Medicine and Health Sciences Commons^™

Non-Urgent Use Of Emergency Departments By Rural And Urban Adults, Erika Ziller Phd, Carly Milkowski, Zachariah Croll, Yvonne Jonk Phd

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This study, conducted by researchers at the Maine Rural Health Research Center, provides updated information and addresses gaps in knowledge about rural non-urgent ED use. Understanding the rates of non-urgent ED use among rural adults and the factors associated with this use can inform policy and practice efforts to reduce unnecessary and inappropriate use of EDs in rural communities.

Hospital emergency departments (EDs) serve a vital role in the US health care system, providing lifesaving, around-the-clock care to patients in acute health situations. However, use of the ED for non-urgent care is costly and reflects a suboptimal care setting, with …

Rural Working-Age Adults Report More Cost Barriers To Health Care, Erika C. Ziller Phd, Carly Milkowski Mph, Amanda Burgess Mppm, Mph

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Using the 2019-2020 National Health Insurance Survey, researchers at the Maine Rural Health Research Center examined rural-urban differences in affordability of care and cost-saving strategies among working-age adults. Rural adults (18-64) were more likely than their urban counterparts to report problems paying, or being unable to pay, their medical bills. They were also more likely to delay or go without needed care because of the cost. Compared with urban adults, those in rural areas were more likely to engage in prescription drug cost-saving measures such as skipping doses, delaying refills, or taking less medication than prescribed. For all affordability measures, …

Patterns Of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 And Older, 2010-2017, Yvonne Jonk Phd, Heidi O'Connor Ms, Amanda Burgess Mppm, Carly Milkowski Mph

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The purpose of this study was to examine rural-urban differences in health care use among Medicare beneficiaries age 85+. Understanding these differences, and the socioeconomic characteristics that contribute to them, can have important implications for Medicare policies aimed at serving the age 85+ population. Using the Medicare Current Beneficiary Survey 2010-13 Cost and Use and 2015-17 Cost Supplement Files, we examined whether and how rural and urban Medicare beneficiaries age 85+ differ in terms of their:

1. socioeconomic and health characteristics that may inform health care use;
2. trends in health care use, including use of inpatient and emergency department (ED) care; …

Health Care Use And Access Among Rural And Urban Nonelderly Adult Medicare Beneficiaries, Erika C. Ziller Phd, Amanda Burgess Mppm, Deborah Thayer Mba

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Little is known about the characteristics and health care use of rural residents with disabilities. Using the Medicare Current Beneficiary Survey (2009-2013), we compared access to and use of health services among rural and urban nonelderly Medicare beneficiaries with a disability, and examined their health and functional status along with sociodemographic characteristics. We found that the characteristics of nonelderly Medicare beneficiaries with a disability reflected the differences observed between rural and urban populations overall: rural recipients were more likely than their urban peers to be older, non-Hispanic white, and have a lower level of educational attainment. Although self-reported access to …

Preventive Health Service Use Among Rural Women, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Nathan Paluso Mph, Jaclyn Janis Bsn, Rn

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Preventive health services and screenings are an important component in the continuum of care provided to individuals across all ages. Yet, research has shown that rural residents generally use fewer preventive health services and screenings. This study used the National Health Interview Survey to examine receipt of preventive health services (cholesterol check, fasting blood sugar test, mammogram, pap smear, and receipt of the HPV vaccine) by rural and urban women over the age of 18. Findings indicate that rural women were less likely than their urban peers to receive preventive health services, and that some of the differences may be …

Access To Health Care Services For Adults In Maine [Policy Brief], Erika C. Ziller Phd, Barbara Leonard Mph, Amanda Burgess Mppm, Nathan Paluso Mph

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This data brief by researchers at the Maine Health Access Foundation and the University of Southern Maine's Maine Rural Health Research Center found ongoing inequality in the ability of people in Maine to get quality health care. The report examines data from 2014-2016 and shows that Maine people, of all income groups, report difficulties in paying medical costs. Research has also found the ability to seek timely and appropriate health care is impacted by income levels, educational background, race and ethnicity.
This brief provides an update to the 2016 study (available in Digital Commons: https://digitalcommons.usm.maine.edu/cgi/viewcontent.cgi?article=1038&context=insurance)

For more information, please …

The Role Of Public Versus Private Health Insurance In Ensuring Health Care Access & Affordability For Low-Income Rural Children, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Amanda Burgess Mppm

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Medicaid and the Children’s Health Insurance Program (CHIP) have played a critical role in ensuring access to health insurance coverage among children and have been particularly important sources of coverage for rural children. More than 35.5 million children were enrolled in Medicaid or CHIP in September 2016—accounting for just over half of total Medicaid and CHIP enrollment. Given the large proportion of rural children covered by public insurance, it is critically important to understand the role of that coverage in ensuring access to affordable healthcare for rural children. Using data from the 2011-2012 National Survey of Children’s Health, this study …

Mental Health Status And Access To Health Care Services For Adults In Maine, Erika C. Ziller Phd, Barbara Leonard Mph

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Maine people with poor mental health describe significant challenges with affordability and access to health care. A new report released by the Maine Health Access Foundation (MeHAF) and the University of Southern Maine, Mental Health Status and Access to Health Care Service for Adults in Maine, describes how adults 18 and older in Maine who report depression and poor mental health have many barriers to getting health care. These results have important implications for planning in a time when major changes in health insurance coverage are expected.

Analyzing data from the ongoing federal/state public health survey, the Behavioral Risk …

Access To Health Care Services For Adults In Maine [Report], Erika C. Ziller Phd

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On October 17, 2016, the Maine Health Access Foundation (MeHAF) released a new research brief developed with the University of Southern Maine that found significant inequality in the ability of people in Maine to access quality health care. The authors, Barbara Leonard from MeHAF and Erika Ziller from the USM Muskie School, found that income, age and education are all closely associated with Maine people’s ability to receive appropriate and timely health care. Specifically, they found that among Maine adults 18 and older, those with family incomes less than $25,000 a year, young adults, racial and ethnic minorities, and people …

Health Insurance Co-Ops: Product Availability And Premiums In Rural Counties, Erika C. Ziller Phd, Zachariah T. Croll Ba, Andrew F. Coburn Phd

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Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available.

This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of …

Health Information Exchange: A Strategy For Improving Access For Rural Veterans In The Maine Flex Rural Veterans Health Access, Karen B. Pearson Mlis, Ma, Amanda Burgess Mppm, John A. Gale Ms, Andrew F. Coburn Phd, Anush Yousefian Hansen Ms, Ma

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This paper reports on the design and implementation of a first-in-the nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers. The paper reviews key factors that have contributed to implementation challenges and successes and lessons relevant to efforts to create interoperable health IT systems across multiple, complex organizational settings.

Rural Disabled Medicare Beneficiaries Spend More Out-Of-Pocket Than Their Urban Counterparts, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

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The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey …

Rural Adults Delay, Forego, And Strategize To Afford Their Pre-Aca Health Care, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

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About 40% of non-elderly adults reported problems paying medical bills or cost-related barriers to obtaining needed medical care in 2012, difficulties that are especially pronounced for the uninsured and underinsured, the chronically-ill, and those with low incomes. Given their lower incomes and higher uninsured rates compared to urban residents, rural residents may face particular cost barriers in accessing health care. Past research has shown that, compared to urban residents, rural residents are more likely to experience higher out-of-pocket costs and delayed or foregone care as a result of cost, even when covered by private health insurance. This study provides detailed …

Out-Of-Pocket Spending Among Rural Medicare Beneficiaries, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

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The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey …

Rural Residents More Likely To Be Enrolled In High-Deductible Health Plans, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, Andrew F. Coburn Phd

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Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance …

High Deductible Health Insurance Plans In Rural Areas, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, Andrew F. Coburn Phd

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Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance …

Health Insurance Coverage Of Low-Income Rural Children Increases And Is More Continuous Following Chip Implementation, Erika C. Ziller Phd

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Key Findings: Prior to CHIP, low-income rural and urban children had comparable rates of public coverage and uninsurance, including chronic (a year or more) uninsurance; By the time CHIP was fully implemented, uninsured rates had declined so much among low-income rural children that they were lower than among urban children; In addition to lower uninsured rates in a given month, low-income rural children experienced dramatic increases in the continuity of their health insurance coverage following CHIP. Controlling for child and family characteristics, low-income rural children have more continuous coverage post-CHIP than do their urban counterparts.

Rural Vets: Their Barriers, Problems, Needs, John A. Gale Ms, Hilda R. Heady

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Evolving population trends--the aging of rural veterans, the growing number of female veterans and rates of homelessness among veterans--place significant demands on VA and rural delivery systems. Coordination among health care providers is essential to increasing the availability of services and expanding veteran outreach programs.

Rural Implications Of Geographic Rating Of Health Insurance Premiums, Andrew F. Coburn Phd, Erika C. Ziller Phd, Zachariah T. Croll Ba, Elizabeth Kilbreth Phd

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This brief examines how and to what extent states allow health plans to vary premiums by geographic rating area and, using insurance data from selected states, assesses the direction and magnitude of variations in rural and urban geographic rating factors. The authors conclude with a discussion of strategies that federal and state policymakers might use to help ensure that premium variations based on geography are justified. KEY POINTS: There is no clear pattern of geographic rating factors favoring rural or urban areas. This lack of a clear pattern suggests that health plans may use geographic rating for business purposes other …

Health Care Access And Use Among The Rural Uninsured [Policy Brief], Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

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In a landmark series of reports, the Institute of Medicine’s Committee on the Consequences of Uninsurance noted the policy significance of the “cascading” effects of uninsurance on patients, families, and communities.¹ Multiple studies confirm that rural residents are more likely to be uninsured than their urban counterparts.^2-4 Additionally, there is ample evidence that the uninsured have poorer access to care, delay care, and obtain care at levels of greater acuity than those with health insurance.⁵ However, the impact of being uninsured versus insured in rural areas, particularly compared to urban areas, is largely unknown.

Using data from …

Rural America: A Look Beyond The Images, John A. Gale Ms

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The issues faced by patients and providers in rural health care differ greatly from those of urban counterparts. They also differ across rural communities. Understanding these differences, and the differences among rural populations across America, is critical to providing health services to rural Americans, who are often impeded by economic factors, cultural and social differences, educational shortcomings and isolation in their efforts to lead normal, healthy lives. The challenges provide opportunities for Catholic health care to make a difference in the lives and health of some of the nation's most vulnerable citizens.

Health Insurance Profile Indicates Need To Expand Coverage In Rural Areas, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, Andrew F. Coburn Phd, Nathaniel J. Anderson Ms, Mph

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Key Findings: A greater percentage of rural residents than urban residents are uninsured, especially those living in remote areas Among adults over age 50, uninsured rates are highest in the most remote rural places Compared to urban adults, rural adults are less likely to be in employment situations where private coverage is offered.

Profile Of Rural Health Insurance Coverage: A Chartbook, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, Andrew F. Coburn Phd

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More than twenty years of research has demonstrated that rural residents are at greater risk of being uninsured compared to urban residents and more recent studies point to problems of underinsurance as well. Most studies have shown that the problems of uninsurance and underinsurance are greatest among rural residents living in smaller communities located further from more urbanized areas. Section I examines recent estimates and changes since 1997 in rural health insurance coverage. Section II explores differences in the demographic, socio-economic, employment and other risk factors for uninsurance among rural and urban residents. Section III profiles the demographic and economic …