Effects of the Rural Environment on Access to Health Care for Elders

The main goal of this study is to examine the relationship among residence ( rural/ nonmetropolitan/ urban), individual traits of elders, community characteristics, and realized access to health care. For this research access to care, referred to as realized access, is defined as ( 1) reported trouble getting care ( 2) physician visits, and ( 3) prescription drug utilization. The aims of this research are to: ( 1) Determine if changes in realized access to care have occurred over a 5 year period from 1999- 2004. ( 2) Determine whether, rural residence’s influence on realized access to care persists when individual traits of elders ( insurance, age, education, income, race, health, and health beliefs) and community traits ( physician supply, percentage of the population aged 65 and older, and transportation issues) are considered. Data for this study are derived from the Medicare Current Beneficiary Survey ( MCBS) and the Area Resource File. All variables except the physician supply and percentage of the population over 65 are obtained from the MCBS for the years of 1999 and 2004. The sample consists of individuals within the MCBS who are living in the community and are aged 65 and over. Multiple OLS regression and logistic regression with difference in difference estimators are used to answer aims 1 and 2. Results indicate a slightly decreased number of elders reporting trouble getting care over the five year period and modest increases in both physician visits and prescription drug use. Nonmetropolitan elders are less likely to report trouble getting care than metropolitan elders, rural elders are found to use fewer physician visits as compared to metropolitan elders, and no difference is found in the use of prescription drugs when controlling for individual and community traits. Only one of the community characteristics ( percentage of the population aged 65+) is found to be related to realized access to care. These findings add to the existing literature by helping to explain the relationships between individual characteristics, community characteristics, and access to care while also providing a wider definition of access