Maine Rural Health Research Center: Rural Health Research Products & Journal Articles

2024

Pediatric and Pregnancy-related Visits at Rural Health Clinics in 2018 Among Medicaid/CHIP Enrollees in 20 States
Policy Brief
Date: 09/2024
This policy brief reports on the percentage of Medicaid-enrolled children and reproductive age women with pregnancy-related service use who visited a Rural Health Clinic in 2018 in 20 states.
Non-Urgent Use of Emergency Departments by Rural and Urban Adults
Policy Brief
Date: 04/2024
This study provides updated information and addresses gaps in knowledge about rural non-urgent emergency department (ED) use. Understanding the rates of non-urgent ED use among rural adults and the factors associated with this use can inform policy and practice efforts to reduce inappropriate use of EDs in rural communities.
Identifying Rural Health Clinics Within the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files
Policy Brief
Date: 03/2024
This brief describes a methodology for identifying Rural Health Clinic encounters within the Medicaid claims data using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.

2023

Excess Deaths Associated With COVID-19 by Rurality and Demographic Factors in the United States
Journal Article
Date: 12/2023
Researchers analyzed U.S. mortality data to quantify excess deaths during the COVID-19 pandemic to describe rural-urban disparities by age, sex, and race/ethnicity. There were nearly 17% more deaths than expected between March 2020 and February 2023.
A Consensus Panel Approach to Estimating the Start-Up and Annual Service Costs for Rural Ambulance Agencies
Policy Brief
Date: 08/2023
This brief fills the information void on the costs of running rural ambulance services and establishes a minimum access standard for ambulances servicing a 25-minute travel time radius from the ambulance station, enabling policymakers and community stakeholders to develop strategic plans for the financing and provision of ambulance services.
Ambulance Deserts: Geographic Disparities in the Provision of Ambulance Services
Chartbook
Date: 05/2023
Access to timely ambulance service is an essential part of the emergency medical system. Yet ambulance access varies widely with significant gaps across the country. This research identifies places and people that are more than 25 minutes from an ambulance station, also called an ambulance desert.
Rural Working-Age Adults Report More Cost Barriers to Health Care
Policy Brief
Date: 03/2023
Using the 2019-2020 National Health Insurance Survey, this study examined rural-urban differences in affordability of care and cost-saving strategies among working-age adults.
Rural-Urban Differences in Workers' Access to Paid Sick Leave
Journal Article
Date: 02/2023
The authors analyzed the prevalence of paid sick leave (PSL) among rural versus urban workers and found that rural workers had lower access to PSL than urban workers, even after adjusting for worker and employment characteristics, especially those who were Hispanic, lacked employer-sponsored insurance, and reported poorer health status.

2022

Patterns of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 and Older, 2010-2017
Policy Brief
Date: 11/2022
This study examines rural-urban differences in health care use among Medicare beneficiaries age 85+.
Community Characteristics and Financial and Operational Performance of Rural Health Clinics in the United States: A Chartbook
Chartbook
Date: 05/2022
This chartbook provides an overview of Rural Health Clinic (RHC) characteristics and issues and will be useful to policymakers and others interested in the performance of RHCs nationally. It provides a discussion of the challenges related to collection and reporting of RHC quality data.
Maine: A Health-Focused Landscape Analysis
Chartbook
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
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
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
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
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.

2021

Use of Electronic Health Records to Manage Tobacco Screening and Treatment in Rural Primary Care
Journal Article
Date: 09/2021
This study compares the performance of rural and urban primary care providers in adhering to evidence-based smoking-related standards of care and assesses the degree to which electronic health record use was related to improved adherence to these standards in the practice of rural versus urban providers.
Voices From the Field: A Qualitative Study of the Challenges and Promising Practices of Rural Public Health in Addressing HIV and Hepatitis C
Journal Article
Date: 05/2021
Interviewing public health professionals from six rural states, researchers examined the challenges involving HIV, HCV, and serving rural people who inject drugs and determined strategies to address those challenges.
Capacity of Rural Counties to Address an HIV or Hepatitis C Outbreak
Policy Brief
Date: 02/2021
This study examines rural-urban differences in state and local health department capacity to prevent, prepare for, and respond to an HIV or hepatitis C outbreak.
Opioid-Related Visits to Rural Emergency Departments
Policy Brief
Date: 02/2021
The purpose of this project was to compare rural and urban opioid-related emergency department visits. Data from the Nationwide Emergency Department Sample were used to examine rural and urban opioid-related visits over time and to compare the outcomes of these visits.
Rural HIV Prevalence and Service Availability in the United States: A Chartbook
Chartbook
Date: 02/2021
This chartbook examines 2016 HIV prevalence and the availability of HIV prevention, testing, and treatment services across the rural-urban continuum and by U.S. census region.
Rural-Urban Residence and Maternal Hepatitis C Infection, U.S.: 2010-2018
Journal Article
Date: 02/2021
This study uses data from the U.S. natality files to examine rural-urban differences in county-level rates of maternal infection with hepatitis C virus (HCV) during 2010-2018. Findings can help inform implementation of community-level interventions to reduce maternal HCV infection and narrow rural-urban disparities.

2020

Acuity Differences Among Newly Admitted Older Residents in Rural and Urban Nursing Homes
Journal Article
Date: 11/2020
This study found newly admitted residents of rural nursing homes were more likely to have cognitive issues/problem behaviors than those in urban facilities. Yet rural facilities admitted less complex older (age 75+) residents than urban, raising questions about the rural long-term services and supports system and capacity of rural nursing homes.
Substance Use Among Rural and Urban Youth and Young Adults
Policy Brief
Date: 11/2020
This study uses national data to examine rural-urban differences in the rates of substance use among youth and young adults. Findings can help inform rural-specific prevention strategies and research targeting rural communities.
Rural-Urban Residence and Mortality Among Three Cohorts of U.S. Adults
Policy Brief
Date: 05/2020
Rural residents have a shorter life expectancy than urban residents. We analyzed national linked survey and death certificate data and found risk of death was 10% higher for rural than urban residents and has increased over time. Findings suggest the overall mortality penalty in rural areas may be partly driven by social determinants of health.
Health Care Use and Access Among Rural and Urban Nonelderly Adult Medicare Beneficiaries
Policy Brief
Date: 01/2020
Little is known about the characteristics and healthcare use of rural residents with disabilities. This study compares access to and use of health services among rural and urban nonelderly Medicare beneficiaries with a disability and the factors associated with rural access issues.

2019

Rural Health Clinic Costs and Medicare Reimbursement
Policy Brief
Date: 11/2019
We used cost report data to examine Rural Health Clinic (RHC) services costs. The findings support the National Advisory Committee on Rural Health & Human Service's conclusion that the cost-based methodology used to determine Medicare reimbursement for RHCs is outdated and RHCs subject to the reimbursement cap are paid less than their costs.
Preventive Health Service Use Among Rural Women
Policy Brief
Date: 04/2019
This study used the National Health Interview Survey to examine differences in receipt of preventive health services among rural and urban women. It found that rural women are less likely to receive HPV vaccines and mammograms, even controlling for rural-urban sociodemographic and resource differences.
Rural-Urban Differences in the Decline of Adolescent Cigarette Smoking
Journal Article
Date: 03/2019
Comparing survey data from 2008-2010 with 2014-2016, we examined change over time in cigarette smoking among rural and urban adolescents. We found that both rural and urban rates declined, but the decrease was smaller in rural counties, which widened the rural-urban gap in adolescent smoking rates.
Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas
Journal Article
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

Medicaid Income Eligibility Transitions Among Rural Adults
Policy Brief
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.
Rural Health Clinic Participation in the Merit-Based Incentive System and Other Quality Reporting Initiatives: Challenges and Opportunities
Policy Brief
Date: 07/2018
This brief discusses the Merit-Based Incentive Payment System (MIPS) within the context of past and current Rural Health Clinic (RHC) quality reporting initiatives and assesses options for encouraging RHCs to voluntarily participate in MIPS.
Residential Settings and Healthcare Use of the Rural "Oldest-Old" Medicare Population
Policy Brief
Date: 03/2018
This study used Medicare Current Beneficiary Survey data to profile rural/urban Medicare beneficiaries ages 85 & older. Rural adults in this age group are more likely to be disabled and live alone in the community or in nursing homes and less likely to live in assisted living facilities. Findings highlight rural needs for community-based services.

2017

Knowledge of Health Insurance Concepts and the Affordable Care Act Among Rural Residents
Policy Brief
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.
Rural Opioid Prevention and Treatment Strategies: The Experience in Four States
Policy Brief
Date: 04/2017
Little is known about what states with large rural populations are doing to combat opioid use disorders (OUD) in rural communities. This qualitative study identified rural challenges to the provision of OUD prevention, treatment, and recovery services and explored promising strategies to tackle the opioid crisis in rural communities.
The Role of Public Versus Private Health Insurance in Ensuring Health Care Access & Affordability for Low-Income Rural Children
Policy Brief
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

Health Insurance CO-OPs: Product Availability and Premiums in Rural Counties
Policy Brief
Date: 10/2016
We describe regional distribution and market prevalence of Consumer Operated and Oriented Plan (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.
Understanding the Business Case for Telemental Health in Rural Communities
Journal Article
Date: 07/2016
This article describes the current landscape and characteristics of rural telemental health programs and then examines their business case.
Are Rural Older Adults Benefiting From Increased State Spending on Medicaid Home and Community-Based Services?
Policy Brief
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.
Health Information Exchange: A Strategy for Improving Access for Rural Veterans in the Maine Flex Rural Veterans Health Access Program
Date: 05/2016
This paper reports on the design and implementation of a first-in-the-nation project to expand rural veterans' access to healthcare by establishing a bi-directional connection between Maine's statewide health information exchange (HIE) and Veterans Administration facilities and centers.
Adverse Childhood Experiences in Rural and Urban Contexts
Policy Brief
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.
Pilot Testing a Rural Health Clinic Quality Measurement Reporting System
Policy Brief
Date: 02/2016
More than 4,000 Rural Health Clinics (RHCs) serve the primary care needs of rural communities. Unfortunately, the Rural Health Clinic Program is plagued by a lack of data participating clinics. This reports on the results with a focus on assessing the feasibility and utility of the reporting system and quality measures for the participating RHCs.
Rural Opioid Abuse: Prevalence and User Characteristics
Policy Brief
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 socioeconomic characteristics associated with their use and other risky behavior.
Mental Health First Aid in Rural Communities: Appropriateness and Outcomes
Journal Article
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.

2015

Implications of Rural Residence and Single Mother Status for Maternal Smoking Behaviors
Policy Brief
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.
Rural Adults Delay, Forego, and Strategize to Afford Their Pre-ACA Health Care
Policy Brief
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 Disabled Medicare Beneficiaries Spend More Out-of-Pocket Than Their Urban Counterparts
Policy Brief
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.
Adoption and Use of Electronic Health Records by Rural Health Clinics: Results of a National Survey
Policy Brief
Date: 09/2015
This study reports the extent of electronic health record implementation and use in a randomly selected sample of 1,497 rural health clinics surveyed in 2013.
Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace
Policy Brief
Date: 02/2015
This policy brief reports findings from a survey of rural health clinics (RHC) that examined their capacity to meet the National Council for Quality Assurance patient-centered medical home requirements and discusses the implications of the findings for efforts to support RHC capacity development.

2014

High Deductible Health Insurance Plans in Rural Areas
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.
Implications of Rurality and Psychiatric Status for Diabetic Preventive Care Use Among Adults With Diabetes
Policy Brief
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.
Integrated Care Management in Rural Communities
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.
Profile of Rural Residential Care Facilities: A Chartbook
Chartbook
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.
Health Insurance Coverage of Low-Income Rural Children Increases and Is More Continuous Following CHIP Implementation
Policy Brief
Date: 03/2014
This study found that following the Children's Health Insurance Program's (CHIP) 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.
Meaningful Use of the Electronic Health Records by Rural Health Clinics
Date: 02/2014
This paper identifies the rates of electronic health record adoption among a random national sample of rural health clinics (RHCs) and the extent to which RHCs that have adopted an EHR are likely to achieve Stage 1 meaningful use.

2013

Telemental Health in Today's Rural Health System
Date: 12/2013
This policy brief describes the organizational setting, services provided, and staff used in 53 telemental rural health programs. It also outlines the opportunities and challenges for telemental health in the rural health system.
Challenges and Opportunities for Improving Mental Health Services in Rural Long-Term Care
Date: 06/2013
This study explores practices for increasing the quality, quantity, and accessibility of mental health services in rural long-term care.
Patterns of Care for Rural and Urban Children With Mental Health Problems
Date: 06/2013
This study reports that rural children are significantly less likely to be diagnosed and treated for non-ADHD mental health problems than urban children and are less likely to receive mental health counseling.
Rural Vets: Their Barriers, Problems, Needs
Journal Article
Date: 05/2013
Evolving population trends--the aging of rural veterans, the growing number of female veterans and rates of homelessness among veterans--place significant demands on VA and rural delivery systems. Coordination among healthcare providers is essential to increasing the availability of services and expanding veteran outreach programs.

2012

Health Care Access and Use Among the Rural Uninsured
Journal Article
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.
Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences? (Policy Brief)
Date: 03/2012
This policy brief finds that after controlling for a broad range of key risk and protective factors, it is clear that an unexplained rural effect persists with rural adolescents still exhibiting higher alcohol use than their urban counterparts.
Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences? (Working Paper)
Date: 03/2012
This study examines alcohol use among rural and urban adolescents between the ages of 12 and 17.

2011

Health Care Access and Use Among the Rural Uninsured (Research & Policy Brief)
Policy Brief
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.

2010

Access to Mental Health Services and Family Impact of Rural Children With Mental Health Problems
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.
Impact of Employment Transitions on Health Insurance Coverage of Rural Residents
Date: 10/2010
This study explores the impact of changes in employment status on insurance coverage for rural and urban workers.
Many Urban and Rural Workers Lose Health Insurance During Job Transitions
Policy Brief
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 Problems Have Considerable Impact on Rural Children and Their Families
Policy Brief
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.
Are Rural Health Clinics Part of the Rural Safety Net?
Policy Brief
Date: 09/2010
This policy brief examines whether rural health clinics are part of the rural safety net.
Safety Net Activities of Independent Rural Health Clinics
Date: 09/2010
Rural Health Clinics (RHCs) provide primary care services to rural residents of 45 states. Since RHCs are in underserved rural areas and serve vulnerable populations, many consider them safety net providers. In this paper, we explore whether, and to what extent, independent RHCs are serving a safety net role or have the capacity to do so.
Mental Health Services in Rural Jails (Working Paper)
Date: 08/2010
This study explored the role of rural jails in the mental health systems in rural communities, investigating how rural jails manage mental health and substance abuse problems among inmates, determining barriers to providing mental health services faced by rural jails, and identifying promising practices for service delivery.
Encouraging Rural Health Clinics to Provide Mental Health Services: What Are the Options?
Date: 05/2010
This study examined changes in the delivery of mental health services by rural health clinics (RHCs), their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services.
The Provision of Mental Health Services by Rural Health Clinics
Date: 05/2010
This study examined changes in the delivery of mental health services by rural health clinics (RHCs), their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services.
Community Benefit Activities of Critical Access Hospitals, Non-Metropolitan Hospitals and Metropolitan Hospitals: National and State Data (State reports)
Date: 03/2010
Quality, financial, and community benefit indicators of critical access hospital (CAH) performance are being analyzed by the Flex Monitoring Team. Here, state-level data on performance of CAHs in each state are summarized.
Monitoring the Community Benefits of CAHs: A Review of the Data (Briefing Paper)
Date: 03/2010
There is a growing national interest in the benefits provided by nonprofit and public hospitals to their communities in exchange for the tax benefits or public funding that they receive.
Monitoring the Community Benefits of Critical Access Hospitals: A Review of the Data
Policy Brief
Date: 03/2010
This brief examines the community benefit activities of critical access hospitals (CAHs) using data from the Flex Monitoring Team's (FMT) pilot test of a set of community benefit data collection tools and performance indicators, the Internal Review Service's (IRS) 2006 Hospital Compliance Study, and the 2007 FMT CAH survey.

2009

Availability, Characteristics, and Role of Detoxification Services in Rural Areas
Date: 12/2009
Few detox providers (n=235) serve rural America; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve patients across a 100-mile radius, making travel distances a barrier to outpatient care. Referral options to substance abuse treatment are limited, especially in isolated rural areas.
Few and Far Away: Detoxification Services in Rural Areas (Research & Policy Brief)
Date: 12/2009
This policy brief finds that few rural detox providers exist; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve a 100-mile radius. Travel distances are a barrier to outpatient detox models. Referral options to substance abuse treatment are limited, especially in isolated rural areas.
Mental Health Services in Rural Jails (Policy Brief)
Policy Brief
Date: 09/2009
The prevalence of mental illness among prison and jail inmates has attracted increasing attention in both mental health and criminal justice circles.
Health Insurance Profile Indicates Need to Expand Coverage in Rural Areas (Policy Brief)
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.
Profile of Rural Health Insurance Coverage: A Chartbook
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.
Rural-Urban Differences in Health Care Access Vary Across Measures
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.
Private Health Insurance in Rural Areas: Challenges and Opportunities
Policy Brief
Date: 04/2009
This brief discusses the challenges of expanding private coverage in rural areas and describes policy options to address them.
Rural Coverage Gaps Decline Following Public Health Insurance Expansions
Policy Brief
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 Children Don't Receive the Mental Health Care They Need
Policy Brief
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.

2008

Rural Adults Face Parity Problems and Other Barriers to Appropriate Mental Health Care
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-Urban Differences in Work Patterns Among Adults With Depressive Symptoms
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.
Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum (Research & Policy Brief)
Policy Brief
Date: 02/2008
This research and policy brief highlights findings from a recent study examining the distribution of substance abuse treatment facilities in rural and urban counties and identifying the type and intensity of services provided.

2007

Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum
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.
State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program
Date: 10/2007
This report explores activities funded by the Medicare Rural Hospital Flexibility Program (Flex Program) to strengthen the rural healthcare infrastructure and discusses which activities were considered most successful by state Flex coordinators.
Rural Inpatient Psychiatric Units Improve Access to Community-Based Mental Health Services, but Medicare Payment Policy a Barrier
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.
Rural Families More Likely to Be Uninsured and Have Different Sources of Coverage
Date: 06/2007
This research and policy brief examines patterns of health insurance coverage within rural families and compares family-level insurance status for rural and urban families.
Substance Abuse Among Rural Youth: A Little Meth and a Lot of Booze
Date: 06/2007
This research and policy brief examines substance abuse among rural youth, with rural-urban comparisons of methamphetamine, Oxycontin, and alcohol abuse.
State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program (Policy Brief)
Policy Brief
Date: 04/2007
To understand the priorities/accomplishments of state Flex Grant Programs, the Flex Monitoring Team asked Flex coordinators to identify and discuss their states' three most successful initiatives in the last two years. Interviews were conducted with Flex coordinators and State Office of Rural Health staff in 45 states.
The Community Impact of Critical Access Hospitals
Date: 02/2007
This policy brief discusses the findings of a project to understand the community involvement and impact of critical access hospitals and the Medicare Rural Hospital Flexibility Program (Flex Program).
Exploring the Community Impact of Critical Access Hospitals
Date: 01/2007
This paper reports on a series of site visits to six diverse rural communities and critical access hospitals to assess the experiences and impact of these hospitals in responding to their community's health infrastructure needs.
Use of Critical Access Hospital Emergency Rooms by Patients With Mental Health Symptoms
Journal Article
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.

2006

Prioritizing Patient Safety Interventions in Small Rural Hospitals
Journal Article
Date: 12/2006
Determines if 26 patient safety practices recommended by an expert panel as relevant to rural hospitals would be validated in terms of rural relevance and implementability by administrators and quality managers. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
Out-of-Pocket Health Spending and the Rural Underinsured
Journal Article
Date: 11/2006
This article estimates underinsurance rates among privately insured rural residents and the characteristics associated with rural underinsurance.
Quality and Performance Improvement Grant Activities Under the Flex Program
Date: 08/2006
This paper describes quality and performance improvement activities proposed by states during the 2005 grant year under the Medicare Rural Health Flexibility Program.
Creating Program Logic Models: A Toolkit for State Flex Programs
Date: 04/2006
This is a tool for planning, managing, reporting on, and assessing Flex Program goals, activities, and accomplishments; assistance in identifying/defining measurable outcomes; information linking state-level Flex Program strategies to measurable outcomes; and a consistent program-reporting framework to share results internally and externally.
A Review of State Flex Program Plans, 2004-2005
Date: 03/2006
This paper examines the objectives and project activities proposed by states in their Medicare Rural Hospital Flexibility Program (Flex Program) grant applications for Fiscal Year 2004 to strengthen the rural healthcare infrastructure in their states. It highlights recent trends in state Flex Program planning, development, and implementation.
Emergency Medical Services (EMS) Activities Funded by the Medicare Rural Hospital Flexibility Program
Date: 02/2006
This paper describes the emergency medical services-related activities that the 45 states receiving funding from the Medicare Rural Hospital Flexibility (Flex) Program proposed to conduct in fiscal year 2004-05.
Rural Health Research in Progress in the Rural Health Research Centers Program, 10th Edition
Date: 02/2006
This book provides policy makers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy and provides a context for legislation that affects rural health services and populations.
Mental Healthcare in Rural Communities: The Once and Future Role of Primary Care
Journal Article
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.
Rural and Frontier Mental and Behavioral Health Care: Barriers, Effective Policy Strategies, Best Practices
Date: 2006
This report discusses barriers to mental and behavioral health service delivery in rural America. It includes model programs and model policy strategies for rural mental and behavioral healthcare delivery and discusses the roles that telehealth and that the State Offices of Rural Health should play in service delivery.
Rural Hospitals and Long-Term Care: the Challenges of Diversification and Integration Strategies
Date: 2006
There are many contemporary challenges experienced by older rural residents and their communities in accessing and providing services. However, the issue is not in comparing rural older adults to their urban counterparts; rather, it is that rural people have unique characteristics that must be considered when planning and providing services.
Rural Residents More Likely to Be Underinsured
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.
Smallest Rural Hospitals Treat Mental Health Emergencies
Date: 2006
This research and policy brief discusses the extent to which rural emergency rooms encounter and treat mental health patients.

2005

Out-of-Pocket Health Care Spending and the Rural Underinsured
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.
Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
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.
Scope of Services Offered by Critical Access Hospitals: Results of the 2004 National CAH Survey
Date: 03/2005
Three years of data were used to examine services offered by critical access hospitals (CAHs). The authors investigated how the services offered by CAHs have changed, the role of network affiliations in the changes, and the reasons administrators gave for reported service expansions. They also looked at how services in CAHs have changed over time.
Rural Health Research in Progress in the Rural Health Research Centers Program, 9th Edition
Date: 02/2005
This book provides policymakers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current that affects rural health services and populations.
Comparing Patient Safety in Rural Hospitals by Bed Count
Date: 2005
This report shares the results of a study to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals.
Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
Journal Article
Date: 2005
The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in 2004 to identify a set of researchable questions concerning rural healthcare.

2004

Are Advanced Practice Nurses a Solution to Rural Mental Health Workforce Shortages?
Date: 04/2004
This paper summarizes the clinical skills and prescriptive authority of advanced practice psychiatric nurses and investigates current trends in their geographic distribution to determine what their future role may be in addressing rural mental health needs.
Rural Health Research in Progress in the Rural Health Research Centers Program, 8th Edition
Date: 02/2004
This book provides policy makers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current and proposed that affects rural health services and populations.
Comparative Performance Data for Critical Access Hospitals
Journal Article
Date: 2004
Discusses the potential use of comparative performance data for critical access hospitals (CPD-CAH) to facilitate performance and quality improvement. Covers potential benefits and drawbacks of CPD-CH and identifies issues in the development and implementation of CPD-CAH.

2003

Health Insurance Coverage of The Rural and Urban Near Elderly
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.
Rural Health Research in Progress in the Rural Health Research Centers Program, 7th edition
Date: 03/2003
This book provides policy makers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current and proposed that affects rural health services and populations.
The Characteristics and Roles of Rural Health Clinics in the United States: A Chartbook
Chartbook
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

The Role of Community Mental Health Centers as Rural Safety Net Providers
Date: 05/2002
This paper investigates the extent to which those organizations formerly designated as community mental health centers currently act as a rural mental health safety net, e.g., provide mental health services for free or at reduced charges to rural populations not covered by public or private insurance or grants.
State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
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.
Diabetes and the Rural Safety Net
Date: 01/2002
This paper investigates the extent to which the rural safety net is able to meet the needs of people with diabetes.

2001

Patterns of Health Insurance Coverage Among Rural and Urban Children
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.
Addressing Mental Health Workforce Needs in Underserved Rural Areas: Accomplishments and Challenges
Date: 10/2001
This study reviews efforts to address mental health workforce needs in rural areas and addresses the questions: How is workforce adequacy measured? How do characteristics of communities and the mental health service delivery system challenge methods for determining workforce adequacy? What role has government played in addressing workforce needs?
Admission Severity and Mortality Rates Among Rural and Urban Nursing Facility Residents With Dementia (Research & Policy Brief)
Date: 09/2001
This brief assesses whether the potentially higher use of nursing facility services in rural communities can be tied to differences in use patterns by older adults with dementia. Specifically, it addresses whether residents with dementia are less impaired at the time of their admission to a nursing facility than urban residents with dementia.
Medicaid Managed Behavioral Health Programs in Rural Areas
Policy Brief
Date: 08/2001
This research and policy brief studies which states have implemented Medicaid-managed behavioral health programs in rural areas. It describes the programs in terms of Medicaid populations served, program design, and implementation model and the experience of programs regarding access to/coordination of services.
Developing Affordable Non-Medical Residential Care in Rural Communities: Barriers and Opportunities
Date: 05/2001
This study explores the challenges and opportunities for affordable non-medical residential care development in rural areas.
Admission Severity and Mortality Rates Among Rural and Urban Nursing Facility Residents With Dementia
Date: 03/2001
This study assesses whether the potentially higher utilization of nursing facility services in rural communities can be attributed to differences in use patterns by older adults with dementia. Specifically, it examines whether rural residents with dementia are less impaired when admitted to a nursing facility than their urban counterparts.
Financing and Payment Issues in Rural Long Term Care Integration (Research & Policy Brief)
Policy Brief
Date: 02/2001
This research and policy brief reviews current research and experience and identifies key policy and program considerations for integrated acute and long-term care financing in rural areas.
Medicaid Managed Behavioral Health in Rural Areas
Date: 01/2001
This study of which states have implemented Medicaid managed behavioral health (MMBH) programs in rural areas describes these programs in terms of Medicaid populations served, program design, and implementation model. It also describes the experience of programs regarding access to and coordination of services.

2000

Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment
Date: 08/2000
This paper offers a rural perspective on the debate about the design/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 various proposals may meet rural needs.
Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals
Date: 06/2000
This policy paper combines the work from current projects of the Maine Rural Health Research Center and the Rural Health Panel of the Rural Policy Research Institute to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare program.
Financing and Payment Issues in Rural Long Term Care Integration
Report
Date: 2000
This report reviews current research and experience and identifies key policy and program considerations for integrated acute and long-term care financing in rural areas.

1996

Integrating Primary Care and Mental Health Services: Current Practices in Rural Areas
Date: 1996
This publication provides information on models for integrating mental health services in rural community health centers, viability of linkages between primary care and mental health providers, resources available, reimbursement, treatment philosophy, diversification, referral, and enhancement.