Medicare Compliance & Reimbursement

Are urban patients better off? A report says, 'Maybe not.'

Any problems patients living in America's rural communities might face when seeking health care may have nothing to do with a lack of local health care providers - but could have a lot to do with lower incomes. Researchers recently found that access to and quality of care in rural areas fares just as well as in urban areas.
 
Center for Studying Health System Change researchers James Reschovsky and Andrea Staiti conducted a Robert Wood Johnson Foundation-funded study called "Access and Quality: Does Rural America Lag Behind?"
 
Reschovsky and Staiti analyzed data from 2000 to 2001, meaning the samples pre-dated the Medicare Modernization Act of 2003, which included special funding and additional Medicare payments to rural providers.
 
Even before this added funding, surveyed patients living in rural areas reported no more access problems than urban patients, researchers said. Furthermore, rural patients and physicians rated the quality of health care higher than their urban counterparts.

Rural Patients Note Financial, Insurance Problems

The researchers found no significant statistical difference in the percentage of surveyed patients in rural and urban areas who reported unmet health care needs. Slightly more rural patients reported delayed care, but researchers said this was due to the fact that rural patients are more likely to be uninsured and are poorer than urban patients.
 
Reschovsky and Staiti cited a greater percentage of rural patients who reported spending more than 5 percent of their income on out-of-pocket health care expenses than urban patients.
 
Because of the sparse population density and geographically scattered physicians in rural areas, patients must travel farther to obtain health care. Despite these factors, rural individuals were more likely than urban patients to report having a usual source of care, Reschovsky and Staiti noted.
 
Surprisingly, rural physicians were less likely than their urban counterparts to report problems obtaining needed services, the study said. Rural physicians indicated fewer problems obtaining ancillary services, hospital admissions and diagnostic imaging, but they did report more problems obtaining mental health services.
 
Although rural primary care physicians were more likely to staff emergency departments and treat a broader range of conditions, only 22 percent of them said they treated more complex and severe conditions than they should (without referrals to specialists), as opposed to 28 percent of urban PCPs.