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From Health Affairs:


Rural Versus Urban Medicare Beneficiaries: Little Use Variation


Bethesda, MD -- 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 new study, being released today as a Web First by Health Affairs, finds that some of these payments may not be necessary. The study compared the use of medical services between urban and rural areas using claims data from all Medicare fee-for-service beneficiaries in 2008 and 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.


Rural And Urban Medicare Beneficiaries Use Remarkably Similar Amounts Of Health Care Services


By Jeffrey Stensland, Adaeze Akamigbo, David Glass, and Daniel Zabinski


The authors are affiliated with the Medicare Payment Advisory Commission, in Washington, D.C.


The study will also appear in the November issue of Health Affairs.


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."

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.