Access to Physician Care for the Rural Medicare Elderly


Patients in rural areas may utilize less medical care than urban patients because of differences in travel distance and time and a utilization of a different mix of generalists and specialists for their care. This study compared travel times, distances, and physician specialty mix of Medicare patients in Alaska, Washington, North Carolina, South Carolina, and Idaho. We used a retrospective design, utilizing 1998 Medicare billing data. Travel time was determined by computing the road distance between the patient’s and the provider’s ZIP codes. There were 39,780 providers in the cohort: 16.1% generalists, 62% specialists, and 21% nonphysician providers. The median overall one-way travel distance and time was 7.7 miles and 11.7 minutes. Rural residents traveled two to three times farther to see medical and surgical specialists than urban residents. Rural residents with cancer, heart disease, depression, or needing complex cardiac procedures or cancer treatment traveled the farthest. Increasing rurality was related to decreased visits to specialists and increasing reliance on generalists. The majority of visits by those living in large rural areas were in large rural areas or the patients’ home ZIP codes. Residents of rural areas have increased travel distance and time compared to their urban counterparts, particularly true of rural residents with specific diagnoses or those undergoing specific procedures. Funded by HRSA’s ORHP.