Middle-Aged and Older Adult Health Care Selection: Health Care Bypass Behavior in Rural Communities in Montana


health care selection, rural older adult health care, health care bypass


This study assesses the prevalence of primary-care physician (PCP) bypass among rural middle-aged and older adults. Bypass is a behavior where people travel beyond local providers to obtain health care. This article applies a precise Geographic Information System (GIS)-based measure of bypass and examines the role of community and non-health-care-related characteristics on bypass. Our results indicate that bypass behavior among rural middle-aged and older adults is multifaceted. In addition to the perceived quality of local primary care, dissatisfaction with local services, such as shopping, creates an effect that increases the likelihood of bypass, whereas strong community ties decrease the likelihood of bypass. The results suggest that the “outshopping theory,” where respondents select services in larger regional economic centers rather than local “mom and pop” providers, now extends to older adult health care selection.

Original Publication Citation

Sanders, Scott R., Lance Erickson, Vaughn R.A. Call, Mathew McKnight. “Middle-Aged and Older Adult Health Care Selection Health Care Bypass Behavior in Rural Communities in Montana.” Journal of Applied Gerontology 36, no. 4 (2017): 441-461.

Document Type

Peer-Reviewed Article

Publication Date


Permanent URL



Journal of Applied Gerontology




Family, Home, and Social Sciences


Social Work

University Standing at Time of Publication

Associate Professor