BRIDGING HEALTHCARE DISPARITIES: A SYSTEMATIC REVIEW OF HEALTHCARE ACCESS FOR DISABLED INDIVIDUALS IN RURAL AND URBAN AREAS
Author(s)
Amer MESMAR, MSc1, Godfrey MBAABU LIMUNGI, MSc1, Mohammed ELMADANI, MSc1, Klára Simon, MSc2, Osama HAMAD, MSc1, Lívia TÓTH, MSc1, Éva HORVÁTH, MSc1, Diána Elmer, BSc, MSc, PhD3, Orsolya Máté, PhD, habil.4;
1University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary, 2University of Pécs, Doctoral School of Health Sciences, Pécs, Hungary, 3University of Pécs, Faculty of Health Sciences, Institute of Health Insurance, Pécs, Hungary, 4University of Pécs, Faculty of Health Sciences, Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, Pécs, Hungary
1University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary, 2University of Pécs, Doctoral School of Health Sciences, Pécs, Hungary, 3University of Pécs, Faculty of Health Sciences, Institute of Health Insurance, Pécs, Hungary, 4University of Pécs, Faculty of Health Sciences, Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, Pécs, Hungary
OBJECTIVES: This systematic review aimed to compare healthcare access for people with disabilities living in rural versus urban areas and to identify key barriers and facilitators influencing access across different geographical settings.
METHODS: The review was pre-registered in PROSPERO (CRD42025648258). Peer-reviewed studies published between January 1, 2010, and December 31, 2024, were identified through searches of PubMed, Scopus, Web of Science, and the Cochrane Library. The data sources included previously published observational and mixed-methods studies drawing on national surveys, administrative healthcare records, and population-based datasets. Studies were eligible if they explicitly compared healthcare access among disabled individuals in rural and urban settings at regional or national levels. Key indicators examined included healthcare utilization, physical accessibility, transportation barriers, availability of healthcare providers, wait times, and financial barriers. Data extraction was conducted using standardized forms, and methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Findings were synthesized using narrative synthesis and thematic analysis in accordance with PRISMA guidelines.
RESULTS: A total of 8 studies conducted in Peru, China, the United States, Mozambique, and South Africa met the inclusion criteria. Across studies, rural areas were consistently characterized by greater transportation barriers, longer travel distances to healthcare facilities, lower healthcare facility density, and reduced provider availability. Urban areas demonstrated higher service availability but faced access limitations related to facility overcrowding and longer wait times. Socioeconomic factors influenced access in both settings, although the nature of these barriers differed. Telemedicine and mobile clinics were identified as key facilitators in rural contexts, while specialized services and public transportation systems were more relevant facilitators in urban areas.
CONCLUSIONS: Disabled individuals experience substantial healthcare access disparities that differ by geographical context. Addressing these inequities requires context-specific strategies, including technological and mobile healthcare solutions in rural areas and system-level optimization in urban healthcare settings.
METHODS: The review was pre-registered in PROSPERO (CRD42025648258). Peer-reviewed studies published between January 1, 2010, and December 31, 2024, were identified through searches of PubMed, Scopus, Web of Science, and the Cochrane Library. The data sources included previously published observational and mixed-methods studies drawing on national surveys, administrative healthcare records, and population-based datasets. Studies were eligible if they explicitly compared healthcare access among disabled individuals in rural and urban settings at regional or national levels. Key indicators examined included healthcare utilization, physical accessibility, transportation barriers, availability of healthcare providers, wait times, and financial barriers. Data extraction was conducted using standardized forms, and methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Findings were synthesized using narrative synthesis and thematic analysis in accordance with PRISMA guidelines.
RESULTS: A total of 8 studies conducted in Peru, China, the United States, Mozambique, and South Africa met the inclusion criteria. Across studies, rural areas were consistently characterized by greater transportation barriers, longer travel distances to healthcare facilities, lower healthcare facility density, and reduced provider availability. Urban areas demonstrated higher service availability but faced access limitations related to facility overcrowding and longer wait times. Socioeconomic factors influenced access in both settings, although the nature of these barriers differed. Telemedicine and mobile clinics were identified as key facilitators in rural contexts, while specialized services and public transportation systems were more relevant facilitators in urban areas.
CONCLUSIONS: Disabled individuals experience substantial healthcare access disparities that differ by geographical context. Addressing these inequities requires context-specific strategies, including technological and mobile healthcare solutions in rural areas and system-level optimization in urban healthcare settings.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR150
Topic
Health Policy & Regulatory
Topic Subcategory
Insurance Systems & National Health Care, Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas