The zip (postal) code difference: methods to improve identification of rural subgroups

Over the past decade national policymakers have grappled with the increasingly difficult issue of implementing programs which sustain the viability of the rural health care system. The set of problems that are of major concern to these decisionmakers include: (1) the shifts in the utilization patterns away from the rural health care delivery system; (2) the impact of modification in the health care reimbursement system which disproportionately favors urban health systems; and, (3) the continuing difficulty in affecting the disproportionate supply of health providers in urban areas compared to rural settings. The complex nature of health services research demands a multidisciplinary approach especially on sociocultural problems such as rural health delivery. Effective analysis in health care crosses many disciplinary boundaries such as medicine, nutrition, economics, sociology, and public health among others disciplines. A major concern to many of these rural health research analysts is the ad hoc treatment of the rural populace in federal and state health policy decisionmaking. The key to understanding the variance in treatment of rural health can be appreciated by reviewing the accuracy of rural definitions. In the present study, a refined rural definition is proposed which will assist research analysts in providing greater information on the distribution of rural health care services. A preliminary analysis of the proposed definitions indicates that a more precise measurement of rural provides greater accuracy in determining the medical needs of rural areas. Adaptation of the concept will benefit the decisionmaking process through improvements in the methodological approach to rural health research. State legislators, regional and state planning agencies, federal funding agencies, foundations, and other programs involved in support of rural life program will be better able to assess the impact of programs through use of the new definition. Finally, a refined typology for rural will also effect other research endeavors and appears to be generalizable to research on other pertinent rural delivery issues such as transportation, education, and regional planning.