Elderly Country Dwellers Face Higher Living Costs, Fewer Choices in Medical Care : Health: On average, they spend all their after-tax income on doctor’s bills. Insurance against illness also is hard to get, study says.

Elderly Americans in rural areas find that money is especially tight and that medical care is more expensive and harder to get than in the city, Agriculture Department researchers said.

They must spend, on average, all of their after-tax income, and they have less money than their city and suburban cousins, according to a study released recently at the agency’s 68th annual outlook conference.

Rural households also spend more for medical insurance, F. N. Schwenk of the Agricultural Research Service’s family economics research group said in a report.

“The income of rural older households was 75% of that of their urban counterparts; rural expenditures were 81% of urban counterparts,” the report said.

For rural households, expenditures accounted for 99% of after-tax income; for urban households it was 95%.

The average gross income of rural older households was $15,367, compared to $20,422 for urban counterparts, the study found. Almost two-thirds of elderly rural people reported household incomes under $15,000 a year, compared to less than half of all urban households.

And while the rural elderly have less to spend, Schwenk’s report said 14% of their budgets go to medical bills, compared to 11% for urban households.

Health insurance also costs the rural elderly more, but that may be because many of them were self-employed or worked for small firms that did not provide coverage as a benefit.

According to another study by Carolyn C. Rogers, a demographer with the agency’s Economic Research Service, elderly country dwellers are more likely to have certain chronic conditions, such as arthritis, than their city contemporaries. And medical services are less accessible to them.

“The non-metro elderly were less likely to use formal health services--physician visits, hospital stays and nursing-home care. Central-city elderly used both community and health services to a greater extent than (others),” Rogers said.

“This suggests that, indeed, there is a gap between the non-metro elderly’s need for care, based on their poorer health status, and the availability of services to meet this need.”

Rural areas, the report said, have fewer doctors, nurses, pharmacists and medical facilities.

In 1989, about 66.2 million people lived in rural areas. Of them, 12% were 65 or older.