One in five U.S. children lives in a rural area. Rural children tend to have less access to health care than urban and suburban children due to greater time and distance to care sites, less available transportation, and fewer doctors. However, children in rural western North Carolina have reasonably good access to care overall. In addition, key determinants of their care use are similar to those of urban and suburban children and likely are universal: health insurance coverage, household income, and parent perceptions of their child's pain, according to a study that was supported in part by the Agency for Healthcare Research and Quality (HS09624).
Programs in rural areas that strengthen health insurance coverage and reduce poverty will have a direct impact on child health, according to researchers from Wake Forest University and the University of North Carolina at Chapel Hill. They randomly surveyed rural households in western North Carolina in June 1999 and January 2000 to assess determinants of health care visits among children in a 12-county region. For children younger than 5 years, the primary determinants of health care use during the previous year were age, insurance status, and household income.
Among children 5 to 17 years of age, determinants of care use were health insurance status, household income, pain during the past month, and race. Medicaid-insured children had almost four times as many health care visits as uninsured children. Those from households with annual incomes between $20,000 and $40,00 had twice as many health care visits as those with annual household incomes less than $20,000. White children had almost twice as many visits in the past year as black children in this age group.
See "Determinants of health care use by children in rural western North Carolina: Results from the mountain accessibility project survey," by Charles R. Woods, M.D., Thomas A. Arcury, Ph.D., James M. Powers, M.Sc., and others, in the August 2003 Pediatrics 112(2), e213.