Is coverage enough? The health care experiences of rural low-income women

A primary goal of health care reform has been to provide health insurance coverage for all Americans, assuming that coverage increases access to care and utilization of preventive services, thereby improving overall health. Using data from Rural Families Speak, a three-year, multi-state study of U.S. rural women and their families between 2000-2002, we qualitatively assessed utilization and continuity of health care among 30 participants with either private (n=15) or public (n=15) health insurance. Employing an integrative secondary thematic analysis of interview data, we generated initial codes and identified overarching themes. Results revealed half of participants traveled 30 or more miles for care. Insurance coverage facilitated utilization, and participants noted the importance of having a usual provider. Publicly insured women reported more chronic health conditions and more often reported seeking care to reactively manage exacerbation of their health conditions or to meet medication needs. Privately insured women reported fewer chronic conditions, proactively managed such conditions with primary providers, and more often sought routine, preventive care. Despite coverage, both groups cited financial barriers to care, including not going to the doctor or waiting to fill prescriptions due to cost. Findings suggest while coverage may reduce some barriers, having insurance does not guarantee health services access, utilization, or receipt of preventive care. The effectiveness of preventive health and health promotion activities in health care reform proposals is in part contingent upon establishing cost-sharing and out-of-pocket expenditures that are not cost prohibitive for low-income rural women.