High-Risk Travel Distance and Number of Primary Care Visits in a North Carolina Medicaid Population

Background: With nearly 20% of the U.S. population in rural areas, a lack of access to primary care may cause rural residents to forego recommended preventive care procedures, and suffer higher morbidity rates than their urban counterparts. Methods: Medicaid billing data from 2009 to 2011 were analyzed to calculate the distance and duration that a Medicaid patient population had to travel when seeking primary care in the 29 rural counties of eastern North Carolina. Primary care codes were analyzed to detect any differences in access patterns for various complexity levels of physician visits. Data were also used to evaluate health professional shortage areas (HPSA) designations in eastern North Carolina based on current federal definition. Results: There was a significant difference in patient visits when comparing HPSA-defined travel times of more or less than 20 miles or 30 minutes; however, the average patient received a sufficient number of primary care visits annually (average ~3) with distance and duration having limited effect on the amount of care the patients received. Implications: As a designation criterion for underserved areas, the current HPSA definition may not adequately identify populations at risk