Rural Health Research Gateway

Andrew F. Coburn, PhD

Deputy Director, Maine Rural Health Research Center

Phone: 207.780.4435
Fax: 207.780.4417
E-mail: andyc@usm.maine.edu

Maine Rural Health Research Center
University of Southern Maine
Institute for Health Policy
PO Box 9300
Portland, ME 04104-9300

Current Projects

Expanding Rural Health Insurance Coverage: How Do Insurance Reform Strategies Stack Up?
Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health insurance and the uninsured, Health policy
This purpose of this study is to inform policymakers about the current state of health insurance coverage in rural America, and to assess how specific reform strategies may differentially affect rural residents. Using a combination of analytic strategies, we will provide policymakers and rural health advocates with the necessary tools to develop reform strategies that meet the needs of rural residents.

Financial Impact of Mental Health Services on Rural Individuals and Families
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health insurance and the uninsured, Mental health
This project will use the Medical Expenditure Panel Survey (MEPS) to examine the financial burden that rural residents face in seeking mental health services, compared to urban residents. Implications of financial burden for access to needed mental health services for rural residents will be assessed.

Impact of Employment Transitions on Health Insurance Coverage of Rural Residents
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Health insurance and the uninsured
This project will use the National Longitudinal Survey of Youth (NLSY), an ongoing nationally representative survey conducted by the Bureau of Labor Statistics, to determine the relationship between employment changes and health insurance status among rural residents and the extent to which this differs from urban residents.

Measuring the Community Benefits and Impact of Critical Access Hospitals
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
This project will develop, test, and implement a set of community benefits and impact indicators for Critical Access Hospitals (CAHs). These indicators will assist CAHs, policymakers, and rural stakeholders to understand the impact of CAHs on their communities and local health care delivery systems.

Completed Projects

Analysis of 2004-2005 State Flex Grant Plans, Lead researcher
Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Networking and collaboration, Quality
This project will analyze state Flex grant applications and related budget and work plan revisions focusing on state activities in the core Flex program areas of networks, quality improvement, and EMS.

Development of State Flex Program Logic Models and Related Toolkit, Lead researcher
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program

Establishing Evidenced-based Safety Standards for Rural Hospitals - Phase 1
Research center: Minnesota Rural Health Research Center
Funders: Agency for Healthcare Research and Quality (AHRQ), Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Quality
This project will develop and test evidence-based safety improvement interventions in rural hospitals by identifying key patient safety areas and interventions of particular relevance to rural hospitals that have the potential to reduce medical errors and improve patient safety.

Health Insurance Coverage and Access to Health Services for the Rural Near Elderly, Lead researcher
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Aging, Health insurance and the uninsured, Health services

Health Insurance Dynamics of Uninsured Rural Families, Lead researcher
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Health insurance and the uninsured
To better understand the dynamics of insurance coverage among rural and urban families, this study will use the Medical Expenditure Panel Survey (MEPS) to compare family health insurance coverage among non-elderly rural and urban families.

Measuring Rural Underinisurance, Lead researcher
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Health insurance and the uninsured

National Rural Hospital Flexibility Program Tracking Project: Tracking State Policy and Program Development, Lead researcher
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program

Patterns of Individual Health Plan Coverage Among Rural Residents, Lead researcher
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health insurance and the uninsured, Rural statistics and demographics

Special Study of EMS Issues, Lead researcher
Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Networking and collaboration
This study will focus on state, community, and hospital level initiatives designed to build the infrastructure to support EMS service capacity and encourage the integration of these services into the rural healthcare infrastructure in the areas of quality improvement, financing, staffing, medical control, and networking and integration.

State Flex Program Quality Improvement Activities, Lead researcher
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality

Urban and Rural Differences in Utilization Patterns, Risk Factors and Expenditures of the Dually Eligible Elderly and Non-Elderly Persons with Disabilities, Lead researcher
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Aging, Disabilities, Medicaid and S-CHIP, Medicare

Using Program Logic Models to Monitor the Performance of State Flex Programs, Lead researcher
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
This project will use a program logic model approach to track state program activities and develop tools that allow states to systematically monitor and manage their accomplishments in the context of Flex Program goals.

Publications

  • Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices
    Author(s): Anthony Wellever, Andrew Coburn, Charles Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy McBride, Keith Mueller, Rebecca Slifkin
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Health care financing, Legislation and regulation, Medicare Prospective Payment System (PPS), Medicare Wage Index
    Date: 08 / 2000
    This Policy Paper summarizes the positions of various rural health advocates and recording the actions taken by Congress and the Health Care Financing Administration (HCFA) to improve the wage index. Finally, it outlines the research needed to energize the policy discussion of the uses and methods of calculating the hospital wage index. Report produced by the RUPRI Rural Health Panel.
  • Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective
    Author(s): Andrew F. Coburn, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Legislation and regulation, Medicare, Pharmacy and prescription drugs
    Date: 01 / 2003
    This Policy Paper assesses legislative proposals to add an outpatient prescription drug benefit to the Medicare program and their implications for the delivery of services and the welfare of beneficiaries in rural areas. Report produced by the RUPRI Rural Health Panel.
  • Characteristics and Roles of Rural Health Clinics in the United States: A Chartbook
    Author(s): John A. Gale, Andrew F. Coburn
    Research center: Maine Rural Health Research Center
    Topics: Health services, Rural Health Clinics (RHCs)
    Date: 01 / 2003
    Reports on the results of a national survey of Rural Health Clinics (RHCs). Information was collected on a wide range of topics of concern to RHCs including: 1) the characteristics and operations of the clinics; 2) their location relative to the underservice problems and access needs of rural areas; 3) safety net functions of RHCs; 4) staffing, recruitment and financial issues; and 5) involvement in the training of health care professionals. Among the findings: most RHCs continue to serve rural, underserved communities; RHCs are filling a valuable safety net role by serving Medicaid, uninsured, and low-income patients and providing free and reduced cost care; recruitment and retention is a problem for RHCs, and some RHCs face continued financial challenges despite cost-based reimbursement. RHCs continue to be an important source of primary care and safety net services in rural communities. Legislative efforts to address concerns about the program have included the refinement of the shortage area criteria used by the RHC program (Balanced Budget Act of 1997) and the implementation of a Medicaid prospective payment system (Benefits Improvement and Protection Act of 2000). Additional research is needed to understand the impact of these changes on the RHCs and the residents of rural communities served by them.
  • Comments on the June 2001 Report of the Medicare Payment Advisory Commission: Medicare in Rural America
    Author(s): Andrew Coburn, Charles Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy McBride, Keith Mueller, Rebecca Slifkin
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Health policy, Medicare
    Date: 09 / 2001
    Comments on and critiques the findings in MedPAC's Medicare in Rural America. The authors believe that while the MedPAC report helps set a framework for analysis, it is not a definitive treatise on the role of Medicare in rural health. Among its findings: most of MedPAC's recommendations would have positive impacts on health care for rural beneficiaries, others would do no harm, others could be strengthened, and a few, particularly those relating to access to services, "suffer from disparities and weaknesses." Report produced by the RUPRI Rural Health Panel.
  • Community Impact of Critical Access Hospitals
    Author(s): John A. Gale, Andrew F. Coburn, Victoria Freeman, Walter R. Gregg, Rebecca Slifkin
    Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
    Report Number: Policy Brief No. 2
    Date: 02 / 2007
    Discusses the findings of a project to understand the community involvement and impact of Critical Access Hospitals (CAHs) and the Medicare Rural Hospital Flexibility Program (Flex Program). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Comparative Performance Data for Critical Access Hospitals
    Author(s): George H. Pink, Rebecca T. Slifkin, Andrew F. Coburn, John A. Gale
    Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
    Citation: Journal of Rural Health, 20(4), 374-382
    Date: 2004
    Discusses the potential use of comparative performance data for critical access hospitals (CPD-CAH) to facilitate performance and quality improvement. Covers potential benefits and drawbacks of CPD-CH and identifies issues in the development and implementation of CPD-CAH.
  • Creating Program Logic Models: A Toolkit for State Flex Programs
    Author(s): John Gale, Stephenie Loux, Andrew Coburn
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
    Date: 04 / 2006
    Provide states with a tool for planning, managing, reporting on, and assessing their Flex Program goals, activities, and accomplishments; assistance in identifying and defining measurable outcomes; information linking state-level Flex Program strategies to specific and measurable outcomes; and a consistent program-reporting framework to convey results to both internal and external stakeholders. The Program Logic Model (PLM) Toolkit is organized according to the steps in the PLM development process and guides the user through each section. Included in the Toolkit is an overview of PLMs, their component parts, and the application of the PLM framework to the planning, implementation, and evaluation of the Flex Program. The bulk of the Toolkit provides a step-by-step approach to developing a Program Logic Model. The final section of the Toolkit lists resources for additional information on PLMs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment
    Author(s): Andrew F. Coburn, Erika C. Ziller, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
    Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
    Date: 08 / 2000
    The purpose of this paper is to offer a rural perspective on the current debate over the design and implementation of a Medicare prescription drug benefit. Background information on rural Medicare beneficiaries' need for, and access to, prescription drugs is provided, along with a set of rural-oriented principles for use in evaluating how different prescription drug proposals may meet the needs of rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
  • Exploring the Community Impact of Critical Access Hospitals
    Author(s): John Gale, Andrew Coburn, Walt Gregg, Rebecca Slifkin, Victoria Freeman
    Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
    Report Number: Flex Monitoring Team Briefing Paper No. 14
    Date: 01 / 2007
    Reports on a series of site visits to six diverse rural communities and Critical Access Hospitals (CAHs) to assess the experiences and impact of these hospitals in responding to their community’s health infrastructure needs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Health Insurance Coverage Of The Rural And Urban Near Elderly
    Author(s): Erika C. Ziller, Andrew F. Coburn
    Research center: Maine Rural Health Research Center
    Topics: Aging, Health insurance and the uninsured
    Report Number: Working Paper No. 27
    Date: 10 / 2003
    Reports the results of a study that used data from the 1996-1998 Medical Expenditure Panel Survey (MEPS) to address two principal research questions related to health insurance coverage for the rural near elderly. Findings indicate that the rural near elderly are both more likely to be uninsured and to be in fair or poor health, and when the near elderly become uninsured they may have a much more difficult time regaining health insurance than younger groups. This issue may be even more problematic in rural areas as the findings indicate that 14% of the rural near elderly are uninsured for the entire survey year, compared to 10% of the urban near elderly.
  • Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals
    Author(s): Andrew F. Coburn, Erika Ziller, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
    Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Legislation and regulation, Pharmacy and prescription drugs
    Date: 06 / 2000
    This Policy Paper combines the work from current projects of the Maine Rural Health Research Center (MRHRC) and the Rural Health Panel of the Rural Policy Research Institute (RUPRI) to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare program. Our intent is to establish a framework for assessing the effects of proposals on rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
  • Out-of-Pocket Health Care Spending and the Rural Underinsured
    Author(s): Erika Ziller, Andrew Coburn, Anush Yousefian
    Research center: Maine Rural Health Research Center
    Topic: Health insurance and the uninsured
    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.
  • Out-Of-Pocket Health Spending And The Rural Underinsured
    Author(s): Erika C. Ziller, Andrew F. Coburn, Anush E. Yousefian
    Research center: Maine Rural Health Research Center
    Topics: Health insurance and the uninsured, Rural statistics and demographics
    Citation: Health Affairs, 25(6), 1688-1699
    Date: 2006
    Estimates underinsurance rates among privately insured rural residents and the characteristics associated with rural underinsurance.
  • Patterns of Health Insurance Coverage Among Rural and Urban Children
    Author(s): Andrew F. Coburn, Timothy McBride, Erika Ziller
    Research center: Maine Rural Health Research Center
    Topics: Children, Health insurance and the uninsured
    Report Number: Working Paper No. 26
    Date: 11 / 2001
    Assesses differences in the patterns of insurance coverage and uninsured spells among rural and urban children in 20 states. Also examines the implications of those differences for the design and implementation of public insurance programs. Among its findings: Although the average duration of new uninsured spells was shorter among rural than urban children, rural children were more likely to experience protracted spells of uninsurance. Rural children were also more likely than urban children to move between public and private coverage. These findings have important implications for designing insurance expansion programs and outreach strategies to effectively enroll and retain rural children.
  • Prioritizing Patient Safety Interventions in Small Rural Hospitals
    Author(s): Michelle Casey, Mary Wakefield, Andrew F. Coburn, Ira Moscovice, Stephanie Loux
    Research centers: Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality
    Citation: Joint Commission Journal on Quality and Patient Safety, 32(12), 693-702
    Date: 12 / 2006
    Reports the results of a study seeking to determine if 26 patient safety practices recommended by an expert panel as relevant to rural hospitals would be validated in terms of rural relevance and implementability by administrators and quality managers in small rural facilities in Maine, Minnesota, Montana, North Dakota, Pennsylvania, and Tennessee. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
  • Redesigning Medicare: Considerations for Rural Beneficiaries and Health Systems
    Author(s): Andrew F. Coburn, Charles W. Fluharty, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Health policy, Medicare
    Report Number: Special Monograph
    Date: 02 / 2001
    Provides a framework to help shape proposals to redesign Medicare to the benefit of rural beneficiaries and providers. Chapters focus on equity, quality, choice, access, and cost. Each chapter outlines the current situation, analyzes the implications of various approaches to changing the program, and makes recommendations for developing a Medicare program of greatest benefit to rural residents. Report produced by the RUPRI Rural Health Panel.
  • Redesigning the Medicare Program: An Opportunity to Improve Rural Health Care Systems?
    Author(s): Andrew F. Coburn, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Health policy, Medicare
    Date: 08 / 2000
    With this paper, the RUPRI Rural Health Panel is presenting a well-defined framework for what should be included in any discussion of Medicare policies.
  • Review of State Flex Program Plans, 2004-2005
    Author(s): Stephenie Loux, John Gale, Anush Yousefian, Andrew Coburn, Walter Gregg
    Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
    Report Number: Flex Monitoring Team Briefing Paper No. 10
    Date: 03 / 2006
    Examines the objectives and project activities proposed by states in their Medicare Rural Hospital Flexibility Program (Flex Program) grant applications for Fiscal Year 2004 to strengthen the rural healthcare infrastructure in their states. Highlights recent trends in State Flex Program planning, development, and implementation. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Rural Assessment of Leading Proposals to Redesign the Medicare Program
    Author(s): Andrew F. Coburn, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Health policy, Medicare
    Date: 05 / 2000
    This Policy Paper provides a critique of two proposals to redesign the Medicare program: the "Medicare Preservation and Improvement Act of 1999" (S. 1895, introduced by Senator Breaux and others) and "The President's Plan to Modernize and Strengthen Medicare for the 21st Century." Rural implications of the proposals are discussed, specifically how they affect rural Medicare beneficiaries and rural providers of health care services. Report produced by the RUPRI Rural Health Panel.
  • Rural Hospitals and Long-Term Care: the Challenges of Diversification and Integration Strategies
    Author(s): Andrew F. Coburn, Stephanie Loux, E.J. Bolda
    Research center: Maine Rural Health Research Center
    Topics: Hospitals and clinics, Long term care
    Citation: In R. T. Goins, & J. A. Krout (Eds.), Service delivery to rural older adults: Research, policy, and practice. (pp. 103-122). New York, NY: Springer Publishing Co.
    Date: 2006
  • Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
    Author(s): Keith J. Mueller, Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin, Mary K. Wakefield
    Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, Upper Midwest Rural Health Research Center
    Topics: Health policy, Legislation and regulation, Medicare, Pharmacy and prescription drugs
    Citation: Journal of Rural Health, 21(3), 194-197
    Date: 2005
    The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in September 2004 to identify a set of researchable questions concerning the impact of the MMA on rural health care. This paper presents research questions in the following areas that congressional staff identified as having the highest priority: access to health plans and pharmacy services, beneficiary outreach and enrollment, technology capacity, provider payment policy, and demonstration projects.
  • Uninsured Rural Families
    Author(s): Erica Ziller, Andrew F. Coburn, N. Anderson, Stephanie Loux
    Research center: Maine Rural Health Research Center
    Topic: Health insurance and the uninsured
    Report Number: Working Paper No. 34
    Date: 2006

This web site includes content provided by and adapted from the Maine Rural Health Research Center, University of Southern Maine under a Cooperative Agreement with the University of North Dakota.