October 30th, 2013
The assumption that rural beneficiaries systematically receive less care than urban beneficiaries is one factor that has led Medicare to pay rural providers $3 billion more each year in special payments than they would receive under traditional payment rates.
A Health Affairs Web First study released today finds that some of these payments may not be necessary. Jeffrey Stensland and colleagues at the Medicare Payment Advisory Commission (MedPAC) compared the use of medical services by urban and rural areas using claims data from all Medicare fee-for-service beneficiaries in 2008; they found no significant differences between rural and urban beneficiaries in either the amount of health care received or in satisfaction with access to care. After adjusting for health status, rural and urban areas in the same region had nearly identical rates of service use.
Although the study found no significant differences between rural and urban beneficiaries in the same region, it did find large differences across both urban and rural areas in different regions. Regional differences among Medicare beneficiaries were larger and more stable than any observed rural differences.
“The key policy implication of this article is that Medicare should not use rural location as a proxy for low service use or access to care,” conclude the authors. “Policies that implicitly assume all rural areas are homogeneous and all rural beneficiaries are underserved are not supported by the data.” This evidence also led the authors to conclude that what region a beneficiary lives in is a “much more potent driver of high versus average service use than whether he or she lives in an urban or rural area.”Email This Post Print This Post
Don't miss the insightful policy recommendations and thought-provoking research findings published in Health Affairs.
to the #1 source of health policy research.