Non-metro dwellers travel twice the distance for primary care

Key takeaways:

• Patients outside of metropolitan areas traveled a median time of 28 minutes for primary care visits.
• Specialty visits were also significantly longer for those living outside of metropolitan areas.

Patients who live outside of metropolitan areas frequently drive for more than 20 minutes for a primary care visit, according to new data published in Annals of Internal Medicine.

Longer travel distances are typical for a significant number of patients, as recent survey findings from the American Association of Nurse Practitioners showed that 40% of respondents had to travel more than 10 miles for health care visits.

Policymakers and researchers “require accurate market definitions to measure and monitor provider competition, access, and variation in outcomes and costs,” according to Sandra L. Decker, PhD, an economist at the Agency for Healthcare Research and Quality, and colleagues.

“One common approach defines geographic markets using patient travel time or distance thresholds,” they wrote. “However, choosing meaningful thresholds requires understanding patient travel patterns, which are understudied.”

Decker and colleagues aimed to better capture these travel patterns for several types of office visits — including ED, primary care and specialty visits — and inpatient stays by analyzing Medical Expenditure Panel Survey data from 2018 to 2021.

The sample included 825,292 office visits, 23,334 ED visits and 10,552 inpatient stays.

The researchers reported a median travel time of 12.7 minutes (interquartile range [IQR], 7-22.3) for primary care visits and 17.1 minutes (IQR, 9.5-30.8) for specialty visits.

People living inside metropolitan statistical areas had median travel time of approximately 14 minutes for primary care visits compared with 28 minutes for those living outside metro areas.

Those outside of metropolitan areas also had to travel significantly greater distances for specialty visits compared with those inside (41.8 minutes vs. 15.9 minutes).

Additional findings included a median travel time of 13.6 minutes (IQR, 7.5-24.2) for ED visits and 18.1 minutes (IQR, 9.6-36.9) for inpatient stays, “with patients traveling longer for stays that did not originate in the ED, were surgical, or were pregnancy- or birth-related,” Decker and colleagues wrote.

Among office and ED visits, 73.8% (95% CI, 72.3%-75.4%) took place within the patient’s county, 81.5% (CI, 80.1%-82.4%) within 30 minutes of their home and 93.3% (CI, 92.6%-94%) within 60 minutes of their home.

Inpatient stays less frequently occurred within the patient’s county (63.3%; 95% CI, 60.8%-65.8%).

The researchers acknowledged some study limitations, which included potential underreporting of medical visits and errors in provider location reporting.

They added that the travel times are also based on the assumption that the patients traveled by car.

The researchers explained that the data show that geographic market definitions like primary care service area exclude a large amount of the care used by patients.
Using these boundaries may result in underestimation of access to care or competition,” they wrote.

Still, the results “can inform choices of market definitions and provide national benchmarks for patient travel time,” they concluded.