Rural Patients Pay More for Health Care, 1948

From Research and Farming, the 1948 annual report of the North Carolina Agricultural Experiment Station, N.C. State College, Raleigh

In a sample survey of 500 rural families of eastern North Carolina, C. Horace Hamilton and staff of the Department of Rural Sociology found that 27 per cent of the families lived more than 10 miles from a doctor and more than 20 miles from a hospital.

The families living at these distances from doctors and hospitals had about the same amount of illness as other families. The survey also showed that they use hospitals and doctors to about the same extent. However, there were two important differences:
The isolated families did not and frequently could not get medical service in their homes; and
If they did get a doctor make the trip, the expense was greater.

Night Calls Higher
The cost of getting a doctor in the country varied with the distance the patient lived from town. The average fee for one call at the doctor’s office was found to be $2.80. The average fee for a home call in the day was $7.12, and for a home call at night, $9.35. On the average, the cost of a call to a patient’s home at night was 31 per cent greater than a daytime call at the same distance.

On the average the cost of a home call in the country started at $2.55 for no distance and increased at the rate of $.66 for each mile the rural family lived from the doctor. This relationship may be tabled as follows:

Cost of Doctor’s Visit to Patient’s Home by Miles Traveled
Miles Traveled	Average Cost
0	$2.55
5	5.85
10	9.25
15	12.45
20	15.75
25	19.05

The initial cost of $2.55 for a home visit with no miles traveled was about the same as the charge for an office visit.


Few Night Calls Result
As a result of the high cost of home calls, especially at night, there are very few such calls. Also there is an increasing tendency for doctors to ask patients to come to their office or to the hospital. This not only saves the doctor’s time but also makes it possible to use laboratory and X-ray equipment which cannot be taken into the country.

Added to this trend in medical service is the fact that more doctors are leaving the small country towns and are located at centers large enough for hospitals. In view of this trend, the development of a rural ambulance service and good rural roads become even more necessary.