Is Physician Supply in Rural
Ohio Associated with Unmet
Need for Physician Visits?
Lars Peterson, M.D., Ph.D. candidate
David Litaker, M.D., Ph.D.
Academy Health
June, 25th 2006
Unmet Needs

Measure of access to health care

Individual Level


Lower income, lack of health insurance and
fair/poor health status
Contextual Level

Percent in poverty, average educational
attainment, and managed care penetration
Unmet Needs

2003 national average for any unmet need
= 5%

Previous studies of contextual effects on
unmet need investigated total unmet needs

Determinants of unmet needs are likely to
differ by type of unmet need and setting
(rural/urban)
Physician Supply
in Rural America

Fewer physicians per capita but more
Primary Care Physicians (PCP) than
urban areas

Many government programs focus on
increasing the supply of physicians in
rural areas
Conceptual Model of Self-Reported Unmet Health Care Need
Rurality
Reported
Unmet Need
Contextual
Characteristics
Health Care System
Socioeconomics
Social Disruption
Individual Characteristics
Social Capital
Predisposing
Characteristics
Policy
Enabling
Resources
Need
Hypotheses

Reduced availability of physicians in rural areas
may be associated with higher unmet need for
physician visit

The specialty mix of physicians (primary care
vs. specialists) in rural areas is associated with
unmet need for physician visits

Increasing rurality will increase unmet need for
a physician visit
Data Sources & Study Design





2004 Ohio Family Health Survey
2003 Area Resource File
Cross sectional analysis
Descriptive statistics
Multi-level logistic regression
Contextual Variables

Physician Supply




Primary Care Physicians (PCP) per capita
Total Physicians per capita
PCP/MD ratio
Rural Urban Continuum Code (RUCC)
Dependent Variable
Respondent answered yes to….
“During the past 12 months, was there
any time when you did not get any
other health care that you needed, such
as a medical exam, medical supplies,
mental health care, or eyeglasses?”


Then, subsequent questioning
identified the unmet need for a
physician visit
Mean
(SD)
OR (95% CI)
for unmet need
OR (95% CI)
for unmet
need
contextual
variables only
full model
Primary Care
Physicians
per 10,000
7.04
(2.34)
1.12
(0.96, 1.31)
1.12
(0.96, 1.37)
Total
Physicians
per 10,000
9.62
(5.45)
0.96
(0.89, 1.04)
0.96
(0.88, 1.04)
PCP/MD Ratio
0.77
(0.23)
0.17
(0.02, 1.30)
0.16
(0.02, 1.49)
N/A
1.05
(0.83, 1.32)
1.06
(0.83, 1.37)
RUCC
Strengths & Limitations






Multi-level models
State representative data set
Highly powered
Cross sectional data
Adequacy of study measures
Did not account for “out of county” or
“out of state” health care
Conclusions

No association between physician workforce
supply or composition with an unmet need for a
physician visit in rural Ohio

Results suggest that increasing the supply of
physicians in rural areas may have little effect on
rural residents’ unmet need for physician visits

These findings may reflect inefficient use of
existing physician supply in rural areas or that
the level of access to physician care for rural
residents matches rural residents’ perceived
need for such care