The Article in Brief

Bypass of Local Primary Care in Rural Counties: Effect of Patient and Community Characteristics

Jiexin (Jason) Liu, PhD, MBA, MS , and colleagues

Background It is important for policy makers and medical professionals to know whether patients bypass their local hospitals for other facilities, yet few studies of this issue have focused on rural areas. This study looks at the frequency with which rural patients bypass local hospitals and clinicians, and solicits suggestions for what hospitals can do to keep local patients.

What This Study Found Approximately one-third of patients living in rural areas bypass local health care professionals and facilities and get medical care elsewhere. There is a wide variation in bypass rates in the 25 rural areas sampled, ranging from 9.4% to 66%. Compared with those who use services in their local community, bypassers are younger, have higher incomes, are more likely to have had inpatient hospital care in the past year, and are less satisfied with their local hospital. When asked why people might bypass local care, respondents cite lack of services or specialty care (50%), referral out of the community by their doctor (19%), poor quality of care (15%), and poor reputation of local facilities (14%). Bypassers suggest that hospitals could keep local patients by adding more specialty services (24%), adding more doctors and services (17%), getting better doctors (17%), and providing better customer service (11%).

Implications

• The wide variation in bypass rates suggests that local communities and facilities need to develop tailored strategies that fit their own circumstances and needs.
• Policies that promote networks of clinicians could benefit rural patients.
• Lower access to primary care physicians in health professional shortage areas (HPSAs) may contribute to bypass of local health care facilities and clinicians.