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The Impact of Rural Health Care Accessibility on Cancer-Related Behaviors and Outcomes

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Abstract

Background

This research seeks to identify the relationship between economic factors related to the ability to receive and pay for health services and adverse cancer outcomes, as well as preventative screening and behavioral factors that influence the risk of cancer. We focus on the Northern High Plains region, where we are able to compare regions with extremely low access to health services with those with relatively high levels of access.

Objective

This study aims to identify health disparities in rural communities, particularly among Native American populations, and, thereby, begin to determine the most effective means by which to deliver health services to areas where geography, economics, and culture might prevent traditional models of health delivery from providing sufficient incentives for the prevention of adverse cancer-related outcomes.

Methods

The Health Care Accessibility Index (HCAI) is computed through the use of principal component analysis and includes economic variables as well as variables concerning institutional and geographic access to health care. Index values are then regressed onto cancer outcomes, cancer-prevention outcomes, and cancer-related risk, using weighted least squares and quantile regressions.

Results

Counties with relatively poor access to health care (low HCAI) also have statistically (1) lower breast cancer screening rates, (2) higher smoking prevalence, (3) higher obesity prevalence, and (4) higher cancer-related mortality rates. Breast cancer screening is found to be especially sensitive to areas of low health accessibility.

Conclusions

Empirical results provide support for policy efforts to increase the accessibility of health care services that are targeted to areas with low mammography screening rates, high obesity rates, high smoking prevalence, as well as areas near Native American reservation territories.

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Notes

  1. Albrecht and Ramasubramanian [17] developed an index of social well-being using the following ten variables: the percentage of residents (1) receiving any form of income support; (2) with any form of disability; (3) not living in own home; (4) living in a home with too few bedrooms; (5) without a high school diploma or equivalent; (6) in single-parent households; (7) below the poverty level; (8) without a car; (9) who were unemployed; and (10) without a phone.

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Funding and conflict of interest

No external funding was received for this paper. The authors have no conflicts of interest to report.

Author contribution

The paper was conceived by EB and BP. Major contributions to the ‘Empirical Methods’ sections were made by EB, EW, and GG. Primary contributions by EW included data collection and statistical analysis, while GG primarily contributed in the implementation of the principal component analysis and its interpretations. Major contributions to the ‘Introduction’ and ‘Discussion’ sections were made by EB and BP. EB is the guarantor for the overall content.

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Authors and Affiliations

  1. Montana State University, P.O. Box 172920, Bozeman, MT, 59717-2920, USA

    Eric J. Belasco & Ethan Wilkes

  2. Health Sciences Center, Texas Tech University, Lubbock, TX, USA

    Gordon Gong & Barbara Pence

Authors
  1. Eric J. Belasco
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  2. Gordon Gong
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  3. Barbara Pence
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  4. Ethan Wilkes
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Corresponding author

Correspondence to Eric J. Belasco.

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Belasco, E.J., Gong, G., Pence, B. et al. The Impact of Rural Health Care Accessibility on Cancer-Related Behaviors and Outcomes. Appl Health Econ Health Policy 12, 461–470 (2014). https://doi.org/10.1007/s40258-014-0099-4

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  • DOI: https://doi.org/10.1007/s40258-014-0099-4

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