Erika Ziller, PhD

Deputy Director, Maine Rural Health Research Center

Phone: 207.780.4615
Fax: 207.228.8138
Email: erika.ziller@maine.edu

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


Current Projects - (3)

  • Eligibility Transitions under the Affordable Care Act: Policy Considerations for Ensuring Coverage Continuity Among Rural Residents
    This study will assess rural versus urban income volatility, the potential effects on states' efforts to ensure continuous health insurance coverage to individuals enrolled in Medicaid expansions or Exchange plans under the Affordable Care Act, and develop policy recommendations to address any observed differences.
    Research center: Maine Rural Health Research Center
    Topics: Health insurance and the uninsured, Medicaid and S-CHIP
  • Health Care Use and Access among Rural and Urban Elderly Medicare Beneficiaries
    This project will examine rural-urban differences in healthcare use and access to healthcare services among elderly Medicare enrollees using the 2011-2013 Medicare Current Beneficiary Survey. We also will identify the socioeconomic and health factors that may place rural seniors at risk for poor healthcare access.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Health insurance and the uninsured, Medicare
  • Understanding Rural-Urban Mortality Differences
    This study will address rural-urban mortality gaps in our understanding of rural mortality disparities using the 1985-2009 National Health Interview Survey (NHIS), linked to national death certificate data, to explore the individual-level characteristics and health behaviors of rural and urban adults and their association with mortality.
    Research center: Maine Rural Health Research Center
    Topic: Health disparities

Completed Projects - (15)

  • 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
  • Consequences of Rural Uninsurance
    This study will assess whether uninsured rural residents have different levels of access to care than their urban counterparts, and the factors associated with any differences (including sub-analyses for individuals with identified chronic conditions). In doing so, it will provide policymakers with critical information for improving rural health systems.
    Research center: Maine Rural Health Research Center
    Topic: Health insurance and the uninsured
  • Expanded Look at Rural Access to Care
    This study will use newly available national health survey data to examine rural-urban differences in access to medical care, access to insurance, and affordability of care.
    Research center: Maine Rural Health Research Center
    Topics: Health disparities, Health insurance and the uninsured
  • 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 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
  • Healthcare Access and Affordability Among Rural Children with Public Versus Private Health Insurance
    To examine differences in healthcare access and affordability among rural children with public (i.e., Medicaid or CHIP) and private health insurance coverage, the study will address the a number of research questions, using data from the 2011-12 National Survey of Children’s Health.
    Research center: Maine Rural Health Research Center
    Topic: Health disparities
  • 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
  • Impact of Mental and Emotional Stress on Rural Employment Patterns
    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.
    Research center: Maine Rural Health Research Center
    Topic: Mental health
  • Knowledge of Health Insurance Concepts and the Affordable Care Act among Rural Residents
    Using the Health Reform Monitoring Survey (HRMS), this project will produce two briefs examining rural-urban comparisons in insurance status, open enrollment knowledge and perceptions, and perceived affordability of coverage available through the Health Insurance Marketplaces.
    Research center: Maine Rural Health Research Center
    Topic: Health policy
  • Measuring Rural Underinsurance
    Research center: Maine Rural Health Research Center
    Topic: Health insurance and the uninsured
  • 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
  • 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
  • Rural-Urban Differences in Access to Children's Mental Health Services
    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.
    Research center: Maine Rural Health Research Center
    Topics: Children, Health services, Mental health

Publications - (40)

  • Access to Mental Health Services and Family Impact of Rural Children with Mental Health Problems
    Maine Rural Health Research Center
    Date: 10/2010
    Rural children are more likely to have mental health problems, to have behavioral difficulties, and to be usually or always affected by their conditions than urban children. Rural children also are more likely to go without access to all parent-reported needed mental health services, and their families spend more time coordinating their care.
  • Adverse Childhood Experiences in Rural and Urban Contexts
    Policy Brief
    Maine Rural Health Research Center
    Date: 04/2016
    This study was designed to address the gap in the literature examining rural-urban differences in adults’ exposure to adverse childhood experiences (ACEs) and to inform health system initiatives geared toward mitigating the impacts of ACEs on rural populations.
  • 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.
  • 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.
  • Diabetes and the Rural Safety Net
    Maine Rural Health Research Center
    Date: 01/2002
    This paper investigates the extent to which the rural safety net is able to meet the needs of people with diabetes.
  • 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 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 Low-Income Rural Children Increases and is More Continuous Following CHIP Implementation
    Policy Brief
    Maine Rural Health Research Center
    Date: 03/2014
    This study found that following the Children’s Health Insurance Program’s implementation, health insurance coverage and continuity increased among low-income children, particularly for those living in rural areas. By CHIP’s maturity, coverage for rural children improved so much that their uninsured rate dropped below that of urban children.
  • 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.
  • 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.
  • Implications of Rural Residence and Single Mother Status for Maternal Smoking Behaviors
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2015
    This study finds rural mothers are more likely than urban mothers to smoke. The authors suggest policymakers consider extending insurance for smoking cessation programs through the Affordable Care Act and Medicaid. Programs at the local, state, and national levels also could help reduce disparities in smoking-related morbidity and mortality.
  • Implications of Rurality and Psychiatric Status for Diabetic Preventive Care Use among Adults with Diabetes
    Policy Brief
    Maine Rural Health Research Center
    Date: 05/2014
    This brief examines patterns of diabetic preventive care use among adults with diabetes to determine whether these patterns vary according to respondents’ rural/urban residence or the presence/absence of a mental health diagnosis.
  • 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.
  • Knowledge of Health Insurance Concepts and the Affordable Care Act among Rural Residents
    Policy Brief
    Maine Rural Health Research Center
    Date: 07/2017
    Health insurance literacy is central to identifying eligibility for coverage and subsidies, choosing a plan, and using optimal healthcare services. This study examined rural-urban differences in knowledge and/or use of the Affordable Care Act Marketplaces; subsidies; the health insurance mandate; and health insurance terms and concepts.
  • 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.
  • Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
    Maine Rural Health Research Center
    Date: 09/2005
    This survey investigates the extent and types of cases that present with mental health problems in critical access hospital emergency rooms (ERs), as well as the resources available to ER staff for addressing such problems and what actually happens to these patients.
  • Mental Health First Aid in Rural Communities: Appropriateness & Outcomes
    Maine Rural Health Research Center
    Date: 01/2016
    Examines Mental Health First Aid (MHFA) appropriateness and impacts in rural areas by using a mixed-methods approach to study MHFA trainings conducted from November 2012 through September 2013 in rural communities across the country.
  • Mental Health First Aid in Rural Communities: Appropriateness and Outcomes
    Maine Rural Health Research Center
    Date: 01/2016
    Mental Health First Aid (MHFA), an early intervention training program for general audiences, has been promoted as a means for improving population-level behavioral health in rural communities by encouraging treatment-seeking. This study examined MHFA's appropriateness and impacts in rural contexts.
  • Mental Health Problems Have Considerable Impact on Rural Children and their Families (Policy Brief)
    Maine Rural Health Research Center
    Date: 10/2010
    This policy brief provides information on the prevalence of children's mental health needs and associated access to care and family impact across rural and urban areas. Analyses are based on the 2005-06 National Survey of Children with Special Health Care Needs.
  • 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.
  • 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.
  • 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.
  • The Role of Public versus Private Health Insurance in Ensuring Health Care Access & Affordability for Low-Income Rural Children
    Policy Brief
    Maine Rural Health Research Center
    Date: 01/2017
    Medicaid and CHIP have played a critical role in ensuring access to health coverage among children –particularly rural children. This study examines rural-urban differences in children’s access to care, and their families’ perceived affordability of that care among those enrolled in Medicaid or CHIP, and those with private insurance plans.
  • Rural Adults Delay, Forego, and Strategize to Afford Their Pre-ACA Health Care
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2015
    This study provides detailed information about rural-urban differences among adults younger than age 65 in perceived affordability of health insurance coverage and services prior to implementation of the Affordable Care Act.
  • 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 Children Don't Receive the Mental Health Care They Need
    Policy Brief
    Maine Rural Health Research Center
    Date: 01/2009
    Controlling for other characteristics that affect access to care, rural children are 20% less likely to have a mental health visit than urban children. Having Medicaid or SCHIP increases the likelihood that a child will receive services, and this is pronounced in rural areas.
  • 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 Disabled Medicare Beneficiaries Spend More Out-of-Pocket Than Their Urban Counterparts
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2015
    Most beneficiaries seek added coverage to close the gap between the care they need and the costs covered by Medicare. This study evaluated rural-urban differences in out-of-pocket spending, supplemental coverage, and variation in spending by type of service.
  • Rural Opioid Abuse: Prevalence and User Characteristics
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2016
    Opioid abuse is the fastest growing substance abuse problem in the nation and the primary cause of unintentional drug overdose deaths. This study examined the rural-urban prevalence of non-medical use of pain relievers and heroin in the past year and the socio-economic characteristics associated with their use and other risky behavior.
  • 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.
  • Rural-Urban Differences in Health Care Access Vary Across Measures
    Maine Rural Health Research Center
    Date: 06/2009
    Higher uninsured rates and workforce shortages in rural areas suggest that rural residents face greater barriers to accessing healthcare than their urban counterparts. Analysis of the 2006 Medical Expenditure Panel Survey found mixed results.
  • Rural-Urban Differences in Work Patterns Among Adults With Depressive Symptoms
    Maine Rural Health Research Center
    Date: 03/2008
    This study addresses poor mental health among young to middle-career rural residents and how their employment may be affected. Using the National Longitudinal Survey of Youth, the authors investigate how depressive symptoms affect employment patterns and the extent to which such effects differ by rural and urban residence.
  • State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
    Maine Rural Health Research Center
    Date: 05/2002
    This paper 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.
  • Use of Critical Access Hospital Emergency Rooms by Patients With Mental Health Symptoms
    Maine Rural Health Research Center
    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.