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Measuring Rural Underinisurance
Multiple studies have documented lower rates of health insurance coverage among rural residents compared to urban residents. To date, there have been limited analyses of the extent to which rural individuals with private coverage are "under-insured" compared to those in urban areas. By "under-insured" we mean that, although they have health insurance coverage, the out-of-pocket costs for medical care may be significantly higher for people living in rural areas.
This project will use the Medical Expenditure Panel Survey (MEPS) conducted by the federal Agency for Healthcare Research & Quality to examine the extent of under-insurance among rural residents compared to urban residents. Using this dataset we will address the following research questions:
- What is the out-of-pocket health care cost burden for privately insured rural residents and how does this compare to that of urban residents?
- To what extent do rural residents with private health insurance coverage report financial barriers to health care? Are there rural-urban differences?
- Do differences in out-of-pocket costs affect rural residents' use of medical care? If so, do these differences persist after controlling for other predisposing, enabling and need factors?
Publications
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Out-of-Pocket Health Care Spending and the Rural Underinsured
Author(s): Erika Ziller, Andrew Coburn, Anush Yousefian
Report Number: Working Paper No. 33
Date: 12 / 2005
Reports the results of a study to identify whether and to what extent there are rural-urban differences in underinsured rates among the privately insured, and, where differences exist, to understand what characteristics of rural residents are related to their likelihood of being underinsured. Using the 2001 and 2001 Medical Expenditure Panel Survey (MEPS), the authors examined the annual out-of-pocket health care expenditures for U.S.residents under age 65 that were continuously insured by a private plan in either 2001 or 2002. Findings showed that, despite having private health insurance coverage, those who use medical services continue to pay for a substantial portion of their own health care costs, particularly those living in rural areas. The average rural non-adjacent individual paid for 39% of their care in 2001 or 2002, compared to 35% for rural adjacent and 32% for urban individuals. Additional findings showed that one out of eight non-adjacent residents is underinsured (12.4%), compared to 10% of rural adjacent and 7% of urban residents.
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Out-Of-Pocket Health Spending And The Rural Underinsured
Author(s): Erika C. Ziller, Andrew F. Coburn, Anush E. Yousefian
Citation: Health Affairs, 25(6), 1688-1699
Date: 2006
Estimates underinsurance rates among privately insured rural residents and the characteristics associated with rural underinsurance.
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Rural Residents More Likely to be Underinsured
Author(s): Erika Ziller
Report Number: Research and Policy Brief
Date: 2006
Multiple studies have demonstrated that rural residents, particularly those living far from urban areas, have high uninsured rates. However, even those with private health insurance coverage can be at risk of having high out-of-pocket health care costs. Understanding the degree to which rural residents are "underinsured" has important implications for rural health policy and practice.
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