Differences in the travel burden for care between rural and urban patients with opioid use disorder by insurance type

Purpose

To compare the time and distance travel burden to access care for rural and urban Medicaid and commercially insured patients with opioid use disorder (OUD), and to understand where they travel for care.

Methods

We used Medicaid and the Health Care Cost Institute commercial insurance administrative claims data from 2019 to examine the travel burden to health care for adults ages 18 years and older with OUD. We calculated the one-way driving distance and travel time between the enrollee's residence and the provider's location. We used the 2013 Urban Influence Codes (UIC) to classify enrollees as either urban (UIC 1–2) or rural (UIC 3–12) based on the patient's residence county.

Findings

The median distance traveled for a visit by a rural Medicaid or rural commercially insured enrollee was more than twice as far as their urban counterparts (rural Medicaid: 45.9 miles, urban Medicaid: 13.9 miles; rural commercially insured: 32.9 miles, urban commercially insured: 12.4 miles). When we imputed zeros for care provided in the same ZIP Code as an enrollee's residence, these differences persisted. Rural Medicaid enrollees carried the largest travel burden spending an average of more than 60 min traveling to care, about 30 min more than rural commercially insured enrollees. Urban enrollees, regardless of insurance type received almost all of their care in an urban location while rural Medicaid and commercially insured patients traveled to an urban location for about half their visits.

Conclusions

Rural and urban Medicaid and commercially insured enrollees experience different time and distance travel burdens.