Perceived availability of health care services in a rural region of North-West Germany

Abstract Background Health care availability in rural areas is restricted by various challenges, such as limited facilities, long travel distances, and economic barriers. Evaluation of the subjective perception of health care availability is of utmost importance, as it can differ from objectively assessed availability and hint at specific needs of rural populations. This study examines the perceived availability of health care services and its associations with sociodemographic characteristics and health factors in a rural population in Northern Germany. Methods We used data from the first wave of a longitudinal study with three survey waves between December 2022 and August 2025 as the study sample. We assessed the perceived availability of various health care services with a newly developed 21-item instrument. We assessed diagnosed chronic illness using a single-item question and depression using PHQ-9. We conducted multivariate stepwise regression analysis. Results The sample consisted of 493 participants. 68.3% (n = 338) were female, 78.3% (n = 386) were living in a rural area. The perceived availability of hospitals (OR = 0.19, 95% CI [0.08, 0.44, p>.001), general practitioners (OR = 0.30, 95% CI [0.14, 0.62], p>.001) and medical specialists (OR = 0.22, 95% CI [0.10, 0.49], p>.001) was associated with living in a rural area. Perceived availability of psychologists (OR = 9.41, 95% CI [1.80, 49.10], p = 0.008) and general practitioners (OR = 2.79, 95% CI [1.10, 7.08], p = 0.032) was associated with depression. The perceived availability of hospitals (OR = 2.11, 95% CI [1.07, 4.16], p = 0.028) and medical specialists (OR = 2.46, 95% CI [1.10, 5.48], p = 0.028) was associated with chronic illness. Conclusions Our findings show that considering perceived availability of health care services is crucial for tailoring health care systems to users’ needs. This approach maximizes efficiency while preventing the overprovision of services that are less accepted or fail to reach those most in need.