Determinants of rural-urban differences in health care provider visits among women of reproductive age in the United States

• Published in: PloS one 2020-12, Vol.15 (12), p.e0240700-e0240700
• Main Authors: Lee, Hyunjung, Hirai, Ashley H, Lin, Ching-Ching Claire, Snyder, John E
• Format: Article
• Language: English
• Subjects: 60 APPLIED LIFE SCIENCES; Adult; Age; Analysis; Availability; Behavior; Censuses; Certified nurse-midwives; Childbirth & labor; Chronic illnesses; Comparative analysis; Demographic aspects; Earth Sciences; Female; Gynecology; Gynecology - statistics & numerical data; Health aspects; Health care; Health care access; Health care disparities; Health care policy; health care providers; Health disparities; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - statistics & numerical data; Humans; Internal medicine; Maternal & child health; Maternal mortality; Medical personnel; Medicine; Medicine and Health Sciences; Midwifery; Midwifery - statistics & numerical data; Morbidity; Nurse practitioners; Nurse Practitioners - statistics & numerical data; nurses; Obstetrics; Obstetrics - statistics & numerical data; obstetrics and gynecology; Office Visits - statistics & numerical data; People and Places; Physician Assistants - statistics & numerical data; Physicians; Physicians, Family - statistics & numerical data; Pregnancy; Primary care; Rural areas; Rural Population - statistics & numerical data; Rural women; Self Report - statistics & numerical data; United States; Urban areas; Urban Population - statistics & numerical data; Urban women; women's health; Women's health services; Women's Health Services - statistics & numerical data; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0240700

Rural health disparities and access gaps may contribute to higher maternal and infant morbidity and mortality. Understanding and addressing access barriers for specialty women's health services is important in mitigating risks for adverse childbirth events. The objective of this study was to investigate rural-urban differences in health care access for women of reproductive age by examining differences in past-year provider visit rates by provider type, and quantifying the contributing factors to these findings. Using a nationally-representative sample of reproductive age women (n = 37,026) from the Medical Expenditure Panel Survey (2010-2015) linked to the Area Health Resource File, rural-urban differences in past-year office visit rates with health care providers were examined. Blinder-Oaxaca decomposition analysis quantified the portion of disparities explained by individual- and county-level sociodemographic and provider supply characteristics. Overall, there were no rural-urban differences in past-year visits with women's health providers collectively (65.0% vs 62.4%), however differences were observed by provider type. Rural women had lower past-year obstetrician-gynecologist (OB-GYN) visit rates than urban women (23.3% vs. 26.6%), and higher visit rates with family medicine physicians (24.3% vs. 20.9%) and nurse practitioners/physician assistants (NPs/PAs) (24.6% vs. 16.1%). Lower OB-GYN availability in rural versus urban counties (6.1 vs. 13.7 providers/100,000 population) explained most of the rural disadvantage in OB-GYN visit rates (83.8%), and much of the higher family physician (80.9%) and NP/PA (50.1%) visit rates. Other individual- and county-level characteristics had smaller effects on rural-urban differences. Although there were no overall rural-urban differences in past-year visit rates, the lower OB-GYN availability in rural areas appears to affect the types of health care providers seen by women. Whether rural women are receiving adequate specialized women's health care services, while seeing a different cadre of providers, warrants further investigation and has particular relevance for women experiencing high-risk pregnancies and deliveries.