{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T11:22:10Z","timestamp":1780572130492,"version":"3.54.1"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T00:00:00Z","timestamp":1607558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100006229","name":"Oak Ridge Institute for Science and Education","doi-asserted-by":"publisher","award":["ORISE-HRSA OPAE fellowship"],"award-info":[{"award-number":["ORISE-HRSA OPAE fellowship"]}],"id":[{"id":"10.13039\/100006229","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Rural health disparities and access gaps may contribute to higher maternal and infant morbidity and mortality. Understanding and addressing access barriers for specialty women\u2019s health services is important in mitigating risks for adverse childbirth events. The objective of this study was to investigate rural-urban differences in health care access for women of reproductive age by examining differences in past-year provider visit rates by provider type, and quantifying the contributing factors to these findings.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>Using a nationally-representative sample of reproductive age women (n = 37,026) from the Medical Expenditure Panel Survey (2010\u20132015) linked to the Area Health Resource File, rural-urban differences in past-year office visit rates with health care providers were examined. Blinder-Oaxaca decomposition analysis quantified the portion of disparities explained by individual- and county-level sociodemographic and provider supply characteristics. Overall, there were no rural-urban differences in past-year visits with women\u2019s health providers collectively (65.0% vs 62.4%), however differences were observed by provider type. Rural women had lower past-year obstetrician-gynecologist (OB-GYN) visit rates than urban women (23.3% vs. 26.6%), and higher visit rates with family medicine physicians (24.3% vs. 20.9%) and nurse practitioners\/physician assistants (NPs\/PAs) (24.6% vs. 16.1%). Lower OB-GYN availability in rural versus urban counties (6.1 vs. 13.7 providers\/100,000 population) explained most of the rural disadvantage in OB-GYN visit rates (83.8%), and much of the higher family physician (80.9%) and NP\/PA (50.1%) visit rates. Other individual- and county-level characteristics had smaller effects on rural-urban differences.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Although there were no overall rural-urban differences in past-year visit rates, the lower OB-GYN availability in rural areas appears to affect the types of health care providers seen by women. Whether rural women are receiving adequate specialized women\u2019s health care services, while seeing a different cadre of providers, warrants further investigation and has particular relevance for women experiencing high-risk pregnancies and deliveries.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0240700","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T18:28:25Z","timestamp":1607624905000},"page":"e0240700","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":25,"title":["Determinants of rural-urban differences in health care provider visits among women of reproductive age in the United States"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0783-5484","authenticated-orcid":true,"given":"Hyunjung","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley H.","family":"Hirai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4882-2826","authenticated-orcid":true,"given":"Ching-Ching Claire","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6569-7991","authenticated-orcid":true,"given":"John E.","family":"Snyder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,10]]},"reference":[{"issue":"3","key":"pone.0240700.ref001","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.whi.2016.02.001","article-title":"Ensuring Access to High-Quality Maternity Care in Rural America","volume":"26","author":"KB Kozhimannil","year":"2016","journal-title":"Women\u2019s health issues: official publication of the Jacobs Institute of Women\u2019s Health"},{"issue":"1","key":"pone.0240700.ref002","doi-asserted-by":"crossref","first-page":"155","DOI":"10.2105\/AJPH.2018.304787","article-title":"Growth and Persistence of Place-Based Mortality in the United States: The Rural Mortality Penalty","volume":"109","author":"AG Cosby","year":"2019","journal-title":"American journal of public health"},{"issue":"12","key":"pone.0240700.ref003","doi-asserted-by":"crossref","first-page":"e164","DOI":"10.1097\/MLR.0000000000000607","article-title":"Defining Rurality in Medicare Administrative Data","volume":"55","author":"JE Snyder","year":"2017","journal-title":"Medical care"},{"issue":"12","key":"pone.0240700.ref004","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1377\/hlthaff.2019.00805","article-title":"Rural-Urban Differences In Severe Maternal Morbidity And Mortality In The US, 2007\u201315","volume":"38","author":"KB Kozhimannil","year":"2019","journal-title":"Health affairs"},{"issue":"285","key":"pone.0240700.ref005","first-page":"1","article-title":"Infant Mortality Rates in Rural and Urban Areas in the United States, 2014","volume":"2017","author":"DM Ely","journal-title":"NCHS data brief"},{"key":"pone.0240700.ref006","article-title":"Levels and causes of maternal mortality and morbidity","volume":"51","author":"V Filippi","year":"2016","journal-title":"Reproductive, Maternal, Newborn, and Child Health"},{"issue":"2 Pt 1","key":"pone.0240700.ref007","first-page":"384","article-title":"ACOG Committee Opinion No. 586: Health disparities in rural women","volume":"123","author":"Women CoHCfU","year":"2014","journal-title":"Obstetrics Gynecology"},{"key":"pone.0240700.ref008","volume-title":"Guidelines for Perinatal Care","author":"American College of Obstetricians and Gynecologists (ACOG)","year":"2017","edition":"8"},{"issue":"15","key":"pone.0240700.ref009","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1503\/cmaj.141633","article-title":"Outcomes of deliveries by family physicians or obstetricians: a population-based cohort study using an instrumental variable","volume":"187","author":"K Aubrey-Bassler","year":"2015","journal-title":"CMAJ: Canadian Medical Association journal = journal de l\u2019Association medicale canadienne"},{"issue":"6","key":"pone.0240700.ref010","first-page":"440","article-title":"Perinatal outcomes: a comparison between family physicians and obstetricians","volume":"8","author":"ME Deutchman","year":"1995","journal-title":"The Journal of the American Board of Family Practice"},{"issue":"4","key":"pone.0240700.ref011","doi-asserted-by":"crossref","first-page":"366","DOI":"10.3122\/jabfm.2013.04.120203","article-title":"A comparison of cesarean delivery outcomes for rural family physicians and obstetricians. 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