Access to care for rural Medicare beneficiaries

This paper examines variations between urban and rural Medicare beneficiari es in three measures of access to care: self-reported access to care, satis faction with care received and use of services. The assessment focuses on t hese measures and their relationship to adjacency to metropolitan areas. Co mparisons are also provided for the relative effects of adjacency versus br oader access barriers such as income. Data from the 1993 Medicare Current B eneficiary Survey are used. The analyses offer several new perspectives on access in rural areas. First, as perceived by respondents, rural residence does not indicate access problems; instead, Medicare beneficiaries in rural counties that are adjacent to urban areas and that have their own city of at least 10,000 people report higher levels of satisfaction and fewer self- reported access problems than do residents of urban counties. These results may stem either from differences in rural residents' expectations regardin g access or willingness to accept appropriate substitutions. Preventive vac cination rates in rural areas are on par with or better than rates by benef iciaries in urban areas. The only services where utilization in rural areas was limited relative to urban areas were preventive cancer screening for w omen and dental care. Development of policies to address these specific ser vice gaps may be warranted. Low income has a more pervasive and problematic relationship to self-reported access, satisfaction and utilization than do es rural residence per se.