Problem: As an increasing number of states and the Congress consider options for covering the uninsured, it is critically important that policymakers consider the rural nature and circumstances surrounding this problem. However, research into the consequences of this lack of coverage on access to care for rural residents has been limited.

Methods: Using the Medical Expenditure Panel Survey (MEPS) data, this study will examine the healthcare utilization patterns among uninsured rural and urban residents, compared to each other as well as to their insured counterparts.

The specific questions we wish to address are:

• What is the level of self-reported access to care (e.g. usual source of care, delay of care, and concerns about access) among the rural uninsured and does it differ from insured residents in rural and urban areas?
• How does healthcare use (including office-based care, preventive care, prescription drug use and emergency care) differ for rural insured versus uninsured residents? Are there differences in the site of care (e.g. office-based care, emergency room) for rural insured versus uninsured residents?
• Among the uninsured, is there a rural-urban difference in healthcare use? If so, how does this differ from patterns of rural versus urban use among the insured?
• To what extent and how are patterns of use among the rural uninsured different among subpopulations with diabetes, asthma, or heart disease?

By identifying whether or not uninsured rural residents have different levels of access to care than their urban counterparts, and the potential source of these differences, we will provide critical information to policymakers committed to rural healthcare issues.

Products: Anticipated products include a Working Paper and associated Research and Policy Brief along with submission to a peer-reviewed journal. Additionally, abstracts will be submitted for presentation at the annual meetings of the National Rural Health Association and AcademyHealth.

Publications

• Health Care Access and Use Among the Rural Uninsured
  Journal Article
  Maine Rural Health Research Center
  Date: 08/2012
  Examines whether uninsured rural residents have different patterns of healthcare use than their urban counterparts, and the factors associated with any differences.
• Health Care Access and Use Among the Rural Uninsured (Research & Policy Brief)
  Policy Brief
  Maine Rural Health Research Center
  Date: 11/2011
  Using data from the 2002-2007 Medical Expenditure Panel Survey, this study examined access to care and service use among non-elderly, uninsured rural and urban residents.