A Geographic Assessment of Health-Care Coverage in Two "Rural" North Carolina Communities

The study shows the value of using basic geographic techniques to examine two key concepts of health-care delivery—service coverage and location of a community along a rural-urban continuum. Three types of coverage are discussed for two small North Carolina communities: the availability of physicians of all types, the accessibility to hospitals of all sizes, and the utilization of primary-care physicians. The usefulness of the concept of a rural-urban continuum in helping to define degree of rurality and how this concept affects coverage is demonstrated by looking at two towns midway along the continuum. Although the towns are only nine miles apart, they have very different coverage profiles, indicating that unique local health-care-delivery situations must be taken into account. The study towns do not fit the rural stereotype of poor availability and accessibility, although these two types of coverage could be improved. The micro-scale study of the utilization of primary care physicians revealed that several sociodemographic factors were not important, but that measuring perceived travel time, whether or not people had to be driven to care, perceived health status, and health insurance status were important.