Access to healthcare services remains a serious public health equity issue. A strategic goal of the Agency for Healthcare Research and Quality is to increase healthcare access among vulnerable groups including racial and ethnic minorities and rural populations. The Institute of Medicine also indicates that rural America is particularly unique in its struggle to provide critical access points for health care services. With recent studies documenting the growing diversification of rural communities, there is an increasing need to understand and meet the challenges of an already strained rural healthcare system. Rural racial and ethnic minority groups in particular may face increased unmet healthcare needs that they or a doctor believed were necessary. Report of timely and regular access to healthcare translates into better health outcomes, greater satisfaction, reduced costs, and decreased emergency department use. This study will investigate the influence of racial/ethnic composition of rural and urban communities and its association with access to timely healthcare, an understudied outcome in the urban/rural literature. This study directly addresses federal agency mandates and initiatives that strive to eliminate healthcare disparities. The proposed study has three aims.
Aim 1 is to understand how rurality is a predictor of racial/ethnic healthcare disparities.
Aim 2 is to understand how estimates of access to healthcare may differ depending on the rurality measurement index. Lastly, Aim 3 is to understand how the racial composition of communities, a proxy for racial segregation, is associated with access to healthcare. It is hypothesized that rural areas have greater racial segregation resulting in higher unmet healthcare needs. To test these aims, this study will use a geocoded version of the Medical Expenditure Panel Survey Household Component (2002-2010) linked to secondary data sources including the decennial census and the Area Resource File. Linking the individual MEPS respondents with other community level files provides the necessary indicators to test the three aims. This study will push health services research to broaden its focus by considering the social determinants of healthcare and will fill a critical gap by taking a comparative, multi-level approach in understanding unmet and delayed healthcare needs of various racial/ethnic groups. The proposed research will inform policy and community-level program development in order that vulnerable and marginalized groups in America have greater access to care.

Public Health Relevance

This study will explore place-based disparities in accessing healthcare, in particular, the proposal aims to understand how rural/urban geography influences access and how race/ethnicity at an individual and contextual level complicates this association. The proposal will address three aims, including rurality measurement issues, predisposing and enabling factors, and the ways in which racial composition influences access. The use of nationally representative survey data will allow providers, consumers, and policymakers throughout the United States to better target their initiatives, ensuring increased accessibility and ultimately better health outcomes among vulnerable groups.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Dissertation Award (R36)
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HSR Health Care Research Training SS (HCRT)
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Willis, Tamara
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University of California Los Angeles
Public Health & Prev Medicine
Schools of Public Health
Los Angeles
United States
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