Lee, Wei-Chen (2013-12). Comparisons of Access to, Cost of, and Quality of Health Care Between Rural and Urban Populations. Doctoral Dissertation.
Thesis
There are 46.2 million Americans (15% of total population) living in rural counties. Rural populations disproportionately suffer from inadequate access to, high cost of, and poor quality of health services compared to urban populations. Furthermore, rural populations have lower income, lower educational attainment, worse insurance coverage, and poor health status. In response to the goal of Healthy People 2020 to eliminate disparities, this dissertation developed and conceptualized three topics to address rural health disparities. Using the 2004-2010 Medical Expenditure Panel Survey (MEPS), the first study found that geriatricians were less likely to be a usual source of care for both rural and urban older adults. The finding may be a result of the geriatrician shortage that exists while the aging population in the United States is growing. Also using the 2010 MEPS, the second study found that rural populations had a higher spending on prescription drugs and urban population had a higher spending on hospital emergency care. The result of quantile regression further indicated that the geographic factor might affect high spending users more than low spending users. For the third study, the 2011 California Healthcare Cost and Utilization Project (HCUP) provided evidence that rural residents had higher maternal readmissions rates in spite of the delivery mode. The maternal readmission rate seems way lower than other procedures but it is still important to monitor the quality of caesarean section deliveries. The primary limitation of this dissertation may be the poor generalizability to populations in different age groups or living in different areas from California. However, the trend data, quantile regression, and generalized estimating equation employed in this dissertation presented rural health disparities in a different approach. Considering access, quality, and cost problems in rural areas as a whole, our research findings suggest that improving access to quality of care in rural areas should be a major priority. Moreover, addressing this healthcare deficiency should also subsequently reduce the unnecessary costs of care. In conclusion, effective strategies and actions are needed to provide more health resources and strengthen the rural health infrastructure.
