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J Rural Health. 2004 Summer;20(3):193-205.

Disparities in access to care among rural working-age adults.

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Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.



Nationally, minority population disparities in health and in the receipt of health services are well documented but are infrequently examined within rural populations.


The purpose of this study is to provide a national picture of health insurance coverage and access to care among rural minorities.


A cross-sectional analysis using the 1999-2000 National Health Interview Surveys examined insurance status and receipt of ambulatory care during the past year. Multiple logistic regression was used to measure factors influencing the odds of insurance coverage and a provider visit.


Among rural minority adults, 32% of blacks, 35% of "other" race persons, and 45% of Hispanics were uninsured compared to 18% of whites. Differences in insurance status were not significant for rural blacks and Hispanics after resources such as education, income, and employment were held constant. Examining use, 37% of rural Hispanics and 27% of blacks, versus 20% of whites and 19% of persons of other race, had not made a health care visit in the past year. When resources were held constant, blacks and persons of other race/ethnicity no longer differed from whites, but differences among Hispanics persisted.


A comprehensive approach to the health needs of rural working age adults must consider the unique characteristics of rural communities and populations, requiring cultural as well as financial creativity in the design of health delivery systems. The importance of resources such as education and employment points to the need to link health problems to area-specific rural economic development.

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