title: Rural health care bypass behavior: how community and spatial characteristics affect primary health care selection.
abstract: OBJECTIVE
  (1) To assess the prevalence of rural primary care physician (PCP) bypass, a behavior in which residents travel farther than necessary to obtain health care, (2) To examine the role of community and non-health-care-related characteristics on bypass behavior, and (3) To analyze spatial bypass patterns to determine which rural communities are most affected by bypass.
  
  
  METHODS
  Data came from the Montana Health Matters survey, which gathered self-reported information from Montana residents on their health care utilization, satisfaction with health care services, and community and demographic characteristics. Logistic regression and spatial analysis were used to examine the probability and spatial patterns of bypass.
  
  
  RESULTS
  Overall, 39% of respondents bypass local health care. Similar to previous studies, dissatisfaction with local health care was found to increase the likelihood of bypass. Dissatisfaction with local shopping also increases the likelihood of bypass, while the number of friends in a community, and commonality with community reduce the likelihood of bypass. Other significant factors associated with bypass include age, income, health, and living in a highly rural community or one with high commuting flows.
  
  
  CONCLUSIONS
  Our results suggest that outshopping theory, in which patients bundle services and shopping for added convenience, extends to primary health care selection. This implies that rural health care selection is multifaceted, and that in addition to perceived satisfaction with local health care, the quality of local shopping and levels of community attachment also influence bypass behavior.
authors.affiliation: Department of Sociology, Brigham Young University, Provo, Utah.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Sanders
authors.forename: Lance D
authors.initials: LD
authors.lastname: Erickson
authors.forename: Vaughn R A
authors.initials: VR
authors.lastname: Call
authors.forename: Matthew L
authors.initials: ML
authors.lastname: McKnight
authors.forename: Dawson W
authors.initials: DW
authors.lastname: Hedges
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009009:Montana; D017060:Patient Satisfaction; D010465:Perception; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D014186:Transportation; D055815:Young Adult
keywords: access to care; health services research; rural health; satisfaction with care; utilization of health services