Differences in access to outpatient medical care for black and white adults in the rural South.
OBJECTIVE
We compared black and white adults in the rural South on multiple indicators of access to outpatient medical care and assessed whether any differences might be explained by group differences in socioeconomic situations or proximity to medical resources.


METHODS
Cross-sectional telephone survey.


METHODS
Survey respondents were 1237 black and 2158 white adults from 113 rural counties in 6 southern states.


METHODS
Blacks and whites were compared on a variety of commonly used survey measures of access, some followed in the Healthy People 2010 Initiative. Access comparisons were adjusted for age, gender, and health status and then reassessed with adjustments for individual socioeconomic indicators and county medical resources: physician-to-population ratios, the presence of hospitals and federally qualified health centers, and urban adjacency.


RESULTS
Compared with whites, blacks reported similar or higher use of outpatient services over the previous year, including the likelihood of having had an outpatient physician visit and regular checkup. Nevertheless, blacks more often reported forgoing needed care, encountering various barriers, and experiencing dissatisfaction with some aspects of care. Adjusting for socioeconomic factors generally reduced but did not eliminate black-white access differences, whereas adjusting for county medical care resources did not affect measured group differences.


CONCLUSIONS
Blacks and whites in the rural South report similar use rates of outpatient medical care, but blacks more often report unmet needs, barriers to care, and dissatisfaction with care. Beyond socioeconomic differences, black versus white differences in sites of care, the quality of care received, the quality of interactions with providers, and expectations for their care may explain group reported access differences.
Pathman
Donald E
DE
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina 27599-7590, USA. don_pathman@unc.edu
Fowler-Brown
Angela
A
Corbie-Smith
Giselle
G
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000208:ethnology; D011314:Preventive Health Services / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012959:Socioeconomic Factors; D015144:Southeastern United States; D044465:White People / Q000706:statistics & numerical data*