Access to Health Care Among Three Cohorts of Older Americans Residing in a Rural State

Three cohorts of older Americans are examined to determine how they perceive the likelihood of being able to access health care in the future. A modified Andersen (1968) model provides the framework for the study. A representative sample of 2,404 noninstitutionalized midwestern older persons separated into three age cohorts (60–69, 70–79, and 80+) was used. Predisposing, enabling, and need factors were examined by logistic regression. Significant differences were found between age cohorts, with the perceptions of the oldest-old and the youngest-old appearing to be markedly more sensitive than those of the middle-old. Need factors of health and the respondents' perceptions of help they needed with instrumental activities of daily living, and enabling factors of community size and the barrier imposed by lack of transportation, combined to explain the perceptions of the oldest-old. For the youngest-old, the significant variables were bills, gender, barriers imposed by inadequate insurance, lack of transportation, and a perception that physicians charged more than allowed by Medicare. Recommendations are made for health care policy with respect to different age cohorts among the elderly, their families, and the rurality of the population.