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Exploring Disparities in Urban and Rural Healthcare Markets: A Closer Look at PRC’s National Consumer Study Data

May 24, 2023

PRC recently completed gathering the data for the 2023 National Consumer Study. As we begin analyzing the data, I wanted to take a specific look at disparities between urban and rural markets. Our previous blog detailed outmigration, where consumers seek specialized care outside of their immediate market. However, not all consumers have the ability to travel for care. Therefore, let’s delve into the data and examine the contrasting characteristics of urban and rural markets.


In reviewing the data, it’s clear that disparities between urban and rural markets persist, particularly when it comes to access in healthcare. The data shows that a staggering 78% of consumers in rural areas, defined by communities of 50,000 population or less, report that the nearest hospital to reach is located within their community. This contrasts with urban markets, where 88% of consumers report having a nearby hospital. It’s worth noting that similar disparities can be seen across other industries, where consumers in remote areas often have to travel further for essential goods and services such as groceries, clothing, and other consumer goods.


I was not surprised to see that people travel for care. Afterall, we often commute for various reasons like a better job, entertainment, or shopping. However, it is essential to note that consumers’ preferences for hospitals may not always align with the easiest to reach. To gain insights, I compared the ratings of preferred hospitals and discovered some interesting insights:

  • In urban areas, 91% of consumers rated their impression of their preferred hospital “excellent” or “very good”
  • 91% also rate the quality of care at the preferred hospital “excellent” or “very good”
  • Those numbers drop in a rural setting, where we recorded 85% and 87% respectively

This difference is worth noting because people in rural communities may be more familiar with their physicians and care teams, much like neighbors they see often (“I share soccer meals with Dr. John on Tuesdays”). My personal assumption for the small difference is that those in urban settings may have more options to choose from, extending and fulfilling the expectation of care.

Larger differences in ratings of impressions and quality of care are seen in the category of hospitals that are easiest to reach, but not the preferred choice. I expected these ratings to be lower than their preferred, and in urban settings, the impression of the easiest-to-reach hospital was 28% “excellent” or “very good” with 30% rating the quality of care “excellent” or “very good.” However, in rural settings, those numbers dropped to only 14% for each. Why might these ratings be so low in rural communities when healthcare is critical, and people know each other so well? The answer is simple: options.

Care Options

I believe there are two major factors contributing to the disparity in ratings of the easiest-to-reach hospitals between urban and rural communities. First, many smaller community hospitals may have fewer resources and fewer specialties available, and many rural hospitals are critical access hospitals. As we have seen from extensive research, high-risk specialty services such as cancer care, heart care, and neurology have a positive halo effects. This means that consumers often believe that hospitals excelling in these areas are also good in everything else. Hospitals offering these services usually have top-notch specialists, cutting-edge technology, and state-of-the-art facilities. Unfortunately, many rural hospitals lack the resources to offer such services.

Another factor contributing to the disparity in ratings of the easiest-to-reach hospitals between urban and rural communities in the role of competition in driving quality. As with most industries, competition motivates companies to innovate and improve their products or services to outdo their rivals. This dynamic is also present in healthcare, where hospitals in highly competitive markets much prioritize providing excellent patient experiences to retain their clientele. In contrast, some rural markets may only have one hospital as the easiest-to-reach option for many consumers, and this may lead to complacent attitude towards improving their services.

We know from our national research that the quality of care is a significant factor when selecting a hospital, but we know that location can play a crucial role in emergency and routine care decisions. To gain insight into this relationship, we asked consumers about their experiences with emergency, outpatient, and inpatient care in the past two years and asked them to rate the quality of care provided. Upon comparing the responses of those who prefer their easiest-to-reach hospital to those who prefer a hospital other than the one that is easiest to reach, we found some intriguing findings. In terms of inpatient care, there was not much difference between the two groups, with both averaging around 41-42% excellent ratings. This similarity is likely because most consumers used their preferred hospital for inpatient care. However, for emergency care, 41% of those who prefer the easiest-to-reach hospital rated it as “excellent” compared to 29% among those who prefer another hospital. This difference was even more prominent in rural communities, with 42% of those preferring the easiest to reach hospital rating it as “excellent” compared to only 22% among those preferring another hospital. These higher ratings can be attributed to the urgency of care with limited options, leading consumers to favor local hospitals. Similarly, for outpatient care, 50% of consumers who prefer the easiest-to-reach hospital rated it as “excellent” compared to 41% among those who prefer another hospital. This difference was more pronounced in rural communities, with 53% rating it as “excellent” among those preferring the easiest to reach hospital and only 39% among those preferring another hospital.

The reason I believe the largest disparity to exist in emergency care, with a contrast solely in outpatient care, is that consumers are more likely to use their preferred hospital regardless of location for inpatient care but may consider location more for outpatient care and certainly for emergency care.


In conclusion, rural markets may have an area of opportunity when it comes to outpatient and emergency care. With limited resources, rural hospitals are surviving based on a lack of other options nearby. That presumption may work today, but it does put some smaller, rural hospitals in a vulnerable state. If a hospital has not established a strong foundation of care, they are at risk of losing patients to a competitor should they decide to enter that market. Waiting for that day to come may be too late. By looking only at market share or the bottom line, a hospital may be missing vital pieces of information including the perceptions of current patients and new consumers alike. Understanding how current patients feel about your quality of care can help enhance your services and build that strong foundation that is resistant to future competition. It’s the little things that make a big difference in healthcare to retain patients, which is where PRC’s Consumer & Brand research, along with PRC Star Ratings and Voices®, help uncover what your patients find the most valuable about your organization.

Contact our Consumer & Brand team to gain insight into how your hospital is perceived In the community and how to improve market share.

About the Author

Keith Schneider
Director, Consumer & Brand
Joining PRC in 2002 with a lifelong passion for branding, Keith employs a deep-seated set of marketing and research skills to help clients obtain actionable insights that will enable them to make strategic decisions to deliver quality care in ways that elevate their brand. During his tenure at PRC, Keith has managed hundreds of complex, custom research projects for healthcare organizations throughout the United States, overseeing the sample design stages, script-writing functions, and sample generation for PRC’s computer-aided telephone interviewing system as well as electronic surveys. Through timely deliverables and engaging, informative presentations, Keith helps ensure that clients have the data they need to assess their image, interpret the findings and fulfill all their research objectives. He currently leads PRC’s Consumer & Brand division and guides custom research to enhance clients’ marketing and branding efforts. Keith earned a Bachelor of Science degree in Business Administration from the University of Nebraska–Omaha.