Rural‐Urban Differences in Access to, Attitudes Toward, and Satisfaction with Care Among Medicare Beneficiaries
Authors: Henning‐Smith C. , Hernandez A. , Lahr M. , Kozhimannil K. 
Published: August 2020

Research ObjectiveWhile the entire population is aging, rural areas are aging at a faster rate and have unique barriers to accessing care. As a result, updated analyses on health care access for rural Medicare beneficiaries are necessary to design effective policies and programs to improve access and, ultimately, health outcomes. We sought to identify rural‐urban differences in access to, attitudes toward, and satisfaction with care among Medicare beneficiaries.Study DesignData from the 2016 Medicare Current Beneficiary Survey (MCBS) were used to determine differences across a range of measures (access to, attitudes toward, and satisfaction with health care) by rurality. MCBS data were weighted to account for the complex sampling design. Weighted chi‐squared tests were used to determine bivariate differences between metropolitan, rural micropolitan, and rural non‐core populations. Survey‐weighted logistic regression was used for dichotomous dependent health care variables, and survey‐weighted linear regression was used for continuous dependent health care variables to determine whether differences in health care measures by rurality remained after adjusting for age, sex, marital status, race and ethnicity, annual income, educational attainment, total number of chronic health conditions, self‐rated health, and Medicare advantage status.Population StudiedOur study sample included 10 625 Medicare beneficiaries who were 65 and older and “ever enrolled” in Medicare during the survey year.Principal FindingsIn general, satisfaction with care decreased with increasing rurality. Even after adjusting for covariates, differences in satisfaction persisted for satisfaction with ease of getting to the doctor from home (adjusted odds ratio [AOR] micropolitan: 0.63, P = 0.037; AOR non‐core: 0.61, P = 0.023) and availability of care by specialists (AOR micropolitan: 0.51, P = 0.001; AOR non‐core: 0.61, P < 0.001). Additionally, rurality was also associated with longer travel times to see providers (β micropolitan: 3.25, P = 0.022; β non‐core: 5.81, P < 0.001), and rural Medicare beneficiaries were more likely to avoid going to the doctor (AOR micropolitan: 1.61, P < 0.001; AOR non‐core: 1.71, P < 0.001) or not tell anyone if they were sick (AOR micropolitan: 1.43, P < 0.001; AOR non‐core: 1.50, P < 0.001) as compared to their urban counterparts. However, rurality did not influence whether or not Medicare beneficiaries had a usual source of care (AOR micropolitan: 0.81, P = 0.499; AOR non‐core: 0.73, P = 0.082).ConclusionsRural Medicare beneficiaries reported lower satisfaction with care than their urban counterparts across a variety of measures, and some of these differences remained after adjusting for covariates. Although all beneficiaries, regardless of rurality, had a usual source of care, rural beneficiaries experience long travel times to care and were less likely to seek care when they are sick.Implications for Policy or PracticeThese findings have implications for access to and quality of care that rural Medicare beneficiaries receive and their subsequent health outcomes. The fact that rural beneficiaries had lower satisfaction with care and were less likely to seek care indicates potential issues with the quality and acceptability of care they receive and may impact care‐seeking behavior to the determinant of continuity and health outcomes.Primary Funding SourceFederal Office of Rural Health Policy.