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

• Out-of-Pocket Health Care Spending and the Rural Underinsured
  Maine Rural Health Research Center
  Date: 12/2005
  This paper 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.
• Out-of-Pocket Health Spending and the Rural Underinsured
  Journal Article
  Maine Rural Health Research Center
  Date: 11/2006
  This article estimates underinsurance rates among privately insured rural residents and the characteristics associated with rural underinsurance.
• Rural Residents More Likely to Be Underinsured
  Maine Rural Health Research Center
  Date: 2006
  Studies have shown that rural residents have high uninsured rates. However, even those with private health insurance coverage can be at risk of having high out-of-pocket healthcare costs. Understanding the degree to which rural residents are underinsured has important implications for rural health policy and practice.