Requests for Assistance on Health Initiatives: Update of Content in MEPS Chartbook No. 13
Medical Expenditure Panel Survey, AHRQ
Sections on Use and Expenses
This chartbook examines the differences in health care access, use, and expenses between urban and rural areas. Counties are classified along the urban-rural continuum according to whether they are metropolitan statistical areas (MSAs) and, if not, their proximity to an MSA. An MSA is a large population nucleus with a high degree of economic and social interaction. The categories along the continuum are metro (counties in an MSA), near-metro, near-rural, and rural.
Authors: Steven R. Machlin and James Kirby
Key Points: 2004-2006 vs. 1998-2000 Estimates for Civilian Noninstitutionalized Population
- The percent of persons with ambulatory care expenses was fairly similar across urban-rural categories in both 2004-2006 and 1998-2000.
- Among the non-elderly with ambulatory expenses, rural residents had an average of about one fewer visit per year than those in non-rural areas in both 2004-2006 and 1998-2000. Among the elderly, however, the pattern of lower ambulatory utilization among rural residents observed in 1998-2000 was not evident in 2004-2006.
- In both time periods, for non-elderly persons with activity limitations, living in less urban areas was associated with having fewer ambulatory visits.
- In both time periods, there was no significant variation across urban-rural categories in average annual ambulatory expenses for children under 18, but rural residents age 18-44 had lower ambulatory expenses than in other areas. On the other hand, the pattern of lower average expenses for adults age 45 and over in rural areas in 1998-2000 was not observed in 2004-2006.
- There was no significant variation across urban-rural categories in the percent of persons with expenses for prescribed medicines in either 1998-2000 or 2004-2006. The average yearly expenditure on prescription drugs for the elderly, however, was higher in the rural category than the metro category in 2004-2006. This was not the case in 1998-2000.
- The proportion of persons under age 65 with expenses for dental care was higher in the metro category than the rural category in both 1998-2000 and 2004-2006. Among individuals age 65 and over, the likelihood of having dental expenses generally declined across the urban to rural continuum in both time periods.
The urban-rural continuum is shown in Table 1.
Table 1. Urban-Rural continuum
||Percent of Population
||Metropolitan statistical area (MSA)
||Adjacent to MSA
||Not adjacent to MSA/
city of 2,500+
||Not adjacent to MSA/
no city of 2,500+
* While categories are as comparable as possible across the two time periods, the Office of Management and Budget changed its definition of metropolitan statistical area over this time period.
Expenses include payments made for care received from all sources including individuals and families (i.e., out of pocket), Medicare, Medicaid, private insurance, and other miscellaneous sources.
Health care services are categorized according to reports by survey respondents.
Ambulatory services include visits to medical providers seen in office-based settings or clinics, hospital outpatient departments, and clinics owned and operated by hospitals.
Prescription medicines include all that were initially purchased or refilled during the year as well as diabetic supplies (some of which may have been purchased without a prescription). Dental services capture any type of dental care, including services provided by general dentists, dental hygienists, dental technicians, dental surgeons, orthodontists, endodontists, and periodontists.
Activity limitations include having an ADL (activity of daily living) limitation such as needing help with bathing or dressing; an IADL (instrumental activity of daily living) limitation such as needing help with shopping or laundry; physical difficulty such as problems climbing stairs, walking, or lifting objects; or vision or hearing impairment.
Figures: 2004-2006 Estimates for Civilian Noninstitutionalized Population
- Among the non-elderly population, about 7 of every 10 persons in metro, near-metro, and near-rural areas had ambulatory expenses (Figure 1). However, the proportion with expenses for ambulatory care was slightly higher in the rural group (75.0%) than in metro areas (69.2%).
- Regardless of urban-rural category, over 90 percent of elderly people had ambulatory expenses.
- Among non-elderly persons with an ambulatory expense, residents of rural counties had an average of about six ambulatory visits per year-about one fewer than the average for other types of areas (Figure 2).
- Among the elderly with ambulatory expenses, residents of near-rural areas had an average of 10.3 visits per year, which was significantly lower than in near-metro (12.2) or metro areas (13.0).
- Among non-elderly people with ambulatory expenses, those in rural counties had a lower average number of ambulatory care visits than residents of more urban places (Figure 3). This pattern was especially pronounced for people with at least one activity limitation.
- For the non-elderly with at least one limitation and some expenses for ambulatory care, the estimated average number of visits was significantly lower in rural counties (9.5) than in metro (12.2) or near-metro counties (13.5).
- For the non-elderly with no limitations and some expenses for ambulatory care, the average number of ambulatory visits in rural counties (4.5) was about one fewer than in other types of counties.
- Similar comparisons for the elderly are not shown because of limited sample size for the rural group.
- For both non-elderly and elderly persons with ambulatory expenses, average annual expenses for ambulatory care did not differ significantly across most urban-rural subgroups (Figure 4).
- While there was no significant variation across categories among persons under 65 in the aggregate (Figure 4), Figure 5 shows that people age 18-44 in rural counties had lower average ambulatory expenses ($869) than those in the other categories ($1,194-$1,349).
- Average ambulatory expenses for children under 18 and persons age 45-64 with expenses did not vary significantly across the urban-rural categories.
- In all of the urban-rural categories, over 90 percent of elderly residents had expenses for prescribed medicines (Figure 6).
- Non-elderly residents of metro counties were slightly less likely to have expenses for prescribed medicine (57.9%) than those living in other types of counties (62.3%-68.1%).
- Among the non-elderly with expenses for prescribed medicines, annual per-person expenses were slightly lower for metro residents ($923) than for near-metro ($1,074) or rural residents ($1,140), as shown in Figure 7.
- Among elderly people with prescription expenses, the average annual expense per person was significantly higher for persons in rural areas ($2,630) than in near-rural ($1,948) or metro areas ($2,074).
- For each urban-rural category, the average annual prescription medicine expense among those with such expenses was at least twice as high for elderly as non-elderly people.
- Among the non-elderly, a significantly higher proportion of metro county residents (43.0%) than residents of near-metro (37.8%) or rural counties (34.1%) had dental expenses (Figure 8).
- Among individuals 65 and over, the likelihood of having dental expenses was highest in metro counties (44.3%).
Current as of April 2009
Health Care in Urban and Rural Areas, Combined Years 2004-2006. Requests for Assistance on Health Initiatives: Update of Content in MEPS Chartbook No. 13. Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/data/meps/chbook13up.htm