Exploring Health Care Accessibility Among Vermont's Rural Seniors

The aging “baby boomer” generation will have a profound impact on the demand for health care services in the United States. This change will be felt strongly in rural areas, where the population is generally older and the supplies of health care services and transportation alternatives are limited. The State of Vermont, one of the oldest and most rural (by population) in the nation, epitimozes this dynamic.

We employed a mixed-method approach to assess the health care accessibility of Medicare-eligible Vermonters in rural areas. Service areas of four health care facility types were calculated in ArcGIS using three modal measurements - automobile driving times, fixed-line transit routing, and operating areas of demand-response transit agencies - and aggregated using an index to illustrate statewide accessibility per health care facility type.  We subsequently interviewed twenty seniors regarding their transportation-to-health care experiences. The geospatial and qualitative results were synthesized to elicit a nuanced perspective on health care accessibility.

The results suggest a myriad of factors impact access to care. The spatial concentration of healthcare and transportation disinfranchises rural seniors more than the general population. Senior health, financial constraints, social networks are additional correlates of accessibility. Despite these factors, Vermont seniors were generally content with their access to care. The universal proliferation of demand-response medical transportation for seniors ensured a fundamental level of health care accessibility across the state, while visiting medical specialists and alternative transportation options further promoted health care accessibility.