Consequences of Rural Uninsurance

Funder:	Office of Rural Health Policy (ORHP)
Research center:	Maine Rural Health Research Center Phone: 207.780.4513
Lead researcher:	Nathaniel Anderson, MPH
Contact:	Nathaniel Anderson, MPH, 207.228.8187, nanderso@usm.maine.edu
Project funded:	September 2008
Project completed:	May 2011
Topic:	Health insurance and the uninsured

Problem: As an increasing number of states and the Congress consider options for covering the uninsured, it is critically important that policymakers consider the rural nature and circumstances surrounding this problem. However, research into the consequences of this lack of coverage on access to care for rural residents has been limited. Methods: Using the Medical Expenditure Panel Survey (MEPS) data, this study will examine the health care utilization patterns among uninsured rural and urban residents, compared to each other as well as to their insured counterparts. The specific questions we wish to address are:

• What is the level of self-reported access to care (e.g. usual source of care, delay of care, and concerns about access) among the rural uninsured and does it differ from insured residents in rural and urban areas?
• How does health care use (including office-based care, preventive care, prescription drug use and emergency care) differ for rural insured versus uninsured residents? Are there differences in the site of care (e.g. office-based care, emergency room) for rural insured versus uninsured residents?
• Among the uninsured, is there a rural-urban difference in health care use? If so, how does this differ from patterns of rural versus urban use among the insured?
• To what extent and how are patterns of use among the rural uninsured different among subpopulations with diabetes, asthma, or heart disease?

By identifying whether or not uninsured rural residents have different levels of access to care than their urban counterparts, and the potential source of these differences, we will provide critical information to policymakers committed to rural health care issues. Products: Anticipated products include a Working Paper and associated Research and Policy Brief along with submission to a peer-reviewed journal. Additionally, abstracts will be submitted for presentation at the annual meetings of the National Rural Health Association and AcademyHealth.

Publications

• Health Care Access and Use Among the Rural Uninsured (Policy Brief)
  Author(s): Erika C. Ziller, Jennifer D. Lenardson, Andrew F. Coburn
  Date: 11 / 2011
  Using data from the 2002-2007 Medical Expenditure Panel Survey (MEPS), this study examined access to care and service use among non-elderly, uninsured rural and urban residents. Key Findings include:
  • Uninsured residents of both rural and urban areas face serious barriers to care compared to those with health insurance coverage.
  • The rural uninsured are more likely to have a usual source of care and to have used ambulatory care in the past year than the urban uninsured.
  • Insured or not, rural residents have difficulty accessing after hours care and traveling to see their usual provider