Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota.
Department of Public Health, St. Catherine University, St. Paul, Minnesota.
J Rural Health. 2018 Feb;34 Suppl 1(Suppl 1):s48-s55. doi: 10.1111/jrh.12235. Epub 2017 Mar 14.
Reduced access to care and barriers have been shown in rural populations and in publicly insured populations. Barriers limiting health care access in publicly insured populations living in rural areas are not understood. This study investigates rural-urban differences in system-, provider-, and individual-level barriers and access to preventive care among adults and children enrolled in a public insurance program in Minnesota.
This was a secondary analysis of a 2008 statewide, cross-sectional survey of publicly insured adults and children (n = 4,388) investigating barriers associated with low utilization of preventive care. Sampling was stratified with oversampling of racial/ethnic minorities.
Rural enrollees were more likely to report no past year preventive care compared to urban enrollees. However, this difference was no longer statistically significant after controlling for demographic and socioeconomic factors (OR: 1.37, 95% CI: 1.00-1.88). Provider- and system-level barriers associated with low use of preventive care among rural enrollees included discrimination based on public insurance status (OR: 2.26, 95% CI: 1.34-2.38), cost of care concerns (OR: 1.72, 95% CI: 1.03-2.89) and uncertainty about care being covered by insurance (OR: 1.70, 95% CI: 1.01-2.85). These and additional provider-level barriers were also identified among urban enrollees.
Discrimination, cost of care, and uncertainty about insurance coverage inhibit access in both the rural and urban samples. These barriers are worthy targets of interventions for publicly insured populations regardless of residence. Future studies should investigate additional factors associated with access disparities based on rural-urban residence.
在农村人口和公共保险人群中，已经显示出获得医疗服务的机会减少和障碍增加。居住在农村地区的公共保险人群中，限制获得医疗保健的障碍尚不清楚。本研究调查了明尼苏达州一个公共保险计划中成年人和儿童的系统、提供者和个人层面的障碍以及获得预防保健的情况，以了解城乡差异。
这是对 2008 年明尼苏达州全州范围、横断面调查的二次分析，该调查研究了与预防保健利用率低相关的障碍，该调查对象为公共保险的成年人和儿童（n=4388）。抽样采用分层，对少数民族进行了过采样。
与城市参保者相比，农村参保者报告过去一年未接受预防保健的可能性更大。然而，在控制了人口统计学和社会经济因素后，这种差异不再具有统计学意义（OR：1.37，95%CI：1.00-1.88）。与农村参保者低利用率相关的提供者和系统层面的障碍包括基于公共保险状况的歧视（OR：2.26，95%CI：1.34-2.38）、对护理费用的担忧（OR：1.72，95%CI：1.03-2.89）和对保险覆盖的护理不确定（OR：1.70，95%CI：1.01-2.85）。这些障碍以及其他提供者层面的障碍也在城市参保者中被发现。
歧视、护理费用和保险覆盖的不确定性在农村和城市样本中都阻碍了获得医疗服务的机会。这些障碍是公共保险人群干预措施的目标，无论其居住地点如何。未来的研究应根据城乡居住情况，调查与获得机会差异相关的其他因素。
