Rural-Urban Differences in Health Care Unaffordability during the Postpartum Period

Hannah MacDougall, Stephanie Hanson, Julia D. Interrante, Erica Eliason

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: The objective of this study was to examine health care unaffordability for rural and urban residents and by postpartum status. Methods: We used cross-sectional survey data on female-identifying respondents ages 18-44 (n=17,800) from the 2019 to 2021 National Health Interview Study. Outcomes of interest were 3 measures of health care unaffordability. We conducted bivariate and multivariable regression models to assess the association between health care unaffordability, rurality, and postpartum status. Results: Bivariate analyses showed postpartum people reported statistically significantly higher rates of being unable to pay medical bills and having problems medical paying bills, as compared with nonpostpartum people. Rural residents also reported statistically significantly higher rates of being unable to pay their medical bills and having problems paying medical bills as compared with urban residents. In adjusted models, the predicted probability of being unable to pay medical bills among postpartum respondents was 12.8% (CI, 10.1-15.5), which was statistically significantly higher than among nonpostpartum respondents. Similarly, postpartum respondents had statistically significantly higher predicted probabilities of reporting problems paying medical bills (18.4%, CI, 15.4-21.4) as compared with nonpostpartum respondents. The rural residency was not significantly associated with the health care unaffordability outcome measures in adjusted models. Conclusions: Both postpartum and rural respondents reported higher rates of being unable to pay medical bills and having problems paying medical bills; however, after adjusting for covariates, only postpartum respondents reported statistically significantly higher rates of these outcomes. These results suggest that postpartum status may present challenges to health care affordability that span the urban/rural context.

Original languageEnglish (US)
Pages (from-to)595-600
Number of pages6
JournalMedical care
Volume61
Issue number9
DOIs
StatePublished - Sep 1 2023

Bibliographical note

Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • affordability
  • geography
  • maternal health
  • postpartum
  • rural

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