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 - (2)

  • 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
  • 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
    Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children 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
    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.
  • 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 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 (MEPS), this study examined access to care and service use among non-elderly, uninsured rural and urban residents. Key Findings include:
    • Uninsured residents of both rural and urban areas face serious barriers to care compared to those with health insurance coverage.
    • The rural uninsured are more likely to have a usual source of care and to have used ambulatory care in the past year than the urban uninsured.
    • Insured or not, rural residents have difficulty accessing after hours care and traveling to see their usual provider
  • 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

    Reports that prior to the passage of the Children’s Health Insurance Program (CHIP), about one in four low-income rural and urban children (family income below 200% of the federal poverty level) were uninsured in a given month. Using data from the Medical Expenditure Panel Survey, this study found that in the years following CHIP’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 (14% compared to 20%, respectively).

  • Health Insurance Coverage Of The Rural And Urban Near Elderly
    Maine Rural Health Research Center
    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.
  • Health Insurance Profile Indicates Need to Expand Coverage in Rural Areas (Policy Brief)
    Maine Rural Health Research Center
    Date: 07/2009
    Rural residents-particularly in the most remote rural communities-are in greater need of health reform, as demonstrated by an uninsured rate higher than that of urban residents. The rural-urban disparity in coverage is driven by higher uninsured rates among rural adults, a group that should be part of any strategic effort to improve coverage. 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

    Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing healthcare costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket healthcare costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.

    Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.

  • Impact of Employment Transitions on Health Insurance Coverage of Rural Residents
    Maine Rural Health Research Center
    Date: 10/2010
    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
    Findings from this study indicate that rural mothers are significantly more likely than their urban counterparts to be smokers, smoke frequently, and smoke heavily, even after adjusting for factors known to increase smoking risk. The authors suggest that policymakers consider methods for extending insurance coverage for smoking cessation interventions through the Affordable Care Act and Medicaid. Additionally, anti-smoking initiatives at the local, state, and national levels could play an important role in decreasing rural-urban 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
    Examines patterns of diabetic preventive care use among adults with diabetes to determine whether these patterns vary according to respondents’ rural/urban residence or psychiatric status (i.e. 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
    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
    Investigates the extent and types of cases that present with mental health problems in Critical Access Hospitals (CAHs) emergency rooms (ERs), as well as the resources available to ER staff for addressing such problems and what actually happens to such patients. Emergency department managers in a random sample of 422 CAHs in 44 states completed a telephone survey (response rate = 84.7%) responding to questions about prevalence of mental health problems in their ER and what options they had for responding to such problems. On average, CAHs had 99 emergency room visits per week. Of these visits, 9.4% were mental health related. CAH ERs play a significant role in providing mental health services to rural residents. Although nearly 20% of mental health encounters result in transfers to other facilities, over 40% of mental health problems are addressed on-site through treatment or referrals. Nearly half (43%) of CAH ER managers reported having no access to local mental health providers of any kind.
  • 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: 01/2017
    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
    Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children are more likely to go without access to all parent-reported needed mental health services and their families spend more time coordinating their care. This policy brief provides information on 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
    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 healthcare 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 healthcare 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.
  • Out-Of-Pocket Health Spending And The Rural Underinsured
    Maine Rural Health Research Center
    Date: 11/2006
    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
    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.
  • Private Health Insurance in Rural Areas: Challenges and Opportunities (Policy Brief)
    Maine Rural Health Research Center
    Date: 04/2009
    Rural residents are less likely than their urban counterparts to have private health insurance coverage. This difference is driven by the unique characteristics of rural places that make it challenging to create and sustain viable private insurance pools, including the predominance of small businesses and self employed, part time, and low wage workers. 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
    As the nation considers whether and how to reform the healthcare system, it is important to consider differences in health insurance coverage for those living in rural and urban areas. Analyses of persons under age 65 from the 2004-05 Medical Expenditure Panel Survey reveal a greater proportion of rural residents than urban residents who are uninsured or covered through public sources, especially among those living in remote areas. Rural adults are at high risk of being uninsured compared to rural children. Uninsured rates are highest among adults over age 50 in the most remote rural places. Compared to urban adults, rural adults are less likely to be in employment situations where private coverage is offered.
  • Profile of Rural Residential Care Facilities: A Chartbook
    Chartbook
    Maine Rural Health Research Center
    Date: 05/2014

    As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF). Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents. Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs. Compared to urban facilities, the policies of rural RCFs appear less likely to support aging-in-place.

  • 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

    About 40% of non-elderly adults reported problems paying medical bills or cost-related barriers to obtaining needed medical care in 2012, difficulties that are especially pronounced for the uninsured and underinsured, the chronically-ill, and those with low incomes. Given their lower incomes and higher uninsured rates compared to urban residents, rural residents may face particular cost barriers in accessing healthcare. Past research has shown that, compared to urban residents, rural residents are more likely to experience higher out-of-pocket costs and delayed or foregone care as a result of cost, even when covered by private health insurance.

    This study provides detailed information about rural-urban differences among adults under age 65 in perceived affordability of health insurance coverage and services prior to implementation of the Affordable Care Act. Rural adults were more likely than urban adults to report problems paying their medical bills and to delay or forego needed care because of cost. To control costs, rural adults were more likely to skip medication doses, take less medicine, delay filling prescriptions, or ask their physician for a lower cost prescription than urban adults.

  • Rural Adults Face Parity Problems and Other Barriers to Appropriate Mental Health Care
    Maine Rural Health Research Center
    Date: 11/2008
    Findings suggest that a multi-level approach is essential for meeting the mental health service needs of rural residents.

    Key facts include: 8% of rural adults say that they are in "fair" or "poor" mental health versus 6% of urban adults;
    Among those using mental health services, rural residents are more likely than urban residents to use medication but not therapy. Practice guidelines for quality mental health treatment recommend that medications be given in combination with therapy;
    Both rural and urban adults have greater cost sharing for their mental healthcare than for their total healthcare use. The percentages do not differ by residence; however, rural residents may be at greater risk of forgoing mental healthcare due to costs.
    This Research & Policy Brief is based on a longer study by the authors. For more information about this study, please contact Erika Ziller at eziller@usm.maine.edu

  • Rural Children Don't Receive the Mental Health Care They Need (Policy Brief)
    Maine Rural Health Research Center
    Date: 01/2009
    Just over one-third of all children with a mental health problem received a mental health visit in the past year. 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 and 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 the characteristics of the rural uninsured and the implications for health insurance reform. Rural is defined as living in a non-metropolitan county, as designated by the Office of Management and Budget (OMB). All presented results are statistically significant at p. = .05.

    Findings: Between 1997 and 2005, the uninsured rate among rural children declined more dramatically than among urban children, following increases in public health insurance. Public health insurance growth among rural adults was much more modest and uninsured rates remained the same. Nearly 60% of the rural uninsured have family incomes below 200% of the federal poverty level suggesting the potential for expanding public coverage. For those with higher incomes, policy strategies to strengthen private coverage will need to account for the unique employment and insurance market characteristics of rural areas.

  • Rural Disabled Medicare Beneficiaries Spend More out-of-Pocket Than Their Urban Counterparts
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2015

    The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey to evaluate rural-urban differences in out-of-pocket spending, supplemental coverage, and variation in spending by type of service. The proportion of total spending paid out-of-pocket is 40% higher among rural disabled Medicare beneficiaries compared to urban disabled beneficiaries. Rural disabled and elderly beneficiaries are more likely to go without any form of supplemental coverage than urban beneficiaries.

  • 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
    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.
  • 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 residents were more likely than urban residents to have a usual source of healthcare (USC), particularly among the uninsured. Despite this, rural adults were somewhat less likely to receive certain preventive care services compared to urban adults. Additionally, rural residents were somewhat more likely to report long travel times to reach their USC and greater difficulty in reaching their provider after hours.
  • Rural-Urban Differences in Work Patterns Among Adults With Depressive Symptoms
    Maine Rural Health Research Center
    Date: 03/2008
    This study addresses the issue of poor mental health among young to middle-career rural residents and how their employment may be affected. Using the National Longitudinal Survey of Youth (NLSY), a nationally representative survey of adults, the authors investigate how depressive symptoms affect employment patterns, and the extent to which such effects differ by rural and urban residence. Analysis of the data identified the rural sample as more likely to be married, have less education, are less likely to be black or Hispanic, and less likely to have health insurance than the urban sample. For both rural and urban subjects, individuals with depressive symptoms work less than those not depressed. Although the findings indicate no significant difference between depressed rural and urban residents in maintaining employment, questions remain about rural access to mental health services, such as employee assistance, productivity on the job, and the survival or coping strategies of rural workers with depressive symptoms.
  • State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
    Maine Rural Health Research Center
    Date: 05/2002
    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. Findings: Licensure laws authorize non-physician mental health providers to practice assessment, treatment planning, and individual and group counseling independently in most of the 40 states studied. Many states do not explicitly grant the authority to all of these professions for diagnosis or psychotherapy, but none explicitly deny it. Despite this finding, Medicare and some other payers do not directly reimburse Marriage and Family Therapists or Licensed Professional Counselors. Laws that require clinical supervision of newly trained practitioners to be performed exclusively by a member of the profession in a face-to face setting may make it difficult for a new graduate seeking rural practice to log the number of required hours within the specified time limit to qualify for independent practice. Some states' laws allow supervision that is not face-to-face, a rural-friendly policy. Also discussed are the nature and effects of guild behavior in the mental health professions. Based on the findings, report recommends that states simplify licensure and clarify clinical roles by combining regulatory functions for several professions into a single office or agency; that Medicare reconsider its position on reimbursing Marriage and Family Therapists or Licensed Professional Counselors; that professional competition over the right to practice and be reimbursed be addressed; and that supervision requirements be modified to allow new mental health professional graduates to address rural needs soon after graduation.
  • 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.