Health insurance and the uninsured

Publications

Listed by publication date. You can also view these publications alphabetically.

2007

• Impact of Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural Native American Elders
  Author(s): Alana Knudson, Mary Wakefield, Kyle Muus, Jacque Gray, Leander McDonald, Richard Ludtke, Gestur Davidson
  Research center: Upper Midwest Rural Health Research Center
  Topics: American Indians and Alaska Natives, Health insurance and the uninsured, Minority health
  Report Number: Final Report No. 6
  Date: 10 / 2007
  Examines health insurance coverage and access to health care among American Indian and Alaska Native elders (Native elders) -- defined as 55 years or older. Young elders, 55 to 64 years of age, are most likely to be uninsured with one-third reporting having no insurance, while 15% of older elders, 65 years of age and over, report they are uninsured. Uninsured Native elders are about twice as likely as insured Native elders to indicate they have no regular provider. In addition, one out of 10 Native elders report they were not able to get care when they needed it during the preceding 12 months. Reasons cited for not getting health care when it was needed included long waiting times, transportation problems, and cost. The authors conclude it is essential to develop policies that address the financial, geographical, and cultural aspects that negatively impact access to culturally appropriate healthcare. Full report available on request by contacting aknudson@medicine.nodak.edu.
• Health Insurance Coverage and Access to Health Care for American Indian and Alaska Native Elders
  Research center: Upper Midwest Rural Health Research Center
  Topics: Aging, American Indians and Alaska Natives, Health insurance and the uninsured, Minority health
  Date: 10 / 2007
  Policy brief reporting findings from a study assessing health insurance coverage and access to health care among American Indian and Alaska Native elders (Native elders), using data from a national survey that included more than 8,300 Native elders.
• Rural Families More Likely to be Uninsured and Have Different Sources of Coverage
  Research center: Maine Rural Health Research Center
  Topic: Health insurance and the uninsured
  Date: 06 / 2007
  Research and policy brief examining patterns of health insurance coverage within rural families and comparing family-level insurance status for rural and urban families.

2006

• Premium Assistance Programs for Low Income Families: How Well Does it Work in Rural Areas?
  Author(s): Pam Silberman, Laura Brogan, Charity Moore, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty
  Report Number: Working Paper No. 85
  Date: 01 / 2006
  Reports results of a study on the viability in rural areas of premium assistance programs use Medicaid or State Children's Health Insurance (SCHIP) funding to subsidize the premium costs of employer-sponsored insurance or private non-group policies for eligible individuals. Because of the characteristics of rural residents and their employment markets, many stand to benefit from premium assistance programs, but there are also reasons to believe that these programs may be less successful in rural communities. Findings form the telephone survey of Medicaid or SCHIP officials in 14 of the 16 states with at least one premium assistance program indicate that premium assistance programs have not lived up to their potential. Enrollment in most of the states' programs has been small, and while positive in concept, these programs have inherent limitations that may preclude more widespread enrollment. Of particular concern is that rural residents are more likely to work for small employers who do not offer health insurance or have higher premiums or less comprehensive benefits. However, with creative program design, premium assistance programs may be a useful tool for states to expand health insurance coverage to the rural uninsured.
• 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
  
• 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.
• 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.

2005

• Impact of Welfare Reform on Health Insurance Coverage in Rural Areas
  Author(s): Timothy D. McBride, Courtney Andrews
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Poverty
  Report Number: Rural Policy Brief Vol. 10, No. 6 (PB2005-6 )
  Date: 12 / 2005
  Explores the impact of welfare reform on the health insurance coverage of welfare recipients and other low-income persons over the period when the reform was phased in. Key findings of this study showed that a substantial percentage of persons who left the Aid to Families with Dependent Children (AFDC) program after reform became uninsured, and former AFDC recipients in rural areas were more likely than urban counterparts to lose insurance coverage. Insurance loss was more likely for those who gained employment than for those who remained unemployed.
• 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.
• Trends in Uninsurance among Rural Minority Children
  Author(s): Amy Martin, Janice C. Probst, Charity G. Moore, Daniel Patterson, Keith Elder
  Research center: South Carolina Rural Health Research Center
  Topics: African Americans, Children, Health insurance and the uninsured, Hispanics, Minority health, Poverty
  Date: 10 / 2005
  Disparities in health insurance coverage for both minority and rural children persist, with children who are simultaneously minority race/ethnicity and living in rural areas being particularly disadvantaged. Using twenty-one years of data from the National Health Interview Survey to explore trends in health insurance and health services utilization for children between 1980 and 2001, and focusing on non-Hispanic white, non-Hispanic African American, and Hispanic children, the authors found that rural children have been consistently less likely to have insurance than urban children, and minority status adds to the disparity. Several factors consistently influenced the odds that a child would lack health insurance, measured in 1980, 1986, 1994 and 2001. Compared to urban white children, rural white children and Hispanic children, both urban and rural, were more likely to lack insurance. Factors consistently associated with lack of health insurance, such as poverty, low education, and non-parental households, have been more prevalent among minority children since 1979, and remained so in 2001. Rural disadvantages for minority children are marked. Executive summary available online.
• Effects of Uninsurance during the Preceding 10 Years on Health Status among Rural Working Age Adults
  Author(s): Janice C. Probst, Charity G. Moore, M. Paige Powell, William Pearson, Amy Brock Martin
  Research center: South Carolina Rural Health Research Center
  Topics: Health insurance and the uninsured, Rural statistics and demographics
  Date: 09 / 2005
  In a population just reaching age 40, continuous health insurance coverage across the preceding 8 to 10 years was not associated with better self-perceived health than interrupted coverage. However, continuous insurance coverage was significantly related to better mental health, with the effect persisting in multivariable analysis controlling for residence, race, and demographic characteristics. Rural residents reaching age 40 in 1998 or 2000 were less likely to have been continuously insured between 1989-2000 than were their urban peers. Executive summary available online.
• Effects of Uninsurance during the Preceding 10 Years On Health Status among Rural Working Age Adults (Fact Sheet)
  Research center: South Carolina Rural Health Research Center
  Topic: Health insurance and the uninsured
  Date: 2005
  Used a long-running panel survey, the National Longitudinal Survey of Youth that began in 1979, to examine the effects of gaps in health insurance coverage on how individuals rate their physical and mental health.
• Federal Employees' Health Benefits Program: A Model for Competition in Rural America?
  Author(s): Keith J. Mueller, Timothy D. McBride, Courtney Andrews, Roslyn Fraser, Liyan Xu
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Medicare Advantage (MA)
  Citation: Journal of Rural Health, 21(2), 105-113
  Date: 2005
  Tests the hypothesis that the Federal Employees' Health Benefits Program (FEHBP) has fostered an environment of competing health plans, especially preferred provider organizations (PPOs), in rural areas. There is a strong relationship between the number of FEHBP plans and areas with high population counts and high population density. In many counties with low population counts (under 3,000), most PPOs are not contracting with the nearest primary care provider. The authors conclude that the FEHBP is not a perfect predictor of Medicare Advantage (MA) plan activity because the MA program does not use the FEHBP approach of certifying regional plans that must offer local access. However, the FEHBP experience indicates that plans are attracted to areas with high population counts and high population density.
• Update: Health Insurance and Utilization of Care Among Rural Adolescents
  Author(s): Janice C. Probst, Charity G. Moore, Elizabeth G. Baxley
  Research center: South Carolina Rural Health Research Center
  Topics: Children, Health insurance and the uninsured
  Citation: Journal of Rural Health, 21(4), 279-287
  Date: 2005
  Using data from the 1999-2000 National Health Interview Survey, the authors found that across races, rural adolescents were as likely to have insurance but less likely to report a preventive visit than urban children; residence did not affect the likelihood of a visit or a usual source of care. Minority rural adolescents were less likely than whites to be insured, report a visit, or have a usual source of care. The authors conclude that most barriers to care among rural and minority youth are attributable to factors originating outside the health care system, such as language, living situation, caretaker education, and income. A combination of outreach activities and programs to enhance rural schools and economic opportunities will be needed to improve coverage and utilization among adolescents.
• Trends in Uninsurance Among Rural Minority Children (Fact Sheet)
  Research center: South Carolina Rural Health Research Center
  Topics: Children, Health insurance and the uninsured, Minority health
  Date: 2005
  Describes childhood disparities found in health insurance, health care utilization, and factors related to acquiring health insurance.

2004

• North Dakota's Uninsured and Uncompensated Care: Costs and Coverage Options
  Author(s): Garth Kruger
  Research center: Upper Midwest Rural Health Research Center
  Topic: Health insurance and the uninsured
  Report Number: Policy Brief
  Date: 11 / 2004
  Policy brief on health insurance coverage and the uninsured in North Dakota. Discusses the financial impact of uncompensated care on the health care system and describes several methods for expanding health insurance coverage.

2003

• 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.
• Availability and Use of Health Plan Choices in Rural America: Medicare+Choice, Commercial HMO, and Federal Employees Health Benefit Program Plans
  Author(s): Timothy McBride, Courtney Andrews, Keith Mueller, Michael Shambaugh-Miller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Medicare
  Date: 10 / 2003
  Discusses availability of Medicare + Choice (M+C), commercial HMO, and Federal Employee Health Benefit Program (FEHBP) insurance plans, and the potential impact of M+C service delivery area changes on health care access in rural areas.
• Enrollment in the Federal Employees Health Benefit Program (FEHBP): State and County-Level Enrollment Analysis
  Author(s): Timothy D. McBride, Courtney Andrews, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Medicare
  Date: 05 / 2003
  Information on Federal Employees Health Benefit Program (FEHBP) enrollment in rural counties, including the number of health insurance plans available and number of enrollees. FEHBP is being considered as a model for involving private insurers in Medicare. Rural FEHBP enrollment choices may provide insights into how a similar program might work for Medicare.
• Enrollment in FEHBP Plans in Rural Areas
  Author(s): Timothy D. McBride, Courtney Andrews, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Medicare
  Date: 05 / 2003
  Study of health plan enrollment decisions made by rural retirees and federal workers. Discusses how a Federal Employees Health Benefit Program (FEHBP) plan may work when applied to Medicare.
• Rural Minority Working Age Adults
  Research center: South Carolina Rural Health Research Center
  Topics: African Americans, Health insurance and the uninsured, Hispanics, Minority health, Rural statistics and demographics
  Date: 2003
  Holding demographic considerations equal, rural residents are less likely to report having health insurance than urban residents. African Americans, Hispanics and persons of other race are all less likely to be insured than whites. The factors placing rural minorities at risk for lacking insurance include low income and low education.
• Demand For Medical Services Among Previously Uninsured Children: The Roles of Race and Rurality
  Research center: South Carolina Rural Health Research Center
  Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Minority health
  Date: 2003
  Fact sheet examining the use of medical services over nearly two years among newly insured and continuously insured children, ages six through twelve, in the CHIP and Medicaid programs in South Carolina and West Virginia.
• Rural Minority Children
  Research center: South Carolina Rural Health Research Center
  Topics: Children, Health insurance and the uninsured, Minority health, Rural statistics and demographics
  Date: 2003
  Fact sheet providing data on rural minority children's health insurance coverage, health care use, poverty and education.
• Rural Minority Elders
  Research center: South Carolina Rural Health Research Center
  Topics: Aging, Health insurance and the uninsured, Minority health, Rural statistics and demographics
  Date: 2003
  Fact sheet providing data on health status, health insurance coverage, education and income of rural elders.

2002

• Demand for Medical Services Among Previously Uninsured Children: The Roles of Race and Rurality
  Research center: South Carolina Rural Health Research Center
  Topics: Children, Health insurance and the uninsured
  Date: 10 / 2002
  Examined the use of medical services over nearly two years among newly insured and continuously insured children, ages six through twelve, in the CHIP and Medicaid programs in West Virginia and South Carolina. The study focused on the patterns of medical care utilization in the children, and found that there was not a significant change in utilization patterns among newly insured children in general. There were findings that newly insured children illustrated delayed demand and actually used fewer health services initially than their continually insured peers. Executive summary available online.
• 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.
• Rural Uninsured: Highlights from Recent Research
  Author(s): Thomas D. Rowley
  Topic: Health insurance and the uninsured
  Date: 2002
  Surveys recent research on issues surrounding underinsurance and uninsurance in rural areas. Synthesizes findings of the literature reviewed and provides summaries of each report.

2001

• 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.
• Is the Rural Safety Net at Risk? Analyses of Charity and Uncompensated Care Provided by Rural Hospitals in Washington, West Virginia, Texas, Iowa, and Vermont
  Author(s): Janet Sutton, Bonnie B. Blanchfield, Andrew Singer, Meredith Milet
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health insurance and the uninsured, Hospitals and clinics
  Date: 01 / 2001
  Examines recent trends in the provision of both charity care and uncompensated care by rural hospitals in five states. Also identifies rural communities whose charity and uncompensated care may diminish if their hospitals face more intense financial pressures as a result of the Balanced Budget Act. Two major findings: 1) differences in hospitals' expenditures on charity and uncompensated care vary dramatically across states; and 2) hospital financial health may have a limited effect on charity and uncompensated care expenditures. Concludes that future access to hospital services in many rural communities will depend upon how the uncompensated care burden is shared between hospitals and the state. Report available on request.

2000

• Health Insurance in Rural America
  Author(s): Louis Pol
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Health insurance and the uninsured
  Date: 08 / 2000
  This brief focuses on the differences between the rural and urban uninsured.
• Data Sources for Studying Uncompensated Care Provided by Rural Hospitals
  Author(s): Bonnie B. Blanchfield, Emily Randall
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Health insurance and the uninsured, Hospitals and clinics
  Date: 08 / 2000
  This policy analysis brief discusses data sources related to hospitals' provision of charity and uncompensated care. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.

1999

• Implementation of the State Children's Health Insurance Program: Outreach, Enrollment, and Provider Participation in Rural Areas (Policy Brief)
  Author(s): Jennifer L. Dunbar, Harvey I. Sloane, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty
  Date: 11 / 1999
  The State Children's Health Insurance Program (CHIP) provides states with an important source of funding for helping low-income, uninsured children overcome financial barriers to medical care. This policy analysis brief assesses CHIP outreach, enrollment, and provider issues in Colorado, Kansas, Oklahoma, Pennsylvania, and West Virginia. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
• Implementation of the State Children's Health Insurance Program: Outreach, Enrollment, and Provider Participation in Rural Areas (Full Report)
  Author(s): Jennifer L. Dunbar, Harvey I. Sloane, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty
  Date: 11 / 1999
  The State Children's Health Insurance Program (CHIP) provides states with an important source of funding for helping low-income, uninsured children overcome financial barriers to medical care. There is considerable interest among federal policy makers and rural advocates that CHIP may be especially important in providing coverage to children living in rural areas. This study qualitatively assesses CHIP outreach, enrollment, and provider issues in Colorado, Kansas, Oklahoma, Pennsylvania, and West Virginia. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.

1998

• Anticipating the 1997 State Children's Health Insurance Program: What's Current in Five Rural States?
  Author(s): Jennifer Dunbar, Curt Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty
  Date: 01 / 1998
  This study examines aspects of of existing children's health insurance or health services to low-income, uninsured children. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.

Related Topics

These related topics also list publications:

• Medicaid and S-CHIP (21 items)