Rural-urban differences in usual source of care and ambulatory service use: analyses of national data using Urban Influence Codes

Med Care. 2003 Jul;41(7 Suppl):III65-III74. doi: 10.1097/01.MLR.0000076053.28108.F2.


Background: Rural-urban disparities in access to and utilization of medical care have been a long-standing focus of concern.

Objective: Using the nine-category Urban Influence Codes, this study examines the relationship between place of residence and having access and utilization of ambulatory health services.

Research design: Data come from the Medical Expenditure Panel Survey, conducted in 1996. Linear and logistic regression analyses assess the relationship between county type and having a usual source of care and ambulatory visits, controlling for demographic and health status measures.

Results: Residents of counties that were totally rural were more likely to report having a usual source of care (adjusted OR: 1.98; CI: 1.01, 3.89) than residents of large metropolitan counties. Residents of places without a city of 10,000 or more, but adjacent to a metropolitan area, were also more likely to report having a usual source of care (adjusted OR: 1.92; CI: 1.16, 3.22). In a regression analysis, residents of the most rural places reported fewer visits during the year (B = -2.42, CI: -3.68, -1.32).

Conclusions: Results suggest that using rural and urban definitions that go beyond the traditional dichotomy of metropolitan and non-metropolitan may assist policymakers and researchers in identifying types of places where there is a disparity in access and subsequent utilization of health care. Rural residents, defined as totally rural in the urban influence coding scheme, may report having a health care provider but report fewer visits to health care providers during a year.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care / statistics & numerical data*
  • Continuity of Patient Care / statistics & numerical data
  • Demography
  • Family Characteristics
  • Geography
  • Health Care Surveys / methods*
  • Health Services Accessibility / classification
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Interviews as Topic
  • Logistic Models
  • Middle Aged
  • Regression Analysis
  • Residence Characteristics
  • Rural Health Services / statistics & numerical data*
  • United States
  • Urban Health Services / statistics & numerical data*