Rural-Urban Differences in the Utilization of Hospital-Based Care for Women of Reproductive Age

To investigate rural-urban differences in hospital-based care utilization among women of reproductive age (18-44 years). Rural-urban differences were estimated for hospital outpatient visits, emergency department (ED) visits, hospitalizations, and associated expenditures both overall and by insurance status, by analyzing a nationally representative sample of women of reproductive age from the Medical Expenditure Panel Survey (2006-2015). The study sample consisted of 48,114 women of reproductive age. Unadjusted results showed that rural women reported higher likelihood of hospital outpatient visits (rural vs. urban: 17.10% vs. 13.34%) although, among those using such care, fewer average visits (rural vs. urban: 2.00 vs. 2.56 visits). Rural women reported higher likelihood of ED visits (rural vs. urban: 18.13% vs. 15.11%) and more hospital stays (rural vs. urban: 0.13 vs. 0.11 stays). Adjusted results showed rural women had higher likelihood of outpatient care use (+2.5 percentage points; 95% confidence interval [CI] = 0.002-0.049) but fewer visits (-0.314 visits, 95% CI = -0.566 to -0.062). For the privately insured, rural women had greater likelihood of outpatient care (+3.1 percentage points, 95% CI = 0.001-0.060) and fewer ED visits (-0.031 visits, 95% CI = -0.061 to -0.003); for the publicly insured, rural women had more hospital stays (+0.045 stays, 95% CI = 0.009-0.083); for the uninsured, rural women had fewer outpatient visits among those using such care (-1.118 visits, 95% CI = -1.865 to -0.372) and shorter hospital stays overall (-0.093 nights, 95% CI = -0.181 to -0.005). Rural-urban expenditure differences were not significant between any insurance grouping. Rural-urban differences in hospital-based care utilization were observed, although somewhat heterogeneous by insurance status. Strengthening outpatient and preventive service access, particularly for publicly insured and uninsured rural women of reproductive age, is important for shifting care to lower cost settings and improving population health.