Insurance company decisions to offer health plans in rural areas seem to be less related to the distance patients must travel for care than analysts had expected, according to research from The Brown School at Washington University in St. Louis.
[Photo: Dr. Abigail Barker]
Researchers looked at health plans created under the Affordable Care Act in 15 Midwestern states. They expected to find that, due to “network adequacy” standards, the long distances patients had to travel in rural areas would dissuade companies from offering plans there.
Using Geographic Information System software to measure travel distance carefully, the authors found no significant relationships. They did find some evidence that the size of the risk pool — i.e. the raw numbers of people who would be likely to sign up for coverage in a given area — was more relevant. They also found that premiums were highest in counties in which over 60 miles or minutes of travel is needed to access a county with 50 or more doctors.
“Rural communities face many health care access barriers, including long distances to available providers as well as health provider shortages,” wrote the study’s lead author, Dr. Abigail Barker, research assistant professor at the Brown School. “A more nuanced study of contracts in rural areas is needed to understand when market power affects this outcome.”
The paper was published by the Center for Rural Health Policy Analysis at the Rural Health Policy Research Institute at the University of Iowa College of Public Health.