Equity in Rural Health and Health Care

  • Lu Ann Aday
  • Beth E. Quill
  • Cielito C. Reyes-Gibby

Abstract

This chapter assesses the equity of rural health and health care delivery. It presents a conceptual framework and normative and empirical criteria for measuring equity; reviews major federal and state policy initiatives to enhance equity; assembles current evidence regarding the extent to which equity has actually been achieved; and presents alternative models of rural health care programs and policy for enhancing equity.

Keywords

Emergency Medical Service Urban Resident Rural Resident Community Health Center Rural Health 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Aday, L. A. (1993). At risk in America: The health and health care needs of vulnerable populations in the United States. San Francisco: Jossey-Bass.Google Scholar
  2. Aday, L. A., and Andersen, R. (1981). Equity of access to medical care: A conceptual and empirical overview. Medical Care, 19 (Supplement) 4–27.CrossRefGoogle Scholar
  3. Aday, L. A., Andersen, R., and Fleming, G. (1980). Health care in the U.S.: Equitable for whom? Beverly Hills: Sage.Google Scholar
  4. Aday, L. A., Begley, C. E., Lairson, D. R., and Slater C. H. (1998). Evaluating the healthcare system: Effectiveness, efficiency, and equity ( 2nd ed. ). Chicago: Health Administration Press.Google Scholar
  5. Agency for Health Care Policy and Research. (1991). Delivery of essential health care services in rural areas: An analysis of alternative models. Rockville, MD: U.S. Department of Health and Human Services.Google Scholar
  6. Agency for Health Care Policy and Research. (1998). Characteristics of nursing home residents, 1996. MEPS Research Findings No. 5. (AHCPR Pub. No. 99–0006 ). Washington, DC: U.S. Government Printing Office.Google Scholar
  7. American Medical Association. (1999). Physician characteristics and distribution in the U.S. Chicago: American Medical Association.Google Scholar
  8. American Public Health Association. (1999, October). Rural hospitals receive means to improve care. The Nation’s Health, 29 (9), p. 24.Google Scholar
  9. Blazer, D. G., Landerman, L. R., Fillenbaum, G., and Homer, R. (1995). Health services access and use among older adults in North Carolina: Urban vs. rural residents. American Journal of Public Health, 85 (10), 1384–90.PubMedCrossRefGoogle Scholar
  10. Braden, J. J., and Beauregard, K. (1994). Health status and access to care of rural and urban populations. Rockville, MD: U.S. Public Health Service.Google Scholar
  11. Brooks, E. E, Bernstein, J. D., DeFriese, G. H., and Graham, R. M. (1981). New health practitioners in rural satellite health centers: The past and future. Journal of Community Health, 6 (4), 246–56.PubMedCrossRefGoogle Scholar
  12. Bushy, A. (1998). Health issues of women in rural environments: An overview. Journal of American Medical Women’s Association, 53 (2), 53–56.Google Scholar
  13. Casey, M. M., Wellever, A., and Moscovice, I. (1997). Rural health network development: Public policy issues and state initiatives. Journal of Health Politics, Policy, and Law, 22 (1), 23–49.Google Scholar
  14. Cheh, V., and Thompson, R. (1997). Rural health clinics: Improved access at a cost. Baltimore, MD: Office of Research and Demonstrations, Health Care Financing Administration.Google Scholar
  15. Cook, H. L., Goeppinger, J., Brunk, S. E., Price, L. J., Whitehead, T. L., and Sauter, S. V. (1985). A reexamination of community participation in health: Lessons from three community health projects. Family and Community Health, 11 (2), 1–13.CrossRefGoogle Scholar
  16. Coward, R. T., and Cutler, S. J. (1989). Informal and formal health care systems for the rural elderly. Health Services Research, 23 (6), 785–806.PubMedGoogle Scholar
  17. Daly, M. (Ed.). (1994). Communitarianism: A new public ethics. Belmont, CA: Wadsworth.Google Scholar
  18. De Lew, N., Greenberg, G., and Kinchen, K. (1992). A layman’s guide to the U.S. health care system. Health Care Financing Review, 14 (1), 151–169.PubMedGoogle Scholar
  19. Economic Research Service. (1998). Appendix Table 2: Metro and non-metro labor force and unemployment by demographic group. Rural Conditions and Trends, 8 (2), 97.Google Scholar
  20. Fordyce, E. J., Thomas, P., and Shum, R. ( 1997 April-June). Evidence of an increasing AIDS burden in rural America. Statistical Bulletin-Metropolitan Insurance Companies, 78 (2), 2–9.Google Scholar
  21. Frenzen, P. (1997). How will measures to control Medicare spending affect rural communities? Agriculture Information Bulletin, 734, 1–10.Google Scholar
  22. Garrett, D. K. (1995). Mobile access: Opening health care doors. Nursing Management, 26, 29–33.PubMedGoogle Scholar
  23. Green, L. W. (1986). Theory of participation: A qualitative analysis of its expressions in national and international health policies. In W. B. Ward, Z. T. Salisbury, S. B. Kar, and J. G. Kapka (Eds.), Advances in health promotion, Vol. 1 (pp. 215–240 ). Greenwich, CT: JAI Press.Google Scholar
  24. Habermas, J. (1996). Between facts and norms: Contributions to a discourse theory of law and democracy (W. Rehg, Trans.). Cambridge, MA: MIT Press.Google Scholar
  25. Heins, H. C., Nance, N. W., and Ferguson, J. E. (1987). Social support in improving perinatal outcome: The resource mothers program. Obstetrics and Gynecology, 70 (2), 263–6.PubMedGoogle Scholar
  26. Hornberger, C. A., and Cobb, A. K. (1998). A rural vision of a healthy community. Public Health Nursing, 15 (5), 363–369.PubMedCrossRefGoogle Scholar
  27. Hoyt, D. R., Conger, R. D., Valde, J. G., and Wiehs, K. (1997). Psychological distress and help seeking in rural America. American Journal of Community Psychology, 25 (4), 449–70.PubMedCrossRefGoogle Scholar
  28. Hwang, H. C., Stallones, L., and Keefe, T. J. (1997). Childhood injury deaths: Rural and urban differences in Colorado 1980–1988. Injury Prevention, 3, 35–37.PubMedCrossRefGoogle Scholar
  29. Kolimaga, J., Konrad, T., and Ricketts, T. (1994). Does subsidizing rural community health centers hurt private practice physicians? Journal of Health Care for the Poor and Underserved, 5, 121–141.CrossRefGoogle Scholar
  30. Kukulka, G., Christianson, J. B., Moscovice, I. S., and DeVries, R. (1994). Community oriented primary care in a brave new world. Archives of Family Medicine, 3, 493–494.CrossRefGoogle Scholar
  31. Long, K. A., and Weinert, C. (1989). Rural nursing: Developing the theory base. Scholastic Inquiries in Nursing Practice, 3 (2), 113–27.Google Scholar
  32. Mainous, A. G., and Kohrs, F. P. (1995). A comparison of health status between rural and urban adults. Journal of Community Health, 20 (5), 423–431.PubMedCrossRefGoogle Scholar
  33. Maningas, P. A. (1991). Emergency medical services in rural America: New solutions to urgent needs. Rockville, MD: Federal Office of Rural Health Policy, 3–7.Google Scholar
  34. McDowell, S. H. (1997). Market reform and managed care: Implications for rural communities. Rockville, MD: Federal Office of Rural Health Policy.Google Scholar
  35. Michielutte, R., Dignan, M. B., Sharp, P. C., Boxley, J., and Wells, H. B. (1996). Skin cancer prevention and early detection practices in a sample of rural women. Preventive Medicine, 25 (6), 673–83.PubMedCrossRefGoogle Scholar
  36. Moscovice, I. (1989). Rural hospitals: A literature synthesis and health services research agenda. Health Services Research, 23 (6), 891–930.PubMedGoogle Scholar
  37. Moscovice, I., and Nestegard, M. (1980). The influence of values and background on the location decision of nurse practitioners. Journal of Community Health, 5 (4), 244–53.PubMedCrossRefGoogle Scholar
  38. Moscovice, I. S., and Rosenblatt, R. A. (1982). Rural health care delivery amidst federal retrenchment: Lessons from the Robert Wood Johnson Foundation’s Rural Practice Project. American Journal of Public Health, 72 (12), 1380–1385.PubMedCrossRefGoogle Scholar
  39. Moscovice, I., Cristianson, J., Johnson, J., Kralewski, J., and Manning, W. (1995). Building rural hospital networks. Ann Arbor, MI: Health Administration Press.Google Scholar
  40. Mulhall, S., and Swift, A. (1992). Liberals and communitarians. Oxford, UK: Blackwell.Google Scholar
  41. Myrick, J. A., Bonnie, B. J., Kishbaugh, D., Pittman, J. V., and Sayford, N. F. (1983). Acceptance of a volunteer first-responder system in rural communities: A field experiment. Medical Care, 21 (4), 389–99.PubMedCrossRefGoogle Scholar
  42. Napolitano, M., and Goldberg, B. W. (1998). Migrant health. In S. Loue (Ed.), Handbook of Immigrant Health (pp. 261–276 ). New York: Plenum.Google Scholar
  43. National Association of Community Health Centers. (1988). Health Care in Rural America: The Crisis Unfolds. Washington, DC: National Association of Community Health Centers.Google Scholar
  44. National Association of Community Health Centers. (1994). A National Survey of Patient Experiences in Community and Migrant Health Centers: Key points. Washington, DC: National Association of Community Health Centers.Google Scholar
  45. National Center for Health Statistics. (1979). Small area estimation: An empirical comparison of conventional and synthetic estimators for states. (DHEW Publication No. PHS 80–1356). Vital and Health Statistics Series 2, No. 82. Washington, DC: U.S. Government Printing Office.Google Scholar
  46. National Center for Health Statistics. (1994). Advance Data 244: Nursing Homes and Board and Care Homes. (DHHS Publication No. PHS 94–1250 ). Hyattsville, MD: Public Health Service.Google Scholar
  47. National Center for Health Statistics. (1997). Health, United States, 1996–97, and Injury Chartbook. Hyattsville, MD: Public Health Service.Google Scholar
  48. National Center for Health Statistics. (1999a). Current estimates from the National Health Interview Survey, 1996. (DHHS Publication No. PHS 99–1528). Vital and Health Statistics Series 10, No. 200. Hyattsville, MD: Public Health Service.Google Scholar
  49. National Center for Health Statistics. (1999b). Health, United States, 1999, with Health and Aging Chartbook. Hyattsville, MD: Public Health Service.Google Scholar
  50. National Rural Health Association. (1996). The rural homeless: America’s lost population. Kansas City: National Rural Health Association.Google Scholar
  51. National Rural Health Association. (1997). Community solutions for rural health: An empowerment initiative for rural communities. Kansas City: National Rural Health Association.Google Scholar
  52. Norman, E. H., Bordley, W. C., Hertz-Picciotto, I., and Newton, D. A. (1994). Rural-urban blood lead differences in North Carolina children. Pediatrics, 94 (1), 59–64.PubMedGoogle Scholar
  53. Office of Rural Health Policy. (1997a). Rural health dictionary of terms, acronyms, and organizations, 1997. Rockville, MD: Office of Rural Health Policy.Google Scholar
  54. Office of Rural Health Policy. (1997b). Facts about rural physicians. Rockville, MD: Office of Rural Health Policy.Google Scholar
  55. Office of Rural Health Policy. (1997c). Exploratory evaluation of rural applications of telemedicine. Rockville, MD: Office of Rural Health Policy.Google Scholar
  56. Office of Technology Assessment. (1990). Health care in rural America. Washington, DC: Congress of the United States.Google Scholar
  57. Orloff, T. M., and Tymann, B. (1995). Rural health: An evolving system of accessible services. Washington, DC: National Governors’ Association.Google Scholar
  58. Pearson, T. A., and Lewis, C. (1998). Rural epidemiology: Insights from a rural population laboratory. American Journal of Epidemiology, 148 (10), 94957.Google Scholar
  59. Perlstadt, H., and Kozak, L. J. (1977). Emergency medical services in small communities: Volunteer ambulance corps. Journal of Community Health, 2 (3), 178–88.PubMedCrossRefGoogle Scholar
  60. Powers, J. G., and Byrd, T. (1998). U.S.-Mexico border health: Issues for regional and migrant populations. Thousand Oaks, CA: Sage.Google Scholar
  61. Puskin, D. S. (1995). Opportunities and challenges to telemedicine in rural America. Journal of Medical Systems 19 (1), 59–67.PubMedCrossRefGoogle Scholar
  62. Ramsey, P., Edwards, J., Lenz, C., Odom, J. E., and Brown, B. (1993). Types of health problems and satisfaction with services in a rural nurse-managed clinic. Journal of Community Health Nursing, 10 (3), 16170.CrossRefGoogle Scholar
  63. Rural Health Research Center. (1997). Rural managed care patterns and prospects, 1997. Minneapolis: University of Minnesota School of Public Health.Google Scholar
  64. Stratton, T. D., Dunkin, J. W., and Juhl, N. (1995). Redefining the nursing shortage: A rural perspective. Nursing Outlook, 43 (2), 71–7.PubMedCrossRefGoogle Scholar
  65. Svenson, J. E., Spurlock, C., and Nypaver, N. (1995). Factors associated with the higher traumatic death rate among rural children. Annals of Emergency Medicine, 27 (5), 625–632.CrossRefGoogle Scholar
  66. Thomas, J. C., Kulick, A. L., and Schoenbach, V. J. (1995). Syphilis in the South: Rural rates surpass urban rates in North Carolina. American Journal of Public Health, 85 (8), 1119–1122.PubMedCrossRefGoogle Scholar
  67. Thorpe, K. E. and Florence, C. S. (1999). Covering uninsured children and their parents: Estimated costs and number of newly insured. Medical Care Research and Review, 56 (2), 197–214.PubMedCrossRefGoogle Scholar
  68. Travers, K. L., Ellis, R. B., and Dartt, L. A. (1995). Comparison of the rural health clinic and federally qualified health center programs. Rockville, MD: Office of Rural Health Policy.Google Scholar
  69. U.S. Department of Health and Human Services. (1987). Work group on rural hospitals. Executive summary of final report on rural hospital strategies. Rockville, MD: Health Resources and Services Administration.Google Scholar
  70. U.S. Department of Health and Human Services. (1991). Health personnel in the United States: Eighth report to Congress. (DHHS Pub. No HRS-P-OD-921). Rockville, MD: Health Resources and Services Administration.Google Scholar
  71. U.S. Health Corporation. (1994). U.S. Health Corporation’s healthy community initiative: The healthy community assessment process. Columbus, OH: U.S. Health Corporation.Google Scholar
  72. Wallerstein, N. (1992). Powerlessness, empowerment, and health: Implications for health promotion programs. American Journal of Health Promotion, 6, 197–205.PubMedCrossRefGoogle Scholar
  73. Wallerstein, N., and Bernstein, E. (1994). Introduction to community empowerment, participatory education, and health. Health Education Quarterly, 21, 14148.Google Scholar
  74. Weil, A. (1997). The new children’s health insurance program: Should states expand Medicaid? Washington, DC: The Urban Institute, Series A, No. A-13.Google Scholar
  75. Weisgrau, S., and Rosenberg, S. (1993a). Independent networks. Vol. 4 of Alternative models for organizing and delivering health care services in rural areas. Princeton, NJ: Robert Wood Johnson Foundation.Google Scholar
  76. Weisgrau, S., and Rosenberg, S. (1993b). State-sponsored alternative models: Experiences of participating providers. Vol. 3 of Alternative models for organizing and delivering health care services in rural area. Princeton, NJ: Robert Wood Johnson Foundation.Google Scholar
  77. Wellever, A., and Rosenberg, S. (1993a). A taxonomy of model types. Vol. 1 of Alternative models for organizing and delivering health care services in rural area. Princeton, NJ: Robert Wood Johnson Foundation.Google Scholar
  78. Wellever, A., and Rosenberg, S. (1993b). State-sponsored alternative models: The state government perspective. Vol. 2 ofAlternative models for organizing and delivering health care services in rural areas. Princeton, NJ: Robert Wood Johnson Foundation.Google Scholar
  79. Whitehead, M. (1992). The concepts and principles of equity and health. International Journal of Health Services, 22, 429–45.PubMedCrossRefGoogle Scholar
  80. World Health Organization Healthy Cities Project. (1988). A guide to assessing healthy cities. (WHO Healthy Cities Paper No. 3 ). Copenhagen: Association of Danish Medical Students Publishing House.Google Scholar
  81. Wysong, J. A., Bliss, M. K., Osborne, J. W., Graham, R. P., and Pikuzinski, D. A. (1999). Managed care in rural markets: Availability and enrollment. Journal of Health Care for the Poor and Underserved, 10 (1): 72–84.PubMedCrossRefGoogle Scholar
  82. Zimmerman, M. A. (1990). Citizen participation in rural health: A promising resource. Journal of Public Health Policy, 11 (3), 323–340.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Lu Ann Aday
    • 1
  • Beth E. Quill
    • 1
  • Cielito C. Reyes-Gibby
    • 1
  1. 1.University of Texas School of Public HealthHoustonUSA

Personalised recommendations