care quality and disparities from 2000-2014/2015. The authors examine measures of affordability, coordination, effective treatment, healthy living, patient safety and others to assess the performance of the health care system and evaluate disparities by urban vs. rural, race/ethnicity, and socioeconomic status.

What it finds …

  • Disparities persist between care in rural (noncore and micropolitan counties) and metropolitan areas, especially for the poor and uninsured, African-Americans and Hispanics.
  • In the “Healthy Living” Section towards the end, there are lots of measures on child health.
    • In 2014, 84% of children under 18 had a wellness checkup in the year, up from 78% in 2009. During this time period, all geographic locations except noncore areas showed improvement.
    • Children in rural areas are less likely to receive advice about exercise, healthy eating, and smoking than children in metropolitan areas. Many of these disparities increase for children who are African American or Hispanic.
    • In 2014, 54% of children under 18 had a dental visit in the year. Children in noncore areas were less likely to have a dental visit than children in metropolitan areas.

Why it matters …

  • About 13 million children under 18 and 47 million adults live in nonmetropolitan areas. They make up 20% of the population, but, 65% of all the counties in the country are rural.
  • Half of the nation’s hospitals are in rural areas and they are more likely to serve poorer patients than hospitals in metropolitan areas. Individuals in rural areas tend to have a shorter supply of providers and often live farther away from health care resources.
  • Individuals living in rural areas are more likely to be older, poorer, sicker and uninsured. They also have higher injury, smoking, suicide and opioid misuse rates. The life expectancy between rural and metropolitan areas widened over time.
  • Individuals, providers and hospitals in rural areas face unique challenges in health care and Medicaid helps rural areas address these challenges. Our research found that Medicaid covers a larger share of children and nonelderly adults in rural areas than in metropolitan areas and this trend is strongest among children.

Health Affairs’ Health Care In The Suburbs: An Analysis Of Suburban Poverty And Health Care Access

This study compares patterns of insurance coverage and health care access in suburban, urban and rural areas from 2005 through 2015.

What it finds …

  • About 17 million Americans in poverty live in the suburbs, more than the number living in poverty in cities or rural areas. However, rates of poverty are higher in cities and rural areas.
  • Nearly 40% of the uninsured population live in the suburbs. Overall, the uninsurance rate is lower in suburban areas than in cities and rural areas.
  • After controlling for income and other demographic factors, rates of access to care were similar across all geographies. Access for the poor is substantially worse than access for the non-poor across all geographies, too.

Why it matters …

  • The Medicaid expansion has particularly benefited the suburbs: 68% of the suburban population, 54% of the rural population and 42% of the urban population live in Medicaid expansion states.
  • Poverty and uninsurance in the suburbs present unique challenges (just like poverty and uninsurance in rural areas also present unique challenges).

Find more Research Updates here.

Karina Wagnerman
Karina Wagnerman is a Senior Health Policy Analyst at the Center for Children and Families

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