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Rural Health
Research Gateway

Health services

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

2025

  • Rural Access to Certified Community Behavioral Health Clinics (CCBHCs)
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 05/2025
    This study compares rural/urban access to Certified Community Behavioral Health Centers and the services they offer.
  • Federal and State Reimbursement for Youth Behavioral Health Services
    Report
    WWAMI Rural Health Research Center
    Date: 04/2025
    Medicaid is an important source of health care coverage for children and youth in rural areas. This policy brief details the state and federal policies that impact access to behavioral health care services for youth in rural areas, including Medicaid reimbursement policies in all 50 states and the District of Columbia.

2024

2023

  • Medicare Advantage Enrollment Update 2023
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
    Date: 11/2023
    This policy brief continues RUPRI Center's annual update of Medicare Advantage (MA) enrollment including the changes in enrollment in types of MA plans, and health policy changes that may have had an impact.
  • Rural Emergency Hospital Map and Data
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 10/2023
    This interactive map tracks hospitals that have converted to Rural Emergency Hospitals since January 2023.
  • Suitability of Low-Volume Rural Emergency Departments to New Rural Emergency Hospital Designation
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 09/2023
    The Rural Emergency Hospital is a new Medicare payment model that requires hospitals to focus on emergency, observation, and outpatient services in lieu of inpatient care. This study's exploratory objective was to examine care delivery from eligible hospitals to assess their fit with the new payment model.
  • Colorectal Cancer Screening in Rural and Urban Primary Care Practices Amid Implementation of the Medicare Access and CHIP Reauthorization Act
    Journal Article
    Rural and Underserved Health Research Center
    Date: 06/2023
    This study examined whether colorectal cancer screening rates improved among rural and urban primary care practices amid implementation of the Medicare Access and CHIP Reauthorization Act. Researchers tested for rural/urban differences and changes in screening rates between 2016 and 2020.
  • Diabetes Prevalence and Monitoring in Nonmetropolitan and Metropolitan Areas Within a Commercially Insured U.S. Population
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 06/2023
    This study used recent claims data, from services received between 2018 and 2020, to examine the prevalence of diabetes and to determine if patients with diabetes are more or less likely to receive annual hemoglobin A1c screening.
  • Advancing the Age-Friendly Movement in Rural Communities
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 02/2023
    The research team looked at the role of Aging Life Care Managers® to help support the age-friendly movement in rural areas. The team explored ways in which Aging Life Care Managers® could advocate for the needs and interests of their clients, help them access care and support, and involve rural communities in the age-friendly movement.
  • Changes in Service Offerings Post-System Affiliation in Rural Hospitals
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2023
    This policy brief aims to understand the range of effects on service offerings after rural hospitals become part of, or leave, a regional or national healthcare system.

2022

2021

2020

2019

  • Partial Psychiatric Hospitalization Program Availability in Nonmetropolitan and Metropolitan Hospitals Nationally
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 12/2019
    Partial psychiatric hospitalization programs (PPHPs) are intended to reduce or avoid inpatient stays by providing intensive psychiatric services in outpatient settings. We provide national estimates of PPHP availability among nonmetropolitan and metropolitan hospitals and describe the hospital characteristics associated with the provision of PPHPs.
  • The Prevalence of Chronic Diseases Among Current and Ex-Miners in the United States
    Journal Article
    Rural and Underserved Health Research Center
    Date: 12/2019
    This paper compares the prevalence and odds of chronic diseases among ex-miners and current miners, adjusting for certain variables that might influence health outcomes. The analysis found that the prevalence of chronic disease is significantly higher among ex-miners.
  • Hospital Closures and Short-Run Change in Ambulance Call Times
    Journal Article
    Rural and Underserved Health Research Center
    Date: 11/2019
    Hospital closures affect the availability of emergency department services. This paper examines changes in ambulance ride times in areas with hospital closures compared to those in similar areas without hospital closures and separately analyzes changes in ambulance ride times between urban and rural areas and among Medicare-eligible patients.
  • Prescribing Practices of Nurse Practitioners and Physician Assistants Waivered to Prescribe Buprenorphine and the Barriers They Experience Prescribing Buprenorphine
    Journal Article
    WWAMI Rural Health Research Center
    Date: 10/2019
    This study surveyed rural and urban nurse practitioners (NPs) and physician assistants (PAs) with Drug Enforcement Agency waivers to provide medication treatment for opioid use disorder by prescribing buprenorphine. Rural NPs and PAs reported facing many of the same barriers to providing buprenorphine as rural physicians have reported.
  • Declining Endoscopic Care by Family Physicians in Both Rural and Urban Areas
    Journal Article
    Rural and Underserved Health Research Center
    Date: 07/2019
    This paper explores the decline in the percentage of family physicians providing endoscopic services overall and in urban and rural areas. This has implications on the availability of colonoscopies, endoscopies, and flexible sigmoidoscopies in areas that lack specialists who perform such services.
  • Suicidal Thoughts, Plans, and Attempts by Non-Metropolitan and Metropolitan Residence
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 05/2019
    Suicide is among the leading causes of death in the US, and rates in non-metropolitan (rural) counties have historically exceeded those in metropolitan (urban) counties. This study examined the prevalence of suicidal thoughts, plans, and attempts by year (2010-2016) and county type (non-metropolitan, small metropolitan, and large metropolitan).
  • Differences in Care Processes Between Community-Entry Versus Post-Acute Home Health for Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 04/2019
    This study describes home healthcare processes for rural Medicare beneficiaries who are admitted from the community (community-entry) versus those who are admitted following an inpatient stay (post-acute). Care processes include timely initiation of care, length of stay, and services provided (e.g., physical therapy, medical social work).
  • Do Hospital Closures Affect Patient Time in an Ambulance?
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2019
    Our study explores how a local hospital closure changes patient time in an ambulance for 9-1-1 calls. Access to emergency department services in communities, especially rural communities, persists as a priority for the Medicare program. We found when hospitals close, rural patients requiring ambulance services are disproportionately affected.
  • Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas
    Journal Article
    Maine Rural Health Research Center
    Date: 01/2019
    Analyzing the Medicare Current Beneficiary Survey, authors from the Maine Rural Health Research Center found that compared to their urban counterparts, rural Medicare beneficiaries had higher odds of nursing home use after controlling for beneficiary characteristics and contextual factors including nursing home bed supply.

2018

  • Update: Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population, 2012-2015
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 11/2018
    Delivery of pneumococcal vaccines to fee-for-service Medicare beneficiaries increased 380% from 2014-2015 as a result of uptake of pneumococcal conjugate vaccine (PCV13). However, a significant rural-urban disparity remains. Pharmacy providers delivered a significantly greater proportion of vaccines in rural versus urban counties.
  • Different Populations Served by the Medicare Home Health Benefit: Comparison of Post-Acute Versus Community-Entry Home Health in Rural Areas
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 07/2018
    This study describes differences between rural, fee-for-service Medicare beneficiaries who are admitted to home health from the community (community-entry) and those who are admitted to home health following an inpatient stay (post-acute) in terms of their clinical and non-clinical characteristics as well as the communities in which they live.
  • Service Provision and Quality Outcomes in Home Health for Rural Medicare Beneficiaries at High Risk for Unplanned Care
    Journal Article
    WWAMI Rural Health Research Center
    Date: 06/2018
    This study examined service provision and quality outcomes among rural Medicare beneficiaries who used home health from 2011-2013 and were at high risk for unplanned care. More skilled nursing visits and visits by more types of providers were associated with higher hospital readmission and emergency department use and lower community discharge.
  • Telepharmacy Rules and Statutes: A 50-State Survey (Journal Article)
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2018
    Peer-reviewed paper identifying state-enacted regulations and legislation authorizing use of community telepharmacy initiatives and describing implications for patients in underserved rural communities. Also provides a table listing states that permit telepharmacy, and pilot programs and waivers that enable telepharmacy initiatives.
  • Rural Family Physicians Have a Broader Scope of Practice Than Urban Family Physicians
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2018
    While the scope of practice of family physicians has been shrinking, they still practice broadly, often due to fewer health care resources in rural areas. Using data from family physicians seeking continued board certification in 2014 and 2015, we found that a high percentage of rural family physicians provide nearly every clinical service queried.
  • Rural Family Physicians in Patient Centered Medical Homes Have a Broader Scope of Practice
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2018
    The Patient Centered Medical Home (PCMH) is supposed to provide accessible and comprehensive care. Using data from family physicians seeking to continue their American Board of Family Medicine certification in 2014 and 2015, we found that rural family physicians in PCMH practices generally provide more services than those in non-PCMH practices.
  • Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2018
    Using 2014 Medicare data, we found a significant disparity in pneumococcal vaccine service delivery to fee-for-service Medicare beneficiaries. Although primary care providers delivered the majority of pneumococcal vaccines to this population, pharmacy providers delivered a significantly greater proportion of vaccines in rural versus urban counties.
  • Illicit Drug and Opioid Use Disorders Among Non-Metropolitan Residents
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 01/2018
    We provide estimates of the prevalence of illicit drug and opioid use disorders among non-metropolitan adults ages 18-64. Prevalence rates did not decline from 2011-2013 to 2014-2015 despite the implementation of major substance use treatment policies. Of particular concern, heroin use disorder prevalence increased in recent years.
  • Perceived Treatment Need and Utilization for Illicit Drug and Opioid Use Disorders in Non-Metropolitan Areas
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 01/2018
    The vast majority of non-metropolitan adults 18-64 who satisfy criteria for an illicit drug use or opioid use disorder do not perceive a need for treatment or receive formal substance use treatment. Despite policies to increase treatment access during the 2008-2015 study period, we found few changes in perceived treatment need and utilization.

2017

2016

2015

  • Medicare Value-Based Payment Reform: Priorities for Transforming Rural Health Systems
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 11/2015
    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.
  • Rural Bypass for Elective Surgeries
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2015
    Describes the elective surgical bypass rate, the procedures most commonly bypassed by rural residents, the distribution of volume among Critical Access Hospitals (CAHs) that offer elective surgical services, and factors predictive of bypass.
  • Prehospital Emergency Medical Services Personnel in Rural Areas: Results From a Survey in Nine States
    Report
    WWAMI Rural Health Research Center
    Date: 08/2015
    This study examines supply and demand for emergency response personnel, the involvement of medical directors, and the availability of medical consultation in rural and urban emergency service personnel (EMS) agencies in nine states.
  • Perspectives of Rural Hospice Directors
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 03/2015
    Rural hospice care is under pressure by a variety of factors that are reviewed in this document. However, a central core element of rural hospice remains the strong sense of community that is embodied in the system and design of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states.
  • Developmental Strategies and Challenges for Rural Accountable Care Organizations
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2015
    This brief offers insights into the initial strategic decisions and challenges of four accountable care organizations (ACOs) with rural presences. These ACOs were formed as a step toward a value-driven rural delivery system. While several challenges need to be addressed, these insights can inform development of other rural ACOs.
  • Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 02/2015
    This brief describes the variation in emergency department use for non-emergent health conditions across rural and urban areas as well as by U.S. Census regions. Potential risk factors, including patients' socioeconomic characteristics and levels of primary care resources, are identified. Quality of care indicators are also addressed.

2014

  • Facilitating the Formation of Accountable Care Organizations in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2014
    This brief shows characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries, one each of the four census regions. The findings can help rural providers interested in forming/participating in an ACO assess the status and potential gaps of their core structures and capabilities.
  • 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.
  • Do Rural Patients With Early-Stage Prostate Cancer Gain Access to All Treatment Choices? (Final Report)
    Report
    WWAMI Rural Health Research Center
    Date: 02/2014
    This report compares rates of receipt of prostate cancer treatments and of the treatment options between early-stage prostate cancer patients living in urban and four levels of rural counties.

2013

  • Promotion and Protection of Rural Miner Health: Are the Resources in Place? (Final Report)
    West Virginia Rural Health Research Center
    Date: 06/2013
    This report shows that mining areas in the United States, compared to non-mining areas, have on average better supplies of safety net providers, hospitals, and practicing primary care physicians. However, the study results support the need to examine the availability of safety net provider types in selected geographic areas where mining is done.
  • Rural Implications of the Primary Care Incentive Payment Program
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2013
    This policy brief reports on eligibility among rural primary care providers for the Primary Care Incentive Payments established in the Patient Protection and Affordable Care Act.

2012

2011

2010

2009

2008

2007

  • Access to Cancer Services for Rural Colorectal Cancer Patients (Project Summary)
    WWAMI Rural Health Research Center
    Date: 10/2007
    This summary provides a brief overview of findings from a study to determine how far rural and urban colorectal cancer patients travel to three types of specialty cancer care services: surgery, medical oncology consultation, and radiation oncology consultation.
  • Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum
    Maine Rural Health Research Center
    Date: 10/2007
    This study examines the distribution of substance abuse treatment services across the continuum of rural and urban counties, identifying the type and intensity of services provided.
  • Rural Inpatient Psychiatric Units Improve Access to Community-Based Mental Health Services, but Medicare Payment Policy a Barrier
    Maine Rural Health Research Center
    Date: 08/2007
    This study investigates the characteristics/admission processes of inpatient psychiatric units (IPUs) in rural hospitals with less than 50 beds and the community-based services available to them when discharging patients. Reasons for developing IPUs, barriers to opening and operating a rural IPU, and factors leading some to close are also explored.
  • Why Are Fewer Hospitals in the Delivery Business?
    NORC Walsh Center for Rural Health Analysis
    Date: 04/2007
    This study examines the declining availability of hospital-based obstetric services in rural areas from the mid-1980s to the early 2000s. It looks at potential causes for this trend and explores the effects of medical malpractice reforms.
  • Intensive Care in Critical Access Hospitals
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2007
    Describes the facilities, equipment, and staffing used by Critical Access Hospitals (CAHs) for intensive care, the types of patients receiving ICU care, and the perceived impact of closing the ICU on CAH staff and the local community.
  • Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention
    Journal Article
    FORHP-funded Individual Grantees
    Date: 2007
    Describes the results of a study to assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally.

2006

  • Wyoming Physicians Are Significant Providers of Safety Net Care
    Journal Article
    WWAMI Rural Health Research Center
    Date: 11/2006
    Describes the contributions of family and general practice physicians from Wyoming to the health care safety net.
  • Care Across the Continuum: Access to Health Care Services in Rural America (2006)
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 2006
    The article is divided into 3 sections: 1) basic principles that determine services to be included in the continuum and how success in providing those services is judged; 2) definition of the continuum and its basic stages based on the health systems research literature; 3) applications of the continuum and policy implications of the framework.
  • Mental Healthcare in Rural Communities: The Once and Future Role of Primary Care
    Journal Article
    Maine Rural Health Research Center
    Date: 2006
    Discusses issues related to the delivery of mental health services in the United States. Addresses how these issues complicate the delivery of services in rural areas. Offers an argument for integrating primary care and mental health in rural areas.

2005

2004

  • Access To Primary Care and Quality of Care in Rural America
    NORC Walsh Center for Rural Health Analysis
    Date: 06/2004
    This report provides findings from a population-based study addressing the impact of the availability of healthcare resources on the rate of potentially avoidable hospitalizations. It suggests shortcomings with previous research conducted in communities that experienced problems accessing primary care services.

2003

  • Care Across the Continuum: Access to Health Care Services in Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2003
    This paper proposes that a continuum of care serve as the framework with which to consider rural healthcare policies, focusing on people and on places where people live rather than on the wants of providers and constituencies.
  • Who Receives Inpatient Charity Care in California?
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2003
    This policy analysis brief examines the results of a study regarding how California hospitals determine charity 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.

2002

  • Health Services at Risk in "Vulnerable" Rural Places
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2002
    This brief discusses implications of a method to identify places in rural America at risk of being without healthcare services because they may lack a sufficient number of people to support a practice/provider, they are able to pay the full cost of care, or the population size/composition doesn't warrant the level of services currently available.
  • Impact of National Policy on Access to Health Care: The Rural Perspective
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2002
    This document discusses the current state of financial and geographic access to healthcare in the United States and federal policy.

1997