The Impact of Rural Health Care Accessibility on Cancer-Related Behaviors and Outcomes

• Published in: Applied health economics and health policy Vol. 12; no. 4; pp. 461 - 470
• Main Authors: Belasco, Eric J., Gong, Gordon, Pence, Barbara, Wilkes, Ethan
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2014; Springer Nature B.V
• Subjects: Behavior; Breast cancer; Cancer; Costs; Economic factors; Economic models; Economics; Education; Female; Geography; Health Administration; Health Behavior - ethnology; Health care; Health care access; Health Economics; Health insurance; Health risks; Health services; Health Services Accessibility; Healthcare Disparities - ethnology; Households; Humans; Impact analysis; Indians, North American; Male; Mammography; Medical screening; Medicine; Medicine & Public Health; Mental health services; Mortality; Native North Americans; Native reservations; Neoplasms - ethnology; Neoplasms - therapy; Northwestern United States; Obesity; Original Research Article; Outcome Assessment (Health Care); Pharmacoeconomics and Health Outcomes; Principal Component Analysis; Principal components analysis; Prostate; Public Health; Quality of Life Research; Rural areas; Rural communities; Rural health care; Rural Health Services; School dropouts; Smoking; Socioeconomic factors; Studies; Variables; Northwestern United States; United States > US; Health Care Service; Quantile Regression; Screening Rate; Behavioral Risk Factor Surveillance System; Indian Health Service
• ISSN: 1175-5652; 1179-1896; 1179-1896
• DOI: 10.1007/s40258-014-0099-4

Background This research seeks to identify the relationship between economic factors related to the ability to receive and pay for health services and adverse cancer outcomes, as well as preventative screening and behavioral factors that influence the risk of cancer. We focus on the Northern High Plains region, where we are able to compare regions with extremely low access to health services with those with relatively high levels of access. Objective This study aims to identify health disparities in rural communities, particularly among Native American populations, and, thereby, begin to determine the most effective means by which to deliver health services to areas where geography, economics, and culture might prevent traditional models of health delivery from providing sufficient incentives for the prevention of adverse cancer-related outcomes. Methods The Health Care Accessibility Index (HCAI) is computed through the use of principal component analysis and includes economic variables as well as variables concerning institutional and geographic access to health care. Index values are then regressed onto cancer outcomes, cancer-prevention outcomes, and cancer-related risk, using weighted least squares and quantile regressions. Results Counties with relatively poor access to health care (low HCAI) also have statistically (1) lower breast cancer screening rates, (2) higher smoking prevalence, (3) higher obesity prevalence, and (4) higher cancer-related mortality rates. Breast cancer screening is found to be especially sensitive to areas of low health accessibility. Conclusions Empirical results provide support for policy efforts to increase the accessibility of health care services that are targeted to areas with low mammography screening rates, high obesity rates, high smoking prevalence, as well as areas near Native American reservation territories.