Rural Health
Research Gateway

2000 Research Publications

Browse the full list of research publications from 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.

  • Influence of Rural Residence on the Use of Preventative Health Care Services
    University of Minnesota Rural Health Research Center
    Date: 11/2000
    This paper details a study of the utilization of specific preventive healthcare services by rural women and men to assess the impact of rural residence, the availability of healthcare providers and technology, demographic factors, and health insurance status on the likelihood of obtaining several preventive healthcare services.
  • Financial Viability of Rural Hospitals in a Post-BBA Environment
    University of Minnesota Rural Health Research Center
    Date: 10/2000
    This paper evaluates the financial viability of rural hospitals under the Balanced Budget Act of 1997 and the Balanced Budget Refinement Act of 1999 Medicare payment policies. It estimates the number of hospitals that will become critical access hospitals and the number of beds at each hospital.
  • Rural Hospital Area Wages and the PPS Wage Index: 1900-1997
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2000
    This paper examines the hospital wage index used by the Health Care Financing Administration and its effects on rural hospitals.
  • Background on the Wage-Related Portion of the Medicare DRG Payments
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2000
    This report discusses how to calculate Medicare diagnostic related group (DRG) payments. It includes examples and a diagram of how to calculate a DRG payment.
  • Redesigning the Medicare Program: An Opportunity to Improve Rural Health Care Systems?
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    With this paper, the RUPRI Rural Health Panel is presenting a well-defined framework for what should be included in any discussion of Medicare policies.
  • Health Insurance in Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    This brief focuses on the differences between the rural and urban uninsured.
  • Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    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.
  • The Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    This policy paper summarizes the positions of various rural health advocates and records the actions taken by Congress and the Health Care Financing Administration to improve the wage index. Finally, it outlines the research needed to energize the policy discussion of the uses and methods of calculating the hospital wage index.
  • Data Sources for Studying Uncompensated Care Provided by Rural Hospitals
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2000
    This policy analysis brief discusses data sources related to hospitals' provision of charity and uncompensated care.
  • Why Do Rural Primary-Care Physicians Sell Their Practices?
    University of Minnesota Rural Health Research Center
    Date: 06/2000
    This study evaluates why rural primary care physicians sell their practices. It examines the factors that led independent physicians to sell their practices to either non-local buyers, local hospitals, or local physicians.
  • A Report on Enrollment: Rural Medicare Beneficiaries in Medicare+Choice Plans
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2000
    This policy brief describes the experience to date with the Medicare+Choice program, focusing on changes in enrollment and plan formation through Fall 1999.
  • Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    Date: 06/2000
    This policy paper combines the work from current projects of the Maine Rural Health Research Center 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.
  • Calculating and Using the Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2000
    This policy brief explains how the area wage index is calculated and used and identifies the major unresolved issues related to its calculation and use.
  • Potential Supply-Side Implications of the BBA Limits on Reimbursement to Provider-Based Rural Health Clinics
    NORC Walsh Center for Rural Health Analysis
    Date: 06/2000
    This policy analysis brief examines whether provider-based (typically hospital operated) rural health clinics are likely to close due to the reimbursement cap introduced by the Balanced Budget Act of 1997.
  • U.S. Medical Schools and the Rural Family Physician Gender Gap
    Journal Article
    WWAMI Rural Health Research Center
    Date: 05/2000
    Women comprise increasing proportions of med school graduates. They tend to choose primary care but are less likely than men to choose rural practice. This study identified the U.S. medical schools most successful at producing rural family physicians and general practitioners of both genders.
  • A Rural Assessment of Leading Proposals to Redesign the Medicare Program
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2000
    This paper provides a critique of two proposals to redesign the Medicare program: the "Medicare Preservation and Improvement Act of 1999" and "The President's Plan to Modernize and Strengthen Medicare for the 21st Century." Rural implications of the proposals are discussed.
  • Rural Home Health Agencies: The Impact of the Balanced Budget Act
    Policy Brief
    NORC Walsh Center for Rural Health Analysis
    Date: 04/2000
    This policy analysis brief examines how the characteristics of rural and urban Medicare-certified home health agencies differ, estimates the impact of interim payment system on these agencies, and discusses policy implications for a Medicare home health prospective payment system.
  • Medicare Reforms: The Rural Perspective
    NORC Walsh Center for Rural Health Analysis
    Date: 04/2000
    This policy analysis brief discusses Medicare reforms considered by the National Bipartisan Commission on the Future of Medicare (created by the Balanced Budget Act of 1997), including prescription drug coverage, funding graduate medical education, and increasing the eligibility age.
  • Race and Place: Urban-Rural Differences in Health for Racial and Ethnic Minorities
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2000
    This findings brief investigates urban-rural disparities for racial and ethnic minorities in six health areas: infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV infection, and child and adult immunizations.
  • Rural and Urban Patterns of Home Health Use: Implications for Access Under the Interim Payment System
    Policy Brief
    NORC Walsh Center for Rural Health Analysis
    Date: 03/2000
    This policy analysis brief compares patterns of home health utilization among rural and urban Medicare beneficiaries in order to estimate the potential impact of an interim payment system on access to home care in rural areas of the country.
  • At-Risk Hospitals: The Role of CAH Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2000
    This report examines not-for-profit hospitals that potentially qualify as critical access hospitals and identifies facilities at risk as a result of Medicare's prospective payment systems to non-acute care settings.
  • The Effect of the Doctor-Patient Relationship on Emergency Department Use Among the Elderly
    Journal Article
    WWAMI Rural Health Research Center
    Date: 01/2000
    OBJECTIVES: This study sought to determine the rate of emergency department use among the elderly and examined whether that use is reduced if the patient has a principal-care physician.
    METHODS: The Health Care Financing Administration's National Claims History File was used to study emergency department use by Medicare patients older than 65 years in Washington State during 1994. RESULTS: A total of 18.1% of patients had 1 or more emergency department visits during the study year; the rate increased with age and illness severity. Patients with principal-care physicians were much less likely to use the emergency department for every category of disease severity. After case mix, Medicaid eligibility, and rural/urban residence were controlled for, the odds ratio for having any emergency department visit was 0.47 for patients with a generalist principal-care physician and 0.58 for patients with a specialist principal-care physician.
    CONCLUSIONS: The rate of emergency department use among the elderly is substantial, and most visits are for serious medical problems. The presence of a continuous relationship with a physician--regardless of specialty--may reduce emergency department use.
  • Strategic Choices of Rural Health Networks: Implications for Goals and Performance Measurement
    University of Minnesota Rural Health Research Center
    Date: 01/2000
    The purpose of this study is to obtain a greater understanding of rural health networks by classifying them according to their functions and purposes. Examples of performance measures that might be used for the different network types are given.
  • Role of CAH Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2000
    This findings brief examines rural hospitals that potentially qualify as critical access hospitals and identifies facilities at substantial financial risk as a result of Medicare's expansion of prospective payment systems to non-acute settings.
  • Effect of Market Reform on Rural Public Health Departments
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2000
    This study seeks to determine how rural health departments and the populations they serve have been affected by recent health system changes, especially Medicaid managed care.
  • Emergency Department Use by the Rural Elderly
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2000
    This study uses Medicare data to compare emergency department (ED) use by rural and urban elderly beneficiaries. Given the similarity of diagnostic conditions associated with ED visits, rural EDs must be capable of dealing with the same range of emergency conditions as urban EDs.
  • The Distribution of Rural Female Generalist Physicians in the United States
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2000
    Female physicians are underrepresented in rural areas. What impact might the increasing proportion of women in medicine have on the rural physician shortage? To begin addressing this question, we present data describing the geographic distribution of female physicians in the United States.
  • Educating Generalist Physicians for Rural Practice: How Are We Doing?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2000
    About 20 percent of Americans live in rural areas, 9 percent of physicians practice there. Physicians consistently settle in metropolitan, suburban, and other nonrural areas. This report summarizes the successes/failures of medical education and government initiatives intended to prepare and place more generalist physicians in rural practice.
  • Financing and Payment Issues in Rural Long Term Care Integration
    Report
    Maine Rural Health Research Center
    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.