Rural-urban differences in usual source of care and ambulatory service use: analyses of national data using Urban Influence Codes.

BACKGROUND: Rural-urban disparities in access to and utilization of medical care have been a long-standing focus of concern.

OBJECTIVE: Using the nine-category Urban Influence Codes, this study examines the relationship between place of residence and having access and utilization of ambulatory health services.

RESEARCH DESIGN: Data come from the Medical Expenditure Panel Survey, conducted in 1996. Linear and logistic regression analyses assess the relationship between county type and having a usual source of care and ambulatory visits, controlling for demographic and health status measures.

RESULTS: Residents of counties that were totally rural were more likely to report having a usual source of care (adjusted OR: 1.98; CI: 1.01, 3.89) than residents of large metropolitan counties. Residents of places without a city of 10,000 or more, but adjacent to a metropolitan area, were also more likely to report having a usual source of care (adjusted OR: 1.92; CI: 1.16, 3.22). In a regression analysis, residents of the most rural places reported fewer visits during the year (B = -2.42, CI: -3.68, -1.32).

CONCLUSIONS: Results suggest that using rural and urban definitions that go beyond the traditional dichotomy of metropolitan and non-metropolitan may assist policymakers and researchers in identifying types of places where there is a disparity in access and subsequent utilization of health care. Rural residents, defined as totally rural in the urban influence coding scheme, may report having a health care provider but report fewer visits to health care providers during a year.