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Determinants of rural-urban differences in health care provider visits among women of reproductive age in the United States.
Lee, Hyunjung; Hirai, Ashley H; Lin, Ching-Ching Claire; Snyder, John E.
Afiliación
  • Lee H; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee, United States of America.
  • Hirai AH; Office of Health Equity (OHE), Health Resources and Services Administration (HRSA), Rockville, Maryland, United States of America.
  • Lin CC; Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA), Rockville, Maryland, United States of America.
  • Snyder JE; Office of Planning, Analysis, and Evaluation (OPAE), Health Resources and Services Administration (HRSA), Rockville, Maryland, United States of America.
PLoS One ; 15(12): e0240700, 2020.
Article en En | MEDLINE | ID: mdl-33301492
BACKGROUND: Rural health disparities and access gaps may contribute to higher maternal and infant morbidity and mortality. Understanding and addressing access barriers for specialty women's health services is important in mitigating risks for adverse childbirth events. The objective of this study was to investigate rural-urban differences in health care access for women of reproductive age by examining differences in past-year provider visit rates by provider type, and quantifying the contributing factors to these findings. METHODS AND FINDINGS: Using a nationally-representative sample of reproductive age women (n = 37,026) from the Medical Expenditure Panel Survey (2010-2015) linked to the Area Health Resource File, rural-urban differences in past-year office visit rates with health care providers were examined. Blinder-Oaxaca decomposition analysis quantified the portion of disparities explained by individual- and county-level sociodemographic and provider supply characteristics. Overall, there were no rural-urban differences in past-year visits with women's health providers collectively (65.0% vs 62.4%), however differences were observed by provider type. Rural women had lower past-year obstetrician-gynecologist (OB-GYN) visit rates than urban women (23.3% vs. 26.6%), and higher visit rates with family medicine physicians (24.3% vs. 20.9%) and nurse practitioners/physician assistants (NPs/PAs) (24.6% vs. 16.1%). Lower OB-GYN availability in rural versus urban counties (6.1 vs. 13.7 providers/100,000 population) explained most of the rural disadvantage in OB-GYN visit rates (83.8%), and much of the higher family physician (80.9%) and NP/PA (50.1%) visit rates. Other individual- and county-level characteristics had smaller effects on rural-urban differences. CONCLUSION: Although there were no overall rural-urban differences in past-year visit rates, the lower OB-GYN availability in rural areas appears to affect the types of health care providers seen by women. Whether rural women are receiving adequate specialized women's health care services, while seeing a different cadre of providers, warrants further investigation and has particular relevance for women experiencing high-risk pregnancies and deliveries.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Población Rural / Población Urbana / Servicios de Salud para Mujeres / Disparidades en Atención de Salud / Accesibilidad a los Servicios de Salud Aspecto: Determinantes_sociais_saude / Equity_inequality Límite: Adult / Female / Humans / Pregnancy País/Región como asunto: America do norte Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2020 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Población Rural / Población Urbana / Servicios de Salud para Mujeres / Disparidades en Atención de Salud / Accesibilidad a los Servicios de Salud Aspecto: Determinantes_sociais_saude / Equity_inequality Límite: Adult / Female / Humans / Pregnancy País/Región como asunto: America do norte Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2020 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos