Something that should also be factored in, IMO, is the gap between "on paper" and "reality", and how it varies by area.
That is, my friends in rural areas report a lot more cases of hostile workers in medicaid/etc processes actively doing their best to screw people over, to an extent that I, as someone who's always lived in the suburbs or cities, would have expected someone to get fired over. "Misplaced" paperwork, "oops, I told you to submit the wrong thing and now the deadline is passed, too bad so sad", "refer you to another doctor with no openings for 3 months...who then refuses to see you because the referral was malformed, and now you need to get in again at the first place because they refuse to do paperwork without an appointment..." ...the list of ways that you can be malicious in the gap is very large.
But in larger environments, my experience is those people get fired or transferred out of those positions once a stink is made, because regardless of the organization's feelings as a whole, they don't want the attention the stink caused. In smaller settings, that response is harder to trigger.
So that would be, I suspect, a major reason this can work better in urban settings - because the people who actively sabotage the use of these services are better filtered out.
That is, my friends in rural areas report a lot more cases of hostile workers in medicaid/etc processes actively doing their best to screw people over, to an extent that I, as someone who's always lived in the suburbs or cities, would have expected someone to get fired over. "Misplaced" paperwork, "oops, I told you to submit the wrong thing and now the deadline is passed, too bad so sad", "refer you to another doctor with no openings for 3 months...who then refuses to see you because the referral was malformed, and now you need to get in again at the first place because they refuse to do paperwork without an appointment..." ...the list of ways that you can be malicious in the gap is very large.
But in larger environments, my experience is those people get fired or transferred out of those positions once a stink is made, because regardless of the organization's feelings as a whole, they don't want the attention the stink caused. In smaller settings, that response is harder to trigger.
So that would be, I suspect, a major reason this can work better in urban settings - because the people who actively sabotage the use of these services are better filtered out.