Why rural medical care users migrate for physician services

Residents of rural areas face substantial barriers to the utilization of physician services. Local physicians are often unavailable or are perceived as having poor technical and interpersonal skills. As a result of these and, potentially, other factors, many rural residents bypass local physicians and other health care providers. In other words, many rural residents migrate for physician care. This study builds upon previous research and helps close the gap in our understanding of rural medical care users' migration for physician care. A slightly modified version of Andersen's Behavioral Model of Health Services Use was employed to guide analyses. Data were collected through a random mail survey of 1,000 residents living in Iowa's eighty-nine rural counties. Hierarchical chunkwise logistic regression was used to determine which variables were associated with migration. One statistical model was tested to determine which factors were related to migration for family physician care. A second statistical model was tested to determine which factors were related to migration for specialty physician care.;Results suggest that a variety of health system, predisposing, and enabling factors impact the location of physician service use. A positive rating of the local delivery system, perceived shortage of local family physicians, Lutheran affiliation, living in-town, having a non-local specialty physician, and fee-for-service insurance coverage were associated with migration for family physician services. A perceived shortage of local specialty physicians, marital status, living on a farm, having a local family physician, Medicaid coverage, and a positive rating of one's health insurance coverage were associated with migration for specialty physician services. Surprisingly, perceived health status, as measured by the SF-12, was not related to the location of physician service use.;The findings have numerous implications for health care managers and policy makers. Health care managers should find the results particularly meaningful as they attempt to improve access to local physician services and expand rural physician clinic market shares. Health policy makers should pay heed to the findings which suggest that factors other than the supply of local physicians, or at least perceived supply, influence the location of physician service use.