Access to care in rural areas is often a problem. Some studies have found that rural residents are less likely to seek preventive care such as vaccinations in part due to the need to travel long distances to get primary care. Even if rural residents do access their primary care physician (PCP), however, are they able to access specialist care as well?
A paper by Geissler (2020) aims to answer this question. Using data from the 2005-2016 National Ambulatory Medical Care Survey (NAMCS), they find that:
A PCP visit was 1.9 percentage points (95% confidence interval: 0.1 pp, 3.8 pp) more likely to result in a referral in nonrural areas than rural areas, controlling for physician and patient characteristics, a 17 percent increase. This difference is driven by a widening gap in referral rates between nonrural and rural areas over time, with large differences in later periods. The regression‐adjusted predicted probability of a PCP visit resulting in a referral was 71 percent higher in nonrural than rural areas in 2013‐2014 and 92 percent higher in 2015‐2016.
The authors admit that there is no clear optimum referral rate. However, it seems clear that rural residents are not able to access high-quality specialist care to the same degree that their urban counterparts are.
- Geissler, Kimberley H. “Differences in referral patterns for rural primary care physicians from 2005 to 2016.” Health Services Research (2019).