title: Rural-Urban Differences in Access to Preventive Health Care Among Publicly Insured Minnesotans.
abstract: Reduced access to care and barriers have been shown in rural populations and in publicly insured populations. Barriers limiting health care access in publicly insured populations living in rural areas are not understood. This study investigates rural-urban differences in system-, provider-, and individual-level barriers and access to preventive care among adults and children enrolled in a public insurance program in Minnesota.
  
  
  
  This was a secondary analysis of a 2008 statewide, cross-sectional survey of publicly insured adults and children (n = 4,388) investigating barriers associated with low utilization of preventive care. Sampling was stratified with oversampling of racial/ethnic minorities.
  
  
  
  Rural enrollees were more likely to report no past year preventive care compared to urban enrollees. However, this difference was no longer statistically significant after controlling for demographic and socioeconomic factors (OR: 1.37, 95% CI: 1.00-1.88). Provider- and system-level barriers associated with low use of preventive care among rural enrollees included discrimination based on public insurance status (OR: 2.26, 95% CI: 1.34-2.38), cost of care concerns (OR: 1.72, 95% CI: 1.03-2.89) and uncertainty about care being covered by insurance (OR: 1.70, 95% CI: 1.01-2.85). These and additional provider-level barriers were also identified among urban enrollees.
  
  
  
  Discrimination, cost of care, and uncertainty about insurance coverage inhibit access in both the rural and urban samples. These barriers are worthy targets of interventions for publicly insured populations regardless of residence. Future studies should investigate additional factors associated with access disparities based on rural-urban residence.
authors.affiliation: Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: John
authors.initials: J
authors.lastname: Loftus
authors.affiliation: Department of Public Health, St. Catherine University, St. Paul, Minnesota.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Allen
authors.affiliation: School of Public Health, Division of Health Policy & Management, and SHADAC, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Kathleen Thiede
authors.initials: KT
authors.lastname: Call
authors.affiliation: Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota.|Department of Medicine, and Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Everson-Rose
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011315:Preventive Medicine / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: access to health care; health disparities; preventive health care; public health insurance; rural health