Rural‐Urban Differences in Access to Preventive Health Care Among Publicly Insured Minnesotans

• Published in: The Journal of rural health 2018-02, Vol.34 (S1), p.s48-s55
• Main Authors: Loftus, John, Allen, Elizabeth M., Call, Kathleen Thiede, Everson‐Rose, Susan A.
• Format: Article
• Language: English
• Subjects: access to health care; Adolescent; Adult; Adults; Aged; Barriers; Chi-Square Distribution; Child; Child, Preschool; Children; Constraints; Cross-Sectional Studies; Demographics; Demography; Discrimination; Economic factors; Ethnic groups; Female; Health care; Health care access; Health care policy; Health disparities; Health insurance; Health Services Accessibility - standards; Health Services Accessibility - statistics & numerical data; Humans; Individual differences; Infant; Insurance; Insurance coverage; Insurance Coverage - standards; Insurance Coverage - statistics & numerical data; Male; Middle Aged; Minnesota; Minority & ethnic groups; Minority groups; Oversampling; Populations; Prevention programs; preventive health care; Preventive medicine; Preventive Medicine - methods; Preventive Medicine - standards; Preventive Medicine - statistics & numerical data; public health insurance; Racial Groups - statistics & numerical data; Residence; Rural areas; Rural communities; rural health; Rural Population - statistics & numerical data; Rural populations; Rural urban differences; Sampling; Secondary analysis; Social factors; Socioeconomic Factors; Socioeconomics; Statistical analysis; Statistical methods; Uncertainty; Urban areas; Urban Population - statistics & numerical data
• ISSN: 0890-765X; 1748-0361
• DOI: 10.1111/jrh.12235

Purpose Reduced access to care and barriers have been shown in rural populations and in publicly insured populations. Barriers limiting health care access in publicly insured populations living in rural areas are not understood. This study investigates rural‐urban differences in system‐, provider‐, and individual‐level barriers and access to preventive care among adults and children enrolled in a public insurance program in Minnesota. Methods This was a secondary analysis of a 2008 statewide, cross‐sectional survey of publicly insured adults and children (n = 4,388) investigating barriers associated with low utilization of preventive care. Sampling was stratified with oversampling of racial/ethnic minorities. Results Rural enrollees were more likely to report no past year preventive care compared to urban enrollees. However, this difference was no longer statistically significant after controlling for demographic and socioeconomic factors (OR: 1.37, 95% CI: 1.00‐1.88). Provider‐ and system‐level barriers associated with low use of preventive care among rural enrollees included discrimination based on public insurance status (OR: 2.26, 95% CI: 1.34‐2.38), cost of care concerns (OR: 1.72, 95% CI: 1.03‐2.89) and uncertainty about care being covered by insurance (OR: 1.70, 95% CI: 1.01‐2.85). These and additional provider‐level barriers were also identified among urban enrollees. Conclusions Discrimination, cost of care, and uncertainty about insurance coverage inhibit access in both the rural and urban samples. These barriers are worthy targets of interventions for publicly insured populations regardless of residence. Future studies should investigate additional factors associated with access disparities based on rural‐urban residence.