Privilege and Place: an exploratory study about healthcare bypass behavior

Area of Science:

• Rural Health
• Healthcare Access
• Social Determinants of Health

Background:

• Healthcare bypass, or seeking care outside one's community, significantly impacts rural healthcare availability, quality, and patient outcomes.
• Previous research on healthcare bypass primarily focused on individual and community characteristics.
• This study introduces place-based characteristics, using the Social Vulnerability of Place Index (SoVI), to provide a more comprehensive understanding of healthcare selection behavior.

Purpose of the Study:

• To investigate the factors influencing rural healthcare bypass behavior.
• To introduce and apply the Social Vulnerability of Place Index (SoVI) in healthcare studies to assess the impact of place on healthcare selection.
• To explore the underlying reasons for healthcare bypass through qualitative analysis.

Main Methods:

• A systematic random sample of 1061 residents from 25 rural Utah towns was surveyed in 2017.
• Logistic regression analysis was used to predict the likelihood of healthcare bypass, incorporating community push/pull factors, individual characteristics, and SoVI scores.
• Qualitative open-ended responses were coded to identify reasons for bypassing local healthcare.

Main Results:

• Dissatisfaction with local healthcare and being female were associated with a higher likelihood of bypass.
• The Social Vulnerability of Place Index (SoVI) revealed nuanced patterns: in low-vulnerability areas, privilege (e.g., college education) increased bypass likelihood, while in high-vulnerability areas, disadvantages (e.g., aging) decreased it.
• Analysis of open-ended responses identified key reasons for bypass, including quality, selection, consistency, cost, convenience, and confidentiality.

Conclusions:

• The SoVI is a valuable tool for understanding how place-based social vulnerability influences rural healthcare bypass.
• Policymakers and public health officials can utilize SoVI scores to target healthcare outreach and resources more effectively, particularly in high-vulnerability areas and for underprivileged populations.
• Improving local healthcare services in areas like quality, consistency, and cost can reduce bypass rates and support the sustainability of rural clinics.