Rural-Urban Differences in Access to Iowa Child Health Services*

Authors

  • Linda M. Levey,

    Corresponding author
    1. JAMES P. CURRY, Ph.D., is Assistant Research Scientist in the Center for Health Services Research at The University of Iowa. He received his Ph.D. in Sociology from The University of Iowa. His recent publications include studies of organizational behavior in health care settings and the utilization of health ServiceS.
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  • James P. Curry,

    1. JAMES P. CURRY, Ph.D., is Assistant Research Scientist in the Center for Health Services Research at The University of Iowa. He received his Ph.D. in Sociology from The University of Iowa. His recent publications include studies of organizational behavior in health care settings and the utilization of health ServiceS.
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  • Samuel Levey

    1. SAMUEL LEVEY, Ph.D., is Gerhard Hartman Professor and Head of the Graduate Program in Hospital and Health Administration and the Center for Health Services Research at The University of Iowa. Dr. b e y holds a doctorate in hospital and health administraton from The University of Iowa and a Master of Science from the Harvard School of Public Health. He has published extensively in the health administration literature, including several textbooks, and is currently the Editor of Hospital and Health saoices Administmtion.
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  • *

    This research was supported in part by a grant from The Commonwealth Fund.

Requests for additional information should be forwarded to: Dr. Linda M. Levey, Center for Health Services Research, College of Medicine, The University of Iowa, Iowa City, Iowa 52242.

ABSTRACT:

Indicators of access, utilization, and quality of available child health services as well as health status were obtained through a telephone survey of Iowa households with children under age six. These indicators were compared for rural-urban subsamples within an AFDC sample drawn from Iowa Department of Human Service files (N=637), and within poverty (N=129) and nonpoverty groups (N=631) drawn from the population of all households in the state with children under age six. About 55 percent of all households studied were rural. Rural households were generally larger than urban households, more likely to be intact maritally, white, and earning a living from farming. The findings support the hypothesis that place of residence has an impact on access, utilization, and quality of child health services over and above family income, although not always to the disadvantage of rural children. Typical problems for rural children, irrespective of income, were access to pediatric care, greater travel time to providers, and discontinuity of well care and sick care. Rural children in all income groups had lower seat belt use than urban children; they were also less likely to have well visits and their providers showed less attentiveness to behavioral and developmental issues at these visits. Rural residency exacerbated problems in access to care for low income children, who were less likely to be eligible for AFDC/ Medicaid than their urban counterparts. Medicaid coverage, however, did not eliminate rural-urban differences in receiving desired medical care.

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