Factors that reduce the value of health care received by residents of rural areas: Findings from the National Healthcare Quality and Disparities Reports

Background: Achieving optimal value for patients mean providing patient-centered, quality care at an affordable cost.  Findings from the National Healthcare Quality and Disparities Reports (NHQR-DR) highlight the areas that impact the value of heath care received by residents of non-metropolitan areas.

Methods: Twenty two measures used in this health care value analysis were obtained from the NHQR-DR database and stratified by geography.  The significant differences between populations for most recent year and trends over time (at least 3 data years) were those with a minimum relative difference of 10 percent between the comparison and reference group, with p <0.05 in two-tailed significance tests.

Findings:

Preventive Care: From 2005-2010, individuals residing in non-metropolitan areas were less likely than residents of metropolitan areas to receive colorectal screening, blood cholesterol check, and meningococcal vaccination.  Children who are residents of non-metropolitan areas were also less likely to receive advice from their health provider about healthy eating and physical activity.

Patient Experience: From 2002-2010, for both adults and children , there were no significant difference in the percentage of patients from metropolitan and non-metropolitan areas whose providers sometimes or never listened carefully, explained things clearly, respected what they had to say and sent enough time with them.

In 3 of 9 years residents of non-metropolitan areas were more likely than metropolitan residents to be asked by their health care provider to help with treatment decisions.

Cost: In 3 of 6 years, residents of non-metropolitan areas were significantly more likely to than  residents of metropolitan areas to have an out of pocket medical expenditure more than 10% of their family income.

During this same period of time, there was no significant difference in people who were unable to or delayed getting needed medical care, dental care, or prescription medicines due to financial or insurance reasons.

In 7 of 10 years non-metropolitan residents were less likely than residents of metropolitan areas to report finance or insurance as the reason for not having a usual source of care.

Conclusions: Residents of non-metropolitan areas show similar patient experience and are similarly impacted by health care cost as urban residents.  However, there are major disparities in one aspect of quality care, the receipt of preventive services.