The research for the present study was funded in part by a training grant for the National Institute on Aging (AG000270). Dr. Al Snih is supported by a research career development award (K12HD052023: Building Interdisciplinary Research Careers in Women's Health Program – BIRCWH) from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD); the National Institute of Allergy and Infectious Diseases (NIAID); and the Office of the Director (OD), National Institutes of Health. The content is solely the responsibility of the author(s) and does not necessarily represent the official views of these Institutes or the National Institutes of Health. For further information, contact: Jennifer J. Salinas, PhD, University of Texas School of Public Health, Brownsville Regional Campus, 80 Fort Brown St., Brownsville, TX 78520-4956; e-mail Jennifer.J.Salinas@uth.tmc.edu.
The Rural–Urban Divide: Health Services Utilization Among Older Mexicans in Mexico
Article first published online: 17 JUN 2010
© 2010 National Rural Health Association
The Journal of Rural Health
Volume 26, Issue 4, pages 333–341, Fall 2010
How to Cite
Salinas, J. J., Al Snih, S., Markides, K., Ray, L. A. and Angel, R. J. (2010), The Rural–Urban Divide: Health Services Utilization Among Older Mexicans in Mexico. The Journal of Rural Health, 26: 333–341. doi: 10.1111/j.1748-0361.2010.00297.x
- Issue published online: 17 JUN 2010
- Article first published online: 17 JUN 2010
Purpose: Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico.
Methods: The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen's “model of health services” of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semi-rural).
Findings: Results showed that older Mexicans living in the most rural areas (populations of 2,500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans.
Conclusions: Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health.