Dynamic landscapes of health care access in the United States: evaluating urban-rural differences in availability, accessibility, and utilization

Receiving health care in the U.S. is complex. Patients must find a provider, confirm insurance acceptance, ensure the needed care is available, and travel to the facility. Navigating such factors become more difficult when hospitals close, providers are scarce, or a patient has no insurance, issues more likely to occur in rural areas compared to urban areas, where services and specialists are more abundant. It is difficult to analyze these changes in the health care industry because data is often not shared or complete. To explore how changes in provider and service availability affect access, I examined three cases: 1) hospital-based cardiac care, 2) breast cancer screening, and 3) diabetic foot ulcer treatment.

Hospital surveys revealed a nationwide decline in full cardiac care availability. In states like Illinois and Wisconsin, losses were larger, but most patients could still reach care within an hour. In Iowa, private insurance data suggest most women could reach a mammogram within 30 minutes, yet fewer than half of insured women aged 40-64 were screened annually. Rural and younger women were less likely to receive a mammogram than urban, older women. For diabetic foot sores, also in Iowa, cases rose, and city patients increasingly saw foot specialists, while rural ones stuck with regular doctors, often traveling far for care.

Health care availability shapes who can access and use health services. My work suggests we need better solutions, like mobile clinics, more rural doctors, or integrated urban-rural care networks to ensure accessible health care for all.