Cost-Sharing as a Barrier to Accessing Care at FQHCs and RHCs for Rural Medicare Beneficiaries


Cost is often a significant barrier to accessing care for the rural Medicare population, so having a better understanding of the variations in cost-sharing at various types of safety-net facilities is important. The purpose of this study was to empirically investigate cost as a barrier to accessing care at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) for the rural Medicare population. In the regression analyses, we found statistically significant variations in cost-sharing, charge, and coinsurance per claim based on facility type, after controlling for other factors. Cost-sharing per claim (sum of the deductible and coinsurance amounts) was higher at RHCs than FQHCs. Despite the substantial set of benefits that Medicare provides, many beneficiaries (especially those living in rural areas) are often left vulnerable by financial burdens and unmet needs. If populations are not able to access care (especially primary care) due to cost, it may lead to several negative consequences. Patients may decide to postpone or forgo care and end up in the emergency department – often a more costly, and less effective, alternative.

North Carolina Rural Health Research and Policy Analysis Center
Alex Schulte, George Pink, G. Mark Holmes, Denise Kirk