Non-Urban Care: How Health Need Influences Access to Care

Marie Gray

doi:10.7273/000004597

Individuals living within rural communities experience more health inequities and adverse health outcomes compared to their urban counterparts (Artiga & Hinton, 2018; Henning-Smith et al., 2017; Wolfe et al., 2020). One of the most consistent findings within health disparity literature is that place matters (Baciu et al., 2017; Bolin et al., 2015; Douthit et al., 2015). Within urban cities life expectancy can differ as much as 25 years from one neighborhood to the next (Baciu et al., 2017; Evans et al., 2012; Zimmerman & Woolf, 2014); within rural communities, these health inequities are getting greater due to access to health services decreasing and hospital and practitioner facility closures all over rural United States (U.S.; Douthit et al., 2015; U.S. Government Accountability Office, 2018). Additionally, mental health concerns and substance use rates are climbing among rural individuals of all ages (Center for Disease Control [CDC], 2018; Leaders, 2019). Using the Andersen Behavioral Health Service Use Model (BHSUM), which measures equitable access to care, and to inform the development of policies to promote equitable access to health care, the purpose of this study was to identify how predisposing, enabling, and needs-based factors influence healthcare physician availability, access to preventative care, and unplanned hospitalization/ER visits. I conducted a series of bivariate associations and regression analyses to assess the associations of predisposing, enabling, and needs-based factors with health-seeking behaviors among rural-dwelling adults. Results revealed significant associations between age, activities of daily living (ADL), need for mental health services, and need for substance use services with physician availability, access to preventative care, and unplanned hospitalization/ER visits. Findings highlight the need for policy provisions and more affordable/accessible long term supports and services in the home and community. This study adds to the literature by 1) conceptualizing mental health as a needs-based factors in addition to physical needs-based factors, and 2) emphasizing the role of prevention to promote health-seeking behaviors in middle and late adulthood.

Non-Urban Care: How Health Need Influences Access to Care

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