Rural-urban differences in health care expenditures and the influenced factors

Research Objective: This study sought to address whether and to what extent there are rural-urban differences in the healthcare expenditures. Additionally, this study explored what characteristics of urban and rural populations related to their expenditures on hospital outpatient, hospital inpatient, and home health care. Study Design: A two-part model was used to compare expenditures and percentage of zero users in rural areas with those in urban areas. Two multinomial regression models were conducted to examine the influenced factors of healthcare expenditures for urban and rural populations, respectively. To account for the complex multi-stage sample design, all analyses were weighted to produce national statistics based on a person-level weight variable generated by the Agency for Healthcare Research and Quality (AHRQ). Population Studied: This secondary data analysis used the 2009 Medical Expenditure Panel Survey (MEPS) data set, a nationally representative survey of the U.S. civilian noninstitutionalizd population. Excluding people under 18 years old and who did not complete the survey, the final sample is composed of 26,008 adults representing 229,283,460 national population. Principal Findings: Overall, there are 15.96 percent of samples from rural areas. Urban-rural differences in expenditures were small across all and within each type of service. There are higher percentages of zero users among urban populations. Urban populations averaged higher in total healthcare expenditures than rural populations after controlling for demographics, care needs, and enabling factors. Age, gender, race, education, insurance, and health conditions influenced the expenditures of urban populations while age, gender, race, marital status, insurance, and several health-related factors influence the expenditures of rural populations. Conclusions and Implications: The hypothesis that expenditures for rural populations would be substantially more than their metropolitan counterparts due to their worse health conditions was not proved. Even though there are fewer nonzero users in urban areas, higher cost of keeping healthy could be the driver of their high expenditures. The healthcare expenditures in the United States have been rising in the past three decades and expected to grow even faster nowadays. For people already receiving care, the quality of care received should be further analyzed. As to better serve uninsured and ill populations, it is imperative to recognize whether the price of care is affordable and whether the services they need are accessible. Greater coordination among rural community hospitals is also important to tackle challenges due to geographic location, small size, limited workforce, and constrained financial resources.