Skip to main content

Equity in Rural Health and Health Care

  • Chapter
Handbook of Rural Health

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • 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 

  • Aday, L. A., and Andersen, R. (1981). Equity of access to medical care: A conceptual and empirical overview. Medical Care, 19 (Supplement) 4–27.

    Article  CAS  Google Scholar 

  • Aday, L. A., Andersen, R., and Fleming, G. (1980). Health care in the U.S.: Equitable for whom? Beverly Hills: Sage.

    Google Scholar 

  • 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 

  • 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 

  • 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 

  • American Medical Association. (1999). Physician characteristics and distribution in the U.S. Chicago: American Medical Association.

    Google Scholar 

  • American Public Health Association. (1999, October). Rural hospitals receive means to improve care. The Nation’s Health, 29 (9), p. 24.

    Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Bushy, A. (1998). Health issues of women in rural environments: An overview. Journal of American Medical Women’s Association, 53 (2), 53–56.

    CAS  Google Scholar 

  • 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.

    CAS  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • Daly, M. (Ed.). (1994). Communitarianism: A new public ethics. Belmont, CA: Wadsworth.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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 

  • 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.

    CAS  Google Scholar 

  • Frenzen, P. (1997). How will measures to control Medicare spending affect rural communities? Agriculture Information Bulletin, 734, 1–10.

    Google Scholar 

  • Garrett, D. K. (1995). Mobile access: Opening health care doors. Nursing Management, 26, 29–33.

    PubMed  CAS  Google Scholar 

  • 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 

  • 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 

  • 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.

    PubMed  Google Scholar 

  • Hornberger, C. A., and Cobb, A. K. (1998). A rural vision of a healthy community. Public Health Nursing, 15 (5), 363–369.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Long, K. A., and Weinert, C. (1989). Rural nursing: Developing the theory base. Scholastic Inquiries in Nursing Practice, 3 (2), 113–27.

    CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • McDowell, S. H. (1997). Market reform and managed care: Implications for rural communities. Rockville, MD: Federal Office of Rural Health Policy.

    Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Moscovice, I. (1989). Rural hospitals: A literature synthesis and health services research agenda. Health Services Research, 23 (6), 891–930.

    PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Moscovice, I., Cristianson, J., Johnson, J., Kralewski, J., and Manning, W. (1995). Building rural hospital networks. Ann Arbor, MI: Health Administration Press.

    Google Scholar 

  • Mulhall, S., and Swift, A. (1992). Liberals and communitarians. Oxford, UK: Blackwell.

    Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • National Center for Health Statistics. (1997). Health, United States, 1996–97, and Injury Chartbook. Hyattsville, MD: Public Health Service.

    Google Scholar 

  • 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 

  • National Center for Health Statistics. (1999b). Health, United States, 1999, with Health and Aging Chartbook. Hyattsville, MD: Public Health Service.

    Google Scholar 

  • National Rural Health Association. (1996). The rural homeless: America’s lost population. Kansas City: National Rural Health Association.

    Google Scholar 

  • National Rural Health Association. (1997). Community solutions for rural health: An empowerment initiative for rural communities. Kansas City: National Rural Health Association.

    Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • Office of Rural Health Policy. (1997a). Rural health dictionary of terms, acronyms, and organizations, 1997. Rockville, MD: Office of Rural Health Policy.

    Google Scholar 

  • Office of Rural Health Policy. (1997b). Facts about rural physicians. Rockville, MD: Office of Rural Health Policy.

    Google Scholar 

  • Office of Rural Health Policy. (1997c). Exploratory evaluation of rural applications of telemedicine. Rockville, MD: Office of Rural Health Policy.

    Google Scholar 

  • Office of Technology Assessment. (1990). Health care in rural America. Washington, DC: Congress of the United States.

    Google Scholar 

  • Orloff, T. M., and Tymann, B. (1995). Rural health: An evolving system of accessible services. Washington, DC: National Governors’ Association.

    Google Scholar 

  • Pearson, T. A., and Lewis, C. (1998). Rural epidemiology: Insights from a rural population laboratory. American Journal of Epidemiology, 148 (10), 94957.

    Google Scholar 

  • Perlstadt, H., and Kozak, L. J. (1977). Emergency medical services in small communities: Volunteer ambulance corps. Journal of Community Health, 2 (3), 178–88.

    Article  PubMed  CAS  Google Scholar 

  • Powers, J. G., and Byrd, T. (1998). U.S.-Mexico border health: Issues for regional and migrant populations. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Puskin, D. S. (1995). Opportunities and challenges to telemedicine in rural America. Journal of Medical Systems 19 (1), 59–67.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Rural Health Research Center. (1997). Rural managed care patterns and prospects, 1997. Minneapolis: University of Minnesota School of Public Health.

    Google Scholar 

  • Stratton, T. D., Dunkin, J. W., and Juhl, N. (1995). Redefining the nursing shortage: A rural perspective. Nursing Outlook, 43 (2), 71–7.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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 

  • Wallerstein, N. (1992). Powerlessness, empowerment, and health: Implications for health promotion programs. American Journal of Health Promotion, 6, 197–205.

    Article  PubMed  CAS  Google Scholar 

  • Wallerstein, N., and Bernstein, E. (1994). Introduction to community empowerment, participatory education, and health. Health Education Quarterly, 21, 14148.

    Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • Whitehead, M. (1992). The concepts and principles of equity and health. International Journal of Health Services, 22, 429–45.

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Zimmerman, M. A. (1990). Citizen participation in rural health: A promising resource. Journal of Public Health Policy, 11 (3), 323–340.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer Science+Business Media New York

About this chapter

Cite this chapter

Aday, L.A., Quill, B.E., Reyes-Gibby, C.C. (2001). Equity in Rural Health and Health Care. In: Loue, S., Quill, B.E. (eds) Handbook of Rural Health. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-3310-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-4757-3310-5_4

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4419-3347-8

  • Online ISBN: 978-1-4757-3310-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics