Factors Influencing Rural Residents’ Utilization of Urban Hospitals
"Objective—To examine, using nationally representative data, which patient, hospital, and county characteristics influence rural residents’ urban hospitalization.

Methods—Rural residents hospitalized in urban hospitals (crossovers) are compared with those hospitalized in rural hospitals (noncrossovers). National Hospital Discharge Survey data were merged with Area Resource File and Centers for Medicare & Medicaid Services data to study rural inpatients’ characteristics; hospital descriptors; and county or state socioeconomic and health service variables. Multivariate logistic regression analysis identified covariates of the likelihood of being a crossover.

Findings—About one-third of the rural resident hospitalizations in 2003 were in urban hospitals. Other factors constant, those requiring greater resources had higher odds of crossing over, as did younger inpatients, those transferred from other hospitals, receiving surgery, and with mental diagnoses or congenital anomalies. Males, emergency admissions, and intervertebral disk disorder inpatients had lower odds of crossing over compared with those who were not in these categories. Crossover patients’ hospitals had higher Medicare case mix indices than hospitals used by noncrossovers. Rural inpatients in government hospitals, rather than proprietary or non-profit hospitals, had greater odds of crossing over, as did rural patients from counties with lower population density, fewer hospital beds, more hospitals, more commuters, and lower per capita income compared with those in other categories.

Conclusions—Rural hospitals continue to be an important source of inpatient care, but rural residents travel to urban hospitals in some specific instances."

Health Status and Health Care Access of Farm and Rural Populations
"Rural residents have higher rates of age-adjusted mortality, disability, and chronic disease than their urban counterparts, though mortality and disability rates vary more by region than by metro status. Contributing negatively to the health status of rural residents are their lower socioeconomic status, higher incidence of both smoking and obesity, and lower levels of physical activity. Contributing negatively to the health status of farmers are the high risks from workplace hazards, which also affect other members of farm families who live on the premises and often share in the work; contributing positively are farmers’ higher socioeconomic status, lower incidence of smoking, and more active lifestyle. Both farm and rural populations experience lower access to health care along the dimensions of affordability, proximity, and quality, compared with their nonfarm and urban counterparts."

Hard Times in the Heartland: Health Care in Rural America
"Health and Human Services Secretary Kathleen Sebelius today released a new report, Hard Times in the Heartland: Health Care in Rural America, outlining the health care challenges facing rural communities. The report was developed by HHS staff from across the department and comes on the same day Director of the White House Office of Health Reform Nancy-Ann DeParle, HRSA Administrator Mary Wakefield, and Representative Mike Ross will hold a meeting with Americans from rural communities as part of the ongoing series of White House Health Care Stakeholder Discussions. The report is available at www.HealthReform.gov. Today’s White House Health Care Stakeholder Discussion will be Webcast live on www.WhiteHouse.gov and www.HealthReform.gov at 10:00 a.m. EDT.

“Americans in rural communities have seen their premiums skyrocket and are finding it difficult, if not impossible to get the care they need,” Secretary Sebelius said. “Today’s report confirms that we cannot wait to enact comprehensive health reform.”

Hard Times in the Heartland indicates that nearly 50 million people in rural America face challenges accessing health care. Not only do these Americans face higher rates of poverty, they report more health problems, are more likely to be uninsured, and have less access to a primary health care providers than do Americans living in urban areas. The report notes:

* Nearly one in five of the uninsured -- 8.5 million people -- live in rural areas.
* Rural residents pay on average for 40 percent of their health care costs out of their own pocket, compared with the urban share of one-third.
* In a multi-state survey, one in five insured farmers had medical debt.."