Andrew F. Coburn, PhD

Director, Maine Rural Health Research Center

Phone: 207.780.4435
Fax: 207.228.8138
Email: coburn@maine.edu

University of Southern Maine
PO Box 9300
34 Bedford Street
Portland, ME 04104-9300


Current Projects - (5)

  • Acuity Differences among Newly Admitted Rural and Urban Nursing Home Residents
    This study will use nursing home assessment data to examine rural-urban differences in resident acuity upon admission; whether differences persist among newly admitted Medicare and non-Medicare residents; and whether and how nursing home, local health system, and market characteristics are associated with differences in resident acuity.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Long term care
  • Healthcare Use and Access Among Rural & Urban Non-elderly Disabled Medicare Beneficiaries
    This project will explore healthcare use and barriers to healthcare access among disabled Medicare beneficiaries under 65 in rural and urban areas. The study will be based on quantitative analyses of the 2009-2013 Medicare Current Beneficiary Survey.
    Research center: Maine Rural Health Research Center
    Topics: Disabilities, Health disparities, Medicare
  • Rates of Telemental Health Use among Rural Medicaid Enrollees: Associations with Telehealth Policy and Mental Health Access
    This study will examine telemental health use among rural and urban Medicaid beneficiaries with mental illness. The goals are to: 1) compare rates and patterns of telemental health; 2) assess how use rates are associated with state-level Medicaid telehealth policies; and 3) determine the extent to which telemental health provides access to care.
    Research center: Rural Telehealth Research Center
    Topics: Medicaid and S-CHIP, Mental health, Telehealth
  • Rural Health Clinics Chartbook
    This project will produce a comprehensive, descriptive chartbook detailing the characteristics and status of rural health clinics (RHCs) nationally. It will also assess the use of secondary data to construct a national set of indicators for RHCs and identify gaps in our knowledge that cannot be addressed using secondary data.
    Research center: Maine Rural Health Research Center
    Topic: Rural Health Clinics (RHCs)
  • Use of Telehealth Services Among Rural Medicaid Enrollees: A Baseline Inventory
    Uses data from the Medicaid Analytic Extract (MAX) for 2011 to create a 50-state, baseline inventory of telehealth services provided to Medicaid enrollees in rural and urban settings. Provides important information on the feasibility of using MAX data to study the effects of Medicaid telehealth policies.
    Research center: Rural Telehealth Research Center
    Topics: Medicaid and S-CHIP, Telehealth

Completed Projects - (23)

  • Access To and Use of Home and Community-Based Services in Rural Areas
    This study will use data from the 2010 Medicaid Analytic eXtract (MAX) file and in-depth policy reviews and interviews in four states to examine differences in the use of institutional and home and community-based service (HCBS) use by older adults across urban and rural areas, and the policy and community factors that contribute to differences or comparability in use.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Home health, Long term care
  • Analysis of 2004-2005 State Flex Grant Plans
    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.
    Research centers: Maine Rural Health Research Center, University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Networking and collaboration, Quality
  • Assessing Health Information Technology (HIT) Strategies to Improve Access for Rural Veterans
    Rural veterans face unique barriers to care including insufficient communication and coordination of care provided across multiple settings—both within and outside of the Veteran’s Administration. To help reduce these barriers, multiple agencies within the federal government have promoted technology as an opportunity to improve access and care coordination to veterans living in remote areas. Most recently, programs in Maine, Montana and Alaska have received grants to use health information technology (HIT) to expand and integrate services—including mental health services—for rural Veterans. However, little is known about the challenges these programs face on the ground, or what conditions and program strategies may facilitate success. This study will consist of case studies of these programs in each of the three states, and will identify best practices and barriers for implementing rural HIT initiatives that could inform future strategies in this area.
    Research center: Maine Rural Health Research Center
    Topic: Veterans
  • Challenges and Opportunities for Improving Rural Long-Term Services and Supports under the Affordable Care Act
    This project will examine strategies, models, and policy options for improving access to, and quality of, rural long-term services and supports. Through focused policy analyses, we will highlight the rural options, opportunities, and barriers of implementing the coordinated care, health home, and long-term services and supports provisions in the Affordable Care Act.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Health policy, Long term care
  • Development of State Flex Program Logic Models and Related Toolkit
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  • Expanding Rural Health Insurance Coverage: How Do Insurance Reform Strategies Stack Up?
    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.
    Research centers: Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    Topics: Health insurance and the uninsured, Health policy
  • Financial Impact of Mental Health Services on Rural Individuals and Families
    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.
    Research center: Maine Rural Health Research Center
    Topics: Health insurance and the uninsured, Healthcare financing, Mental health
  • Health Insurance Coverage and Access to Health Services for the Rural Near Elderly
    Research center: Maine Rural Health Research Center
    Topics: Aging, Health insurance and the uninsured, Health services
  • Health Insurance Dynamics of Uninsured Rural Families
    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.
    Research center: Maine Rural Health Research Center
    Topic: Health insurance and the uninsured
  • Health Insurance Stability among Rural Children Following Public Coverage Expansions
    While estimates indicate that the uninsured rate among rural children has dramatically decreased since the 1997 passage of the State Children's Health Insurance Program (CHIP), it is not clear whether or not coverage has become more stable and uninsured spells shorter. The purpose of this study is to investigate changes in insurance stability among rural and urban children following CHIP, and whether this is affected by specific state eligibility and enrollment policies or clusters of policies. Using the 1996, 2001, and 2004 panels of the Survey of Income and Program Participation (SIPP), we will measure rural-urban differences in uninsured spell length and frequency, sources of coverage before and after uninsured spells, movement between sources of coverage, how these measures of stability have changed over time, and the factors that relate to greater continuity of coverage among rural children.
    Research center: Maine Rural Health Research Center
    Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP
  • Impact of Employment Transitions on Health Insurance Coverage of Rural Residents
    This project aims to examine rural-urban differences in the proportion of employed adults with private health insurance who experience an employment transition (defined as a change in jobs or hours worked, or no job) and the impact of that change on health insurance status.
    Research center: Maine Rural Health Research Center
    Topic: Health insurance and the uninsured
  • Measuring Rural Underinsurance
    Research center: Maine Rural Health Research Center
    Topic: Health insurance and the uninsured
  • Measuring the Community Benefits and Impact of Critical Access Hospitals
    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.
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  • National Rural Hospital Flexibility Program Tracking Project: Tracking State Policy and Program Development
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  • Out-of-Pocket Costs Among Rural Medicare Beneficiaries
    The purpose of this project is to examine out-of-pocket spending among Medicare beneficiaries, to identify whether there are rural-urban differences in out-of-pocket costs, and to explore what factors account for these differences. Should Medicare redesign occur, this study will provide important information against which to assess the possible impact of different design options on rural Medicare beneficiaries.
    Research center: Maine Rural Health Research Center
    Topics: Disabilities, Health policy, Medicare
  • Patterns of Individual Health Plan Coverage Among Rural Residents
    Research center: Maine Rural Health Research Center
    Topics: Health insurance and the uninsured, Rural statistics and demographics
  • Prevalence and Impact of High Deductible Health Insurance Plans in Rural Areas
    This study will use national health survey data to examine whether privately insured rural residents are more likely than their urban counterparts to have plans with high deductibles. It will also assess whether high deductible health plans create health care barriers for rural residents, and if these differ from the barriers experienced by those in urban areas.
    Research center: Maine Rural Health Research Center
    Topics: Health disparities, Health insurance and the uninsured
  • Role and Early Impact of CO-OPs in the Rural Health Insurance Marketplace
    This study will combine quantitative analysis with administrative health plan practice data with targeted case studies to examine the rural availability and pricing of CO-OP plans, and the early experiences of these plans.
    Research center: Maine Rural Health Research Center
    Topic: Health insurance and the uninsured
  • Rural Residential Care: The Implications of Federal and State Policy Changes
    This project will assess the impact on Medicaid-funded rural residential care options of new and proposed federal policy guiding state compliance with the Americans with Disabilities Act (ADA). The extent to which rural facilities are able to comply with the proposed guidelines may affect their eligibility for funding through Home and Community-Based Services waiver programs.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Disabilities, Medicaid and S-CHIP
  • Special Study of EMS Issues
    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.
    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, Emergency medical services (EMS), Networking and collaboration
  • State Flex Program Quality Improvement Activities
    Research center: Maine Rural Health Research Center
    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
    Research center: Maine Rural Health Research Center
    Topics: Aging, Disabilities, Medicaid and S-CHIP, Medicare
  • Using Program Logic Models to Monitor the Performance of State Flex Programs
    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.
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program

Publications - (49)

  • After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2017
    A new paper describing opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from hospital-based locus of care to new models of care delivery in rural places.
  • Are Rural Older Adults Benefiting from Increased State Spending on Medicaid Home and Community-Based Services?
    Policy Brief
    Maine Rural Health Research Center
    Date: 06/2016
    Little is known about variations in the availability or use of Medicaid Home and Community-Based Services (HCBS) within states, across rural and urban areas. This study used national claims data to examine differences in HCBS use and expenditures among rural and urban older adult Medicaid beneficiaries receiving LTSS.
  • Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices
    RUPRI Center for Rural Health Policy Analysis
    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
    RUPRI Center for Rural Health Policy Analysis
    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.
  • Care Coordination in Rural Communities Supporting the High Performance Rural Health System
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2015
    This paper examines care coordination programs and processes that affect rural areas to discover what is happening in rural communities, how various programs and approaches are working, who benefits, and to make policy recommendations that will facilitate care coordination efforts in support of high performance rural health system development.
  • Challenges and Opportunities for Improving Mental Health Services in Rural Long-Term Care
    Maine Rural Health Research Center
    Date: 06/2013
    This study explores practices for increasing the quality, quantity, and accessibility of mental health services in rural long-term care.
  • The Characteristics and Roles of Rural Health Clinics in the United States: A Chartbook
    Chartbook
    Maine Rural Health Research Center
    Date: 01/2003
    This chartbook reports on a rural health clinics (RHCs) survey. Information was collected on many topics, including their characteristics/operations; their location relative to the underservice problems/rural access needs; their safety net functions; staffing, recruitment, and financial issues; and involvement in training healthcare professionals.
  • Comments on the June 2001 Report of the Medicare Payment Advisory Commission: Medicare in Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2001
    This paper comments on and critiques the findings in MedPAC's Medicare in Rural America.
  • The Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 02/2007
    This policy brief discusses the findings of a project to understand the community involvement and impact of critical access hospitals and the Medicare Rural Hospital Flexibility Program (Flex Program).
  • Comparative Performance Data for Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    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
    Maine Rural Health Research Center
    Date: 04/2006
    This is a tool for planning, managing, reporting on, and assessing Flex Program goals, activities, and accomplishments; assistance in identifying/defining measurable outcomes; information linking state-level Flex Program strategies to measurable outcomes; and a consistent program-reporting framework to share results internally and externally.
  • The Current and Future Role and Impact of Medicaid in Rural Health
    Rural Policy Analysis and Applications
    Date: 09/2012
    This report outlines and describes the current Medicaid program and its importance to rural America. It also discusses rural implications of program expansion, including whether and how states choose to implement changes.
  • Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    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
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 01/2007
    This paper reports on a series of site visits to six diverse rural communities and critical access hospitals to assess the experiences and impact of these hospitals in responding to their community's health infrastructure needs.
  • Health Care Access and Use Among the Rural Uninsured
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2011
    Using data from the 2002-2007 Medical Expenditure Panel Survey, this study examined access to care and service use among non-elderly, uninsured rural and urban residents.
  • Health Care Access and Use Among the Rural Uninsured
    Maine Rural Health Research Center
    Date: 08/2012
    Examines whether uninsured rural residents have different patterns of healthcare use than their urban counterparts, and the factors associated with any differences.
  • Health Information Exchange: A Strategy for Improving Access for Rural Veterans in the Maine Flex Rural Veterans Health Access Program
    Maine Rural Health Research Center
    Date: 05/2016
    This paper reports on the design and implementation of a first-in-the-nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers.
  • Health Insurance CO-OPs: Product Availability and Premiums in Rural Counties
    Policy Brief
    Maine Rural Health Research Center
    Date: 10/2016
    We describe regional distribution and market prevalence of CO-OP products in rural and urban counties, and compare the number of products available in counties with and without CO-OP plans in 2014 and 2015.
  • Health Insurance Coverage Of The Rural And Urban Near Elderly
    Maine Rural Health Research Center
    Date: 10/2003
    This paper reports the results of a study that used data from the 1996-1998 Medical Expenditure Panel Survey to address two principal research questions related to health insurance coverage for the rural near elderly.
  • Health Insurance Profile Indicates Need to Expand Coverage in Rural Areas (Policy Brief)
    Maine Rural Health Research Center
    Date: 07/2009
    This brief provides information on the health insurance status of rural Americans, summarized from a more detailed chartbook. Analyses are based on the 2004-05 Medical Expenditure Panel Survey.
  • High Deductible Health Insurance Plans in Rural Areas
    Maine Rural Health Research Center
    Date: 05/2014
    Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in high deductible health plans and the implications for evolving Affordable Care Act Health Insurance Marketplaces.
  • The High Performance Rural Health Care System of the Future
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2011
    This project describes a future rural system that would be built on foundations of affordability, accessibility, community focus, high quality, and patient centeredness.
  • Impact of Employment Transitions on Health Insurance Coverage of Rural Residents
    Maine Rural Health Research Center
    Date: 10/2010
    This study explores the impact of changes in employment status on insurance coverage for rural and urban workers.
  • Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    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.
  • Integrated Care Management in Rural Communities
    Maine Rural Health Research Center
    Date: 05/2014
    This study reviews the opportunities and challenges reform initiatives under the Affordable Care Act present for rural communities. The study assesses four types of organizational models for delivering integrated care management. Each model has different strengths and drawbacks, weighing for and against implementation in rural areas.
  • Many Urban and Rural Workers Lose Health Insurance During Job Transitions
    Policy Brief
    Maine Rural Health Research Center
    Date: 10/2010
    This policy brief explores the impact of changes in employment status on insurance coverage for rural and urban workers and the factors behind any differences.
  • Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2015
    As Medicare moves to value-based payment, healthcare groups are made more accountable for patient health. But the changes have been concentrated in urban areas. Policies meant to strengthen rural health systems are complicating payment and delivery system reform in rural areas. This study examines ways to include rural areas in the changes.
  • Monitoring the Community Benefits of CAHs: A Review of the Data (Briefing Paper)
    Maine Rural Health Research Center
    Date: 03/2010
    There is a growing national interest in the benefits provided by nonprofit and public hospitals to their communities in exchange for the tax benefits or public funding that they receive.
  • Monitoring the Community Benefits of Critical Access Hospitals: A Review of the Data
    Policy Brief
    Maine Rural Health Research Center
    Date: 03/2010
    This brief examines the community benefit activities of critical access hospitals (CAHs) using data from the Flex Monitoring Team's (FMT) pilot test of a set of community benefit data collection tools and performance indicators, the Internal Review Service's (IRS) 2006 Hospital Compliance Study, and the 2007 FMT CAH survey.
  • 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
    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.
  • Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
    Rural Policy Analysis and Applications
    Date: 09/2010
    This report summarizes six issue areas of the Affordable Care Act and discusses implications for access to services and improving the health status of rural residents. The issue areas are health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care.
  • Patterns of Health Insurance Coverage Among Rural and Urban Children
    Maine Rural Health Research Center
    Date: 11/2001
    This study assesses differences in the patterns of insurance coverage and uninsured spells among rural and urban children in 20 states. It also examines the implications of those differences for the design and implementation of public insurance programs.
  • Pilot Testing a Rural Health Clinic Quality Measurement Reporting System
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2016
    More than 4,000 Rural Health Clinics (RHCs) serve the primary care needs of rural communities. Unfortunately, the Rural Health Clinic Program is plagued by a lack of data participating clinics. This reports on the results with a focus on assessing the feasibility and utility of the reporting system and quality measures for the participating RHCs.
  • Prioritizing Patient Safety Interventions in Small Rural Hospitals
    Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 12/2006
    Determines 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. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
  • Private Health Insurance in Rural Areas: Challenges and Opportunities
    Policy Brief
    Maine Rural Health Research Center
    Date: 04/2009
    This brief discusses the challenges of expanding private coverage in rural areas and describes policy options to address them.
  • Profile of Rural Health Insurance Coverage: A Chartbook
    Maine Rural Health Research Center
    Date: 06/2009
    Analyses of persons under age 65 from the 2004-05 Medical Expenditure Panel Survey reveal a greater proportion of rural vs. urban residents who are uninsured or covered through public sources. Uninsured rates are highest among adults over age 50 in the most remote rural places.
  • Profile of Rural Residential Care Facilities: A Chartbook
    Chartbook
    Maine Rural Health Research Center
    Date: 05/2014
    This chartbook offers information on part of the rural long-term services and supports (LTSS) continuum—the residential care facility (RCF). Survey results identify national/regional differences between rural and urban RCFs, focusing on facilities, resident and service characteristics of RCFs, and the ability to meet the LTSS needs of residents.
  • Redesigning Medicare: Considerations for Rural Beneficiaries and Health Systems
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2001
    This book 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.
  • Redesigning the Medicare Program: An Opportunity to Improve Rural Health Care Systems?
    RUPRI Center for Rural Health Policy Analysis
    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.
  • A Review of State Flex Program Plans, 2004-2005
    Maine Rural Health Research Center, University of Minnesota Rural Health Research Center
    Date: 03/2006
    This paper 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. It highlights recent trends in state Flex Program planning, development, and implementation.
  • Rural Adults Face Parity Problems and Other Barriers to Appropriate Mental Health Care
    Maine Rural Health Research Center
    Date: 11/2008
    The findings of this policy brief suggest that a multi-level approach is essential for meeting the mental health service needs of rural residents.
  • Rural Assessment of Leading Proposals to Redesign the Medicare Program
    RUPRI Center for Rural Health Policy Analysis
    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 healthcare services. Report produced by the RUPRI Rural Health Panel.

  • Rural Coverage Gaps Decline Following Public Health Insurance Expansions
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2009
    This brief uses the Medical Expenditure Panel Survey (MEPS) to compare the health insurance coverage of rural/urban residents in 1997 and 2005 to assess how uninsured rates and sources of coverage have changed since SCHIP was enacted. The authors also discuss characteristics of the rural uninsured and the implications for health insurance reform.
  • Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2015
    This policy brief reports findings from a survey of rural health clinics (RHC) that examined their capacity to meet the National Council for Quality Assurance patient-centered medical home requirements and discusses the implications of the findings for efforts to support RHC capacity development.
  • Rural Hospitals and Long-Term Care: the Challenges of Diversification and Integration Strategies
    Maine Rural Health Research Center
    Date: 2006
    There are many contemporary challenges experienced by older rural residents and their communities in accessing and providing services. However, the issue is not in comparing rural older adults to their urban counterparts; rather, it is that rural people have unique characteristics that must be considered when planning and providing services.
  • Rural Long-Term Services and Supports: A Primer
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2017
    This paper provides policymakers and other interested stakeholders a primer on the fundamentals of the rural LTSS system, rural access to and use of LTSS, and the opportunities and limitations of current federal and state LTSS policy for advancing rural health system transformation toward a high-performing rural health delivery system.
  • Securing High Quality Health Care in Rural America: The Impetus for Change in the Affordable Care Act
    Rural Policy Analysis and Applications
    Date: 12/2010
    The Affordable Care Act calls for the development of a National Health Care Quality Strategy and Plan (National Quality Strategy) that will affect healthcare that is delivered to millions of Americans who live in rural areas and thousands of healthcare providers who care for them.
  • Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis, Upper Midwest Rural Health Research Center
    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 2004 to identify a set of researchable questions concerning rural healthcare.