Healthcare Use in the Heartland: How Health Care Selection Varies Between Rural, Retirement‐Age Migrants and Long‐Term Residents


health care, rural, community, retirement-age, bypass behavior


One increasingly important problem affecting rural health care selection is the tendency of older residents to bypass local health care providers. This research investigates how the effects of community characteristics and attachment on health care bypass behavior vary between rural retirement‐age migrants and retirement‐age long‐term residents. Non‐health‐related behaviors, such as purchasing goods and services outside one's community during a health care trip, that is, “outshopping,” could influence bypass if individuals combine trips for their medical care with other consumer needs. Basing our work on the outshopping theory, we argue that bypass behavior is one facet of consumer consumption patterns for both rural retirement‐age migrants and long‐term residents. In addition, dissatisfaction with local health care and services like shopping can “push” rural residents to bypass local health care and travel greater distances for primary health care. We further contend that strong community attachment has an opposite “pull” effect that can help to negate the push of outshopping and reduce the likelihood of bypass. Our results reveal retirement‐age migrants are significantly more likely to bypass local primary health care providers than retirement‐age long‐term residents. Furthermore, our analysis bridges the rural health care and retirement community development literature to suggest that outshopping theory can now be applied to rural primary health care bypass behavior.

Original Publication Citation

Sanders, Scott R., Lance D. Erickson, Vaughn Call, and Jacob S. Rugh. (2016). “Healthcare Utilization in the Heartland: How Healthcare Selection Varies Between Rural Retirement-Age Migrants and Long-Term Residents.” Rural Sociology. 81(1):66-98.

Document Type

Peer-Reviewed Article

Publication Date



Rural Sociology




Family, Home, and Social Sciences



University Standing at Time of Publication

Associate Professor