Academic journal article Southeastern Geographer

Exploring Inequalities in Health Care Coverage by Degree of Rurality in Western North Carolina

Academic journal article Southeastern Geographer

Exploring Inequalities in Health Care Coverage by Degree of Rurality in Western North Carolina

Article excerpt

The purpose of this study is to examine whether or not there is poorer geographic access to health care in more rural counties. Possible inequalities in health care access and utilization were examined for populations living in twelve counties in the mountain region of North Carolina with different degrees of rurality, defined by Beale Code groupings bused on urban population size and adjacency to a metro area. Several measures of availability, geographic accessibility, and utilization of practitioners were employed in the study. Data were derived from the U.S. Census, public and proprietary physician databases, and a household survey of 1,059 households. Overall, with some small exceptions, there was little difference in access by degree of rurality at the Beale Code level of analysis. Some types of access were better for more rural populations and some were better for less rural populations. Health Professional Shortage Area (HPSA) guidelines for population to primary care physician ratios, and Health and Services Administration (Bureau of Health Professions) guidelines for travel time and distances were met for the majority of the population. The related issues of how to measure rurality and appropriate geographic scales of analysis are discussed.

KEY WORDS: Health care, rurality, accessibility, inequalities, scale, western North Carolina

INTRODUCTION

Mrs. Bivens, an eighty-year old woman with a serious heart condition, lives by herself in a cabin on a mountainside, a few kilometers up a gravel track from a secondary road. She is several kilometers from a primary care provider and more than 80 km from a hospital. She has no means of transportation and relies on others to take her shopping or to receive health care treatment. Although Mrs. Bivens is an imaginary person whose lack of access to care represents an extreme case, she does fit the stereotype of what it means to live in rural isolation. Her story supports a commonly held assumption that people who live in more rural places have less geographic access to care.

There is evidence to show that, on the whole, rural residents have poorer geographic access to care than urban residents. But are there also access differences within rural areas? Is there a connection between "ruralness" or degree of rurality and health care access? We attempt to answer this question from a geographic perspective. We can imagine that we are providing information to planners working in a mainly rural region of a state who are interested in determining whether residents in more rural parts of the region have more difficulty overcoming geographic barriers to care than less rural residents. How would a geographer set about providing this information? One approach would be to choose some subdivision of a study area based on geographic units of observation that have differing degrees of rurality and look for access inequalities among those units.

Examining differences in access by degree of rurality begs an important question that is of particular interest to geographers: how does one measure rurality? Although this may appear on the surface to be an easy question to answer, it definitely is not, as we show below. For this study, we chose to use Beale Codes, a county-level measure which categorizes the degree of rurality along a rural-urban continuum. The county was chosen as the unit of analysis because (1) it is a commonly used unit of analysis in health services research, (2) it is often the unit at which health care policy is made, (3) it is used in measures of rurality along the rural-urban continuum, and (4) it allows the examination of gradations of rurality within our study area.

The purpose of this study is to examine whether or not there is poorer geographic access to health care in more rural counties. A complementary issue that is examined is whether rural populations are adequately served in terms of national standards. Our study site is western North Carolina, a region which contains both isolated and urbanized populations. …

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