While Medicare provides near-universal healthcare coverage in the U.S. for those 65 years of age and older, residents of rural areas may experience more difficulties accessing care from medical and surgical specialists than urban residents. Using 2014 Medicare data from five states, this work describes the provider mix caring for rural and urban beneficiaries. It also examines the number of annual visits received and the distances traveled by beneficiaries for care for several conditions.
Generalist physicians, physician assistants (PAs), and nurse practitioners (NPs) provided 50.7% of visits received by rural beneficiaries, compared to 41.8% among urban beneficiaries. Comparison of results from a similar study using 1998 data from the same five states indicates that the proportion of visits provided by generalist physicians, PAs, and NPs to rural and urban beneficiaries increased between 1998 and 2014.
Rural beneficiaries traveled farther to receive care and spent more time traveling than urban beneficiaries. Median one-way travel times for visits for some serious conditions (including ischemic heart disease and cancer) exceeded 30 minutes among residents of small rural and isolated rural areas and exceeded 60 minutes for 25% of visits received by those residents. Overall, rural beneficiaries received 74.2% of their visits in rural areas. Results indicated that rural beneficiaries, especially those from small rural and isolated small rural areas, continue to face challenges with access to specialty care and continue to rely on a local generalist workforce for care.
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Eric Larson, PhD
WWAMI Rural Health Research Center