Research Alert: October 29, 2026

County-Level Differences in Fee-for-Service Medicare Quality Measures by Rurality and Disability Status

Access to health care is critical for every individual but is not sufficient without ensuring quality of care. Quality in health care can be defined as, “doing the right thing at the right time in the right way for the right person and having the best results possible.” Quality of care extends to a range of settings (e.g. emergency departments, primary care clinics, surgical centers) and types of supports (e.g. acute diagnostics, preventive services). However, there are differences in quality of care by disability status, and rural residents also experience differences in quality of care compared to urban residents. Despite research showing differences in quality of care by disability status and rurality, there is limited research looking at the intersection of the two. In this policy brief, researchers examine county-level differences in three commonly used fee-for-service Medicare quality measures to address differences in quality care by both rurality and disability status.

Key Findings:

• Across three fee-for-service Medicare health care quality measures, rural counties had poorer quality compared to urban counties, including lower rates of flu vaccination (32.8%-40.0% vs 39.6%-51.5%) and mammography screening (35.1%-45.0% vs 39.1%-47.2%), and higher rates of ambulatory-sensitive hospitalization (2,355-3,429 vs 2,417-3,194 per 100,000 people).
• As disability prevalence at the county-level increased, quality of care decreased across these three measures.
• Rural counties with the highest disability prevalence had the lowest rates of flu vaccination (32.8%) and mammography screening (35.1%), and highest rates of hospitalization for ambulatory-sensitive conditions (3,429 per 100,000 people).

Additional Resources of Interest:

• More FORHP-funded research on Disabilities, Medicare, Quality
• More information about the University of Minnesota Rural Health Research Center
• More information from the Rural Health Information Hub's topic guide: Healthcare Quality