Erika Ziller, MS

Maine Rural Health Research Center

Phone: 207.780.4615
Fax: 207.780.4417
E-mail: eziller@usm.maine.edu

Maine Rural Health Research Center
University of Southern Maine
Muskie School of Public Service
PO Box 9300
Portland, ME 04104

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.

Impact of Mental and Emotional Stress on Rural Employment Patterns
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Mental health
This study will use the National Longitudinal Survey of Youth to investigate how mental health symptoms affect employment patterns, and the extent to which these effects differ by rural and urban residence.

Rural-Urban Differences in Access to Children’s Mental Health Services
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Health services, Mental health
This study uses data from the Urban Institute’s National Survey of America’s Families to examine and compare the use of mental health services by rural and urban children, age 6 to 17, relative to their need for mental health care, family income, and insurance status.

Completed Projects

Health Insurance Coverage for Rural Americans, Lead researcher
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funders: Kaiser Commission on Medicaid and the Uninsured, Rural Policy Research Institute (RUPRI)
Topics: Health insurance and the uninsured, Rural statistics and demographics

Health Insurance Dynamics of Uninsured Rural Families
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

Publications

• 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.
• Diabetes and the Rural Safety Net
  Author(s): David Hartley, Erika Ziller, Caroline Macdonald
  Research center: Maine Rural Health Research Center
  Topics: Chronic diseases and conditions, Health insurance and the uninsured
  Report Number: Working Paper No. 28
  Date: 01 / 2002
  Investigates the extent to which the rural safety net is able to meet the needs of people with diabetes. Finds that small rural communities have a relatively greater need for safety net services to diabetics than their urban counterparts. To provide the needed array of services, medications, and support, a coordinated, team approach to care is needed. Such an approach would include the following elements: insurance coverage would be consistent with the standards of care; team management and care coordination would be facilitated, and the informal safety net would be formalized.
• 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.
• Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
  Author(s): David Hartley, Erika Ziller, Stephenie Loux, John Gale, David Lambert, Anush Yousefian
  Research center: Maine Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Mental health
  Report Number: Working Paper No. 32
  Date: 09 / 2005
  Investigates the extent and types of cases that present with mental health problems in Critical Access Hospitals (CAHs) emergency rooms (ERs), as well as the resources available to ER staff for addressing such problems and what actually happens to such patients. Emergency department managers in a random sample of 422 CAHs in 44 states completed a telephone survey (response rate = 84.7%) responding to questions about prevalence of mental health problems in their ER and what options they had for responding to such problems. On average, CAHs had 99 emergency room visits per week. Of these visits, 9.4% were mental health related. CAH ERs play a significant role in providing mental health services to rural residents. Although nearly 20% of mental health encounters result in transfers to other facilities, over 40% of mental health problems are addressed on-site through treatment or referrals. Nearly half (43%) of CAH ER managers reported having no access to local mental health providers of any kind.
• 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.
• Rural Residents More Likely to be Underinsured
  Author(s): Erika Ziller
  Research center: Maine Rural Health Research Center
  Topic: Health insurance and the uninsured
  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.
• State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
  Author(s): David Hartley, Erika C. Ziller, David Lambert, Stephenie L. Loux, Donna C. Bird
  Research center: Maine Rural Health Research Center
  Topics: Legislation and regulation, Mental health, Workforce
  Report Number: Working Paper No. 29
  Date: 05 / 2002
  Investigates whether and the extent to which licensure laws that determine the permissible scope of practice for each of these professions may affect the availability of mental health services, particularly in rural communities. Findings: Licensure laws authorize non-physician mental health providers to practice assessment, treatment planning, and individual and group counseling independently in most of the 40 states studied. Many states do not explicitly grant the authority to all of these professions for diagnosis or psychotherapy, but none explicitly deny it. Despite this finding, Medicare and some other payers do not directly reimburse Marriage and Family Therapists or Licensed Professional Counselors. Laws that require clinical supervision of newly trained practitioners to be performed exclusively by a member of the profession in a face-to face setting may make it difficult for a new graduate seeking rural practice to log the number of required hours within the specified time limit to qualify for independent practice. Some states' laws allow supervision that is not face-to-face, a rural-friendly policy. Also discussed are the nature and effects of guild behavior in the mental health professions. Based on the findings, report recommends that states simplify licensure and clarify clinical roles by combining regulatory functions for several professions into a single office or agency; that Medicare reconsider its position on reimbursing Marriage and Family Therapists or Licensed Professional Counselors; that professional competition over the right to practice and be reimbursed be addressed; and that supervision requirements be modified to allow new mental health professional graduates to address rural needs soon after graduation.
• 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
  
• Use of Critical Access Hospital Emergency Rooms by Patients With Mental Health Symptoms
  Author(s): David Hartley, Erika C. Ziller, Stephenie L. Loux, John A. Gale, David Lambert, Anush E. Yousefian
  Research center: Maine Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Mental health
  Citation: Journal of Rural Health, 23(2), 108-115
  Date: 2007
  Describes the results of a study investigating the use of critical access hospital (CAH) emergency rooms by patients with mental health problems to understand the role these facilities play in rural mental health needs and the challenges they face.