THE USE OF HEALTH-CARE SERVICES BY PEOPLE WITH DIABETES IN RURAL-AREAS

Current standards of health care support the view that diabetes call b e managed in an outpatient setting, thereby preventing costly hospital ization. Yet, recent studies on access to cave suggest that rural resi dents do not receive the same services for diabetes care as their urba n counterparts. This study identifies differences in use for three typ es of services hospital care, home health visits, and physician office visits -by geographical location. Using It sample of 6,698 Medicare b eneficiaries, the authors performed multivariate analysis of variance to test the influence of,geographical differences on each type of serv ice use after controlling for the other types of service use and indiv idual factors. Results showed significant differences among the geogra phical categories, with diabetic individuals in the most sparsely popu lated communities reporting fewer physician office visits and more hom e health visits than their urban counter parts. Because this pattern m ay have a negative impact on health outcomes, additional research is n eeded to determine the optimal array of services necessary to manage c hronic diseases, such as diabetes, in rural areas.