Lack Of Access To Specialists Associated With Mortality And Preventable Hospitalizations Of Rural Medicare Beneficiaries

Health Aff (Millwood). 2019 Dec;38(12):1993-2002. doi: 10.1377/hlthaff.2019.00838.


People living in rural areas have worse health outcomes than their urban counterparts do. Understanding what factors account for this could inform policy interventions for reducing rural-urban disparities in health. We examined a nationally representative survey of Medicare beneficiaries with one or more complex chronic conditions, which represented 61 percent of rural and 57 percent of urban Medicare beneficiaries. We found that rural residence was associated with a 40 percent higher preventable hospitalization rate and a 23 percent higher mortality rate, compared to urban residence. Having one or more specialist visits during the previous year was associated with a 15.9 percent lower preventable hospitalization rate and a 16.6 percent lower mortality rate for people with chronic conditions, after we controlled for having one or more primary care provider visits. Access to specialists accounted for 55 percent and 40 percent of the rural-urban difference in preventable hospitalizations and mortality, respectively. Medicare should consider interventions for rural beneficiaries who lack access to specialist care to reduce rural-urban disparities in health outcomes.

Keywords: Access to care; Activities of daily living; Education; Health policy; Health savings accounts; Medicare savings programs; Mortality rates; Patient engagement; Populations; Preventable hospitalization; Rural health care; medicare; mortality.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Chronic Disease
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Medicare / statistics & numerical data*
  • Mortality / trends*
  • Rural Population / statistics & numerical data*
  • Specialization / statistics & numerical data*
  • United States