Rural-Urban Differences in Health Services Utilization in the US-Mexico Border Region

Purpose: Evaluate the association between driving distance to the US-Mexico border and rural-urban differences in the use of health services in Mexico by US border residents from Texas. Methods: Data for this study come from the Cross-Border Utilization of Health Care Survey, a population-based telephone survey conducted in the Texas border region in spring 2008. Driving distances to the border were estimated from the nearest border crossing station using Google Maps. Outcome measures included medication purchases, physician visits, dentist visits, and inpatient care in Mexico during the 12 months prior to the survey. A series of adjusted logit models were estimated after controlling for relevant confounding factors. Findings: The average driving distance to the nearest border crossing station among rural respondents was 4 times that of urban respondents (42.0 miles vs 10.3 miles [P < .001]). Rural respondents were more likely to be dissatisfied than urban respondents with the health care provided on the US side of the border, yet they were less likely to use health services in Mexico. Driving distance to the border largely explained the observed rural-urban differences in medication purchases from Mexico. In the case of inpatient care, however, rural respondents reported a higher utilization rate than urban respondents and this rural-urban difference became more pronounced after adjusting for the effect of driving distance to the border. Conclusions: Dissatisfaction with US health care services in rural communities in the US-Mexico border region seems to be compounded by the lack of access to health care services in Mexico due to travel distance constraints.