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Rural Health
Research Gateway

Healthcare access

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

  • Impact of Hospital Closure on Rural Communities: A Qualitative Study
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2025
    Rising rates of rural hospital closures have prompted concerns about access to care in affected communities. This paper summarizes findings from interviews with state and community leaders who experienced hospital closures between May 2010 and December 2017, detailing their impact on rural communities and how local communities adapted to them.
  • 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.
  • Rural and Urban Differences in Suicide in the United States, 2018-2021
    Policy Brief
    ETSU/NORC Rural Health Research Center
    Date: 05/2025
    Suicide remains a significant cause of mortality in the United States. This policy brief examines state-level differences in suicide rates by demographics and geography, with a focus on rural and urban areas from 2018 to 2021. The study employs a cross-sectional, retrospective design using secondary data sources.
  • Are HCC Risk Scores a Reliable Health Status Indicator Across Rural and Urban Areas?
    Policy Brief
    ETSU/NORC Rural Health Research Center
    Date: 04/2025
    This brief explores differences in CMS Hierarchical Condition Category (HCC) risk scores between rural and urban Medicare beneficiaries, revealing lower scores for rural populations despite higher chronic disease prevalence. The brief highlights HCC score limitations and suggests improvements and alternatives for accurate health representation.
  • 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.
  • The Rural and Urban Supply of Clinicians With a DEA Waiver to Prescribe Buprenorphine in 2022 Prior to the Elimination of the Waiver Requirement
    WWAMI Rural Health Research Center
    Date: 04/2025
    This data brief describes the supply of all clinicians with a DEA waiver to prescribe medication for opioid use disorder from 2017 to 2022. The supply of eligible clinicians grew in both rural and urban counties in five years. More rural counties lacked waivered clinician compared to urban counties.
  • Examining Differences in Rural and Urban Medicare FFS Beneficiaries' Emergency Department Use Before and During Covid
    Policy Brief
    ETSU/NORC Rural Health Research Center
    Date: 01/2025
    The brief examines changes in emergency department (ED) use among rural and urban Medicare Fee-for-Service (FFS) beneficiaries during the COVID-19 pandemic. Key findings included a moderate increase in rural ED use, higher mortality and inpatient admissions, and decreased use among dual-eligible beneficiaries.

2024

2023

2022

  • Community Sociodemographics and Rural Hospital Survival
    Journal Article
    Center for Economic Analysis of Rural Health
    Date: 12/2022
    This study examines whether community sociodemographic factors are associated with the survival or closure of rural hospitals at risk of financial distress between 2010 and 2019.
  • Patterns of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 and Older, 2010-2017
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2022
    This study examines rural-urban differences in health care use among Medicare beneficiaries age 85+.
  • Rural-Urban Disparities in Quality of Inpatient Psychiatric Care
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 11/2022
    Using data from the Inpatient Psychiatric Facility Quality Reporting program 2015-2019, this study examined differences and changes in the quality of inpatient psychiatric care in rural and urban hospitals.
  • Changes in the Supply and Rural-Urban Distribution of Counselors in the U.S., 2014-2021
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of counselors by rural-urban status and Census Division.
  • Changes in the Supply and Rural-Urban Distribution of Psychiatric Nurse Practitioners in the U.S., 2014-2021
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of psychiatric nurse practitioners by rural-urban status and Census Division.
  • Changes in the Supply and Rural-Urban Distribution of Psychiatrists in the U.S., 1995-2019
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of psychiatrists by rural-urban status and Census Division.
  • Changes in the Supply and Rural-Urban Distribution of Psychologists in the U.S., 2014-2021
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of psychologists by rural-urban status and Census Division.
  • Changes in the Supply and Rural-Urban Distribution of Social Workers in the U.S., 2014-2021
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of social workers by rural-urban status and Census Division.
  • Small Rural Hospitals with Low-Volume Emergency Departments That May Convert to a Rural Emergency Hospital (REH)
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2022
    This study profiles rural hospitals eligible to convert to Rural Emergency Hospitals. The objective is to characterize rural hospitals with very low emergency department volume to inform the clinical and operational decisions that will be required to implement this new provider model.
  • Review of Rural U.S. Economic and Health Care Trends
    Report
    Center for Economic Analysis of Rural Health
    Date: 09/2022
    This report reviews recent literature and publicly available data to explore important issues at the nexus of health care and local economic vibrancy. The report also explores the economic implications associated with COVID-19, however full impacts will not be known for several years.
  • Health Insurance Marketplaces: Issuer Participation Trends in Non-Metropolitan Places, 2014-22
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
    Date: 08/2022
    Since the 2014 implementation of Health Insurance Marketplaces (HIMs), considerable changes have been observed in the number of insurance companies offering plans across the United States. This policy brief describes changes in HIM plan issuers over the 2014-2022 period with an emphasis on variation across metropolitan and non-metropolitan places.
  • Medicare Beneficiary Access to Prescription Drugs in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2022
    Declines in the number of retail pharmacies in rural areas have raised concerns about beneficiary access to prescription medications when their local pharmacy closes. The purpose of this policy brief is to identify the types of pharmacies used by beneficiaries in rural areas with limited or no access to local pharmacies.
  • Rural and Urban Pharmacy Presence – Pharmacy Deserts
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2022
    This policy brief continues the RUPRI Center's ongoing examination of the availability of community pharmacies and their provided services in rural areas of the U.S. The brief also provides a deeper analysis of counties with no retail pharmacies (i.e. pharmacy deserts) based on metropolitan/nonmetropolitan locations.
  • Changes in Access to Community Health Services Among Rural Areas Affected and Unaffected by Hospital Closures Between 2006 and 2018: A Comparative Interrupted Time Series Study
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 07/2022
    In this article, investigators compared access to Federally Qualified Health Centers and Rural Health Clinics by those in rural areas affected versus those in rural areas unaffected by hospital closures.
  • County-Level Availability of Obstetric Care and Economic Implications of Hospital Closures on Obstetric Care
    Policy Brief
    Center for Economic Analysis of Rural Health
    Date: 07/2022
    This policy brief draws out demographic and economic differences between counties with obstetric care facilities and those without. It provides descriptive data on the economic changes underway in counties that lost obstetric care facilities between 2012 and 2019.
  • Nursing Homes in Rural America: A Chartbook
    Chartbook
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2022
    Closure of nursing homes and hospitals with swing beds in recent years has changed the availability of post-acute and long-term care services in rural areas. This study examines the availability of post-acute and long-term care services as well as characteristics of residents and nursing homes in noncore, micropolitan, and metropolitan counties.
  • Non-Metropolitan and Metropolitan Trends in Mental Health Treatment Availability in Community Health and Community Mental Health Centers
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 06/2022
    This study shows how the supply of community mental health centers (CMHCs) and community health centers (CHCs) delivering mental health services changed from 2000 to 2019. While the supply of CHCs offering mental health services increased, the supply of CMHCs decreased.
  • Maine: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • New Hampshire: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • New York: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • The Northern Border Region: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • Vermont: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • Rural Hospital Administrators' Beliefs About Safety, Financial Viability, and Community Need for Offering Obstetric Care
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 03/2022
    This study offers results from a national survey of a sample of 292 rural hospitals that provided obstetric services in 2021. Obstetric unit administrators shared about their experiences, the challenges they face, and the decisions that factor into providing labor and birth care for their rural communities.
  • Contact by Collection Agencies for Medical Debt: Rural-Urban Differences Among Older and Younger Medicare Beneficiaries
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 02/2022
    This study uses data from the 2016 Medicare Current Beneficiary Survey (n = 12,688 U.S. community-dwelling beneficiaries) to understand the impact of medical debt for rural residents. The study analyzed rural-urban differences in rates of collection agency contact for unpaid medical bills.
  • Disparities in Prenatal Immunization Rates in Rural and Urban U.S. Areas by Indicators of Access to Care
    Journal Article
    Southwest Rural Health Research Center
    Date: 02/2022
    This study evaluates variations in immunization rates among pregnant women across the urban-rural continuum. Results indicate pregnant women in rural areas more commonly rely on Medicaid to fund prenatal care but are less likely to have full or expanded access to Medicaid. This finding may contribute to immunization uptake disparities.
  • Meeting the Behavioral Health Needs of Farm Families in Times of Economic Distress
    Policy Brief
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 02/2022
    Economic fluctuations and periods of distress in farming cannot be eliminated, however, their impact on communities and individuals can be mitigated. Strategies for meeting the behavioral health needs of farm families by supporting community-based services, and expanding behavioral health services in rural contexts are highlighted in this work.
  • An Enhanced Method for Identifying Hospital-Based Obstetric Unit Status
    University of Minnesota Rural Health Research Center
    Date: 01/2022
    The purpose of this methodology brief is to describe an enhanced method for identifying hospital-based obstetric unit status and for identifying closures of obstetric units.
  • High-Performing Rural Health System
    Policy Brief
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 01/2022
    This document updates the RUPRI Health Panel's framework, for a high-performing rural health system, originally published in 2011. It offers a revised vision statement and updates the high-performing rural health system pillars (access, affordability, community health, and quality) and describes an underlying base of equity considerations.

2021

2020

2019

2018

  • Assessing the Unintended Consequences of Health Policy on Rural Populations and Places
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 12/2018
    This paper explores the unintended consequences of health policy through an analysis of policy actions that have affected, or had the potential to affect, rural people, places, and/or providers in ways counteractive to policy intent.
  • Patterns of Telehealth Use Among Rural Medicaid Beneficiaries
    Journal Article
    Rural Telehealth Research Center
    Date: 10/2018
    This study uses data from the 2011 Medicaid Analytic eXtract (MAX) to examine the prevalence of telehealth use among rural and urban Medicaid beneficiaries, characteristics of telehealth users, types of telehealth services provided, and diagnoses associated with telehealth use.
  • Health Insurance Marketplaces: Issuer Participation and Premium Trends in Rural Places, 2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2018
    This brief assesses changes from 2014 to 2018 in average Health Insurance Marketplace plan participation and pre-subsidy premiums in rural and urban places. Insurance carriers reduced participation across both, while the gap between average premiums in expansion and non-expansion states is widening at a similar rate in rural and urban counties.
  • Medicaid Income Eligibility Transitions Among Rural Adults
    Policy Brief
    Maine Rural Health Research Center
    Date: 08/2018
    The Affordable Care Act allows Medicaid expansion to adults under 65 with income below 138% of poverty. Research suggests income shifts affecting Medicaid eligibility are common, but the rural impact is unclear. This national study examines rural and urban adults' annual income shifts above or below the Medicaid expansion eligibility threshold.
  • Update: Independently Owned Pharmacy Closures in Rural America, 2003-2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2018
    Rural pharmacies play an important role in health service delivery to rural populations. This RUPRI Center brief updates previous findings on the continued decline in the number of independently owned rural pharmacies since the implementation of Medicare Part D. This brief provides follow-up data on rural pharmacy closures through March 2018.
  • Geographic Distribution of Providers With a DEA Waiver to Prescribe Buprenorphine for the Treatment of Opioid Use Disorder: A 5‐Year Update
    Journal Article
    WWAMI Rural Health Research Center
    Date: 06/2018
    This study compares the geographic distribution of physicians, physician assistants, and nurse practitioners waivered to prescribe buprenorphine in 2012 and 2017.
  • Geographic Variation in the Supply of Selected Behavioral Health Providers
    Journal Article
    WWAMI Rural Health Research Center
    Date: 06/2018
    This study examined the supply of select behavioral health providers by metropolitan, micropolitan, and non-core county and Census Division. Psychiatrists, psychologists, and psychiatric nurse practitioners are unequally distributed throughout the U.S., with disparities between Census Divisions and rural vs. urban areas.
  • Prescribing Practices of Rural Physicians Waivered to Prescribe Buprenorphine
    Journal Article
    WWAMI Rural Health Research Center
    Date: 06/2018
    This study finds more than 60% of rural counties don't have a physician waivered to prescribe buprenorphine, which is used to treat opioid use disorder.
  • Beyond Clinical Complexity: Nonmedical Barriers to Nursing Home Care for Rural Residents
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 02/2018
    Using data from interviews with rural hospital discharge planners, we identified four themes around nonmedical barriers to rural nursing home placement with particular salience in rural areas: financial issues, transportation, nursing home availability and infrastructure, and timeliness. We also identified policy and programmatic interventions.
  • Distance and Networks: A Regional Analysis of Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2018
    Using 2015-16 data on 15 Midwestern states, we examine the possibility that geographic distance to care plays a role in insurance issuer participation, premiums, and enrollment success through its effect on network adequacy and assess the moderating role that state-level policies on network adequacy standards and Rating Area design may have.
  • Access to Care: Populations in Counties With No FQHC, RHC, or Acute Care Hospital
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2018
    To help provide a quick understanding of how many people may have more limited access to primary care and where they live, this brief focuses on three main primary care providers in rural areas (Federally Qualified Health Centers, Rural Health Centers, and acute care hospitals).

2017

  • Barriers to Nursing Home Care for Nonelderly Rural Residents
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 12/2017
    This study uses data from 23 semi-structured interviews with rural hospital discharge planners in five states to identify specific barriers to finding nursing home care for nonelderly rural residents. We found three primary themes—payment status, fit, and medical complexity—as well as two minor themes—caregivers and bureaucratic processes.
  • Home Is Where the Heart Is: Insights on the Coordination and Delivery of Home Health Services in Rural America
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 08/2017
    Access to home health in rural areas is an important public policy concern, particularly with the growing number of older adults residing in rural America. This qualitative study seeks to better understand how home health services are provided in rural areas, and identifies facilitators and barriers to providing care.
  • 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.

2016

2015

  • Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents
    Report
    WWAMI Rural Health Research Center
    Date: 05/2015
    Residents of non-metropolitan counties were less likely than those in metropolitan counties to report having dental visits or teeth cleanings in the last year and more likely to report undergoing tooth extractions. These findings persisted even when controlling for demographic factors, income, insurance, and health/smoking status.
  • A Rural Taxonomy of Population and Health-Resource Characteristics
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2015
    This brief reports the newly developed taxonomy of rural places based on relevant population and health-resource characteristics and discusses how this classification tool can be utilized by policymakers and rural communities.
  • Surgical Services in Critical Access Hospitals, 2011
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2015
    This brief describes the types and volume of major surgical services provided in critical access hospitals across four regionally representative states in 2011.

2009

  • 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.

2007

2006

  • 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.

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

2002

1997