Trends in Special Medicare Payments and Service Utilization for Rural Areas in the 1990s

By Donna O. Farley; Lisa R. Shugarman et al. | Go to book overview

B. DEFINITIONS OF RURALITY

Historically, two principal definitions of rural have been used by the federal government. The first definition is the “urban-rural” classification of populations developed by the Census Bureau. The bureau specifies “urbanized areas” and defines as urban all territory, population, and housing units located in those areas and in places or towns of 2,500 or more persons outside urbanized areas. All other areas not classified as urban are considered to be rural. An urbanized area is a continuously built-up area with a population of 50,000 or more, comprising one or more central places and the adjacent densely settled fringes with a population density of more than 1,000 persons per square mile.25

The second definition is the “metropolitan/non-metropolitan” classification of counties developed by the Office of Management and Budget (OMB). Metropolitan areas contain core counties with one or more central cities of at least 50,000 population or with a Census Bureaudefined urbanized area and a total area population of 100,000 or more, as well as fringe counties that are economically tied to the core counties. All other counties are considered to be nonmetropolitan.

Policy analysis and research studies generally have worked with these definitions or adaptations from them, but the populations that are defined as rural differ substantially depending on which definition is used as the basis for classification. Therefore, the choice of definition is an important aspect of study design and should support the basic research or policy issues being addressed.

For the analyses of Medicare rural payment policies, the county-based definition of metropolitan/non-metropolitan groupings is a useful organization because many Medicare payment policies and related data sources are based on county boundaries. This definition loses much of the granularity of the urbanized area definition, however, which differentiates between areas with concentrated populations and those with more sparsely distributed populations, for which local health care services are likely to be quite different.

Two methods have been available to classify the metropolitan and non-metropolitan counties according to degrees of rurality. The Department of Agriculture developed the Urban Influence Codes (UICs) and the Rural-Urban Continuum Codes (RUCCs). The categories used by these two methods are listed in Table B.I. The methods differ in how they measure a county's urban population for categorizing the county. The UICs work with the size of the largest town or city in a county, whereas the RUCCs sum the total population for all towns and cities of more than 2,500 in a county. Thus, the RUCCs would classify a county with many small towns with populations totaling 20,000, but without a city of at least 10,000 population, as more economically centralized than the UICs would classify that county.

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25
The primary source for this discussion is Ricketts et al. (1998).

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