2002 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.

Hypertension, Diabetes, Cholesterol, Weight, and Weight Control Activities Among Non-Metro Minority Adults
Rural and Minority Health Research Center
Date: 12/2002
This report uses data from the 1998 National Health Interview Survey to examine the prevalence of selected problems among rural populations, with an emphasis on rural minorities.
Rural Dimensions of Medicare Reimbursement for Inpatient and Outpatient Institutional and Physician Services
NORC Walsh Center for Rural Health Analysis
Date: 12/2002
This report examines major Medicare payment policies from the rural perspective and summarizes major payment policies with explicit rural dimensions that directly affect physicians and hospitals. It looks at whether direct rural impacts are consistent with legislative and regulatory intentions.
Access to Care Among Rural Minorities: Children (Appendix - Methods, Data Sources, and Detailed Tables)
Rural and Minority Health Research Center
Date: 11/2002
This is the appendix of a report on rural minority children and the factors affecting their health insurance coverage and health services use.
Access to Care Among Rural Minorities: Children
Rural and Minority Health Research Center
Date: 11/2002
This report profiles the characteristics of non-metro children, their health insurance coverage, and their healthcare visits.
Accounting for Graduate Medical Education Funding in Family Practice Training
Journal Article
WWAMI Rural Health Research Center
Date: 10/2002
Medicare provides the majority of funding to support graduate medical education (GME). Following the flow of these funds from hospitals to training programs is an important step in accounting for GME funding.
Access to Care Among Rural Minorities: Older Adults
Rural and Minority Health Research Center
Date: 10/2002
This report profiles the health status of, and use of physicians by, non-metro older adults.
Access to Care Among Rural Minorities: Older Adults (Appendix - Methods, Data, and Detailed Tables)
Rural and Minority Health Research Center
Date: 10/2002
This is the appendix of a report on health status and health services use among poor and minority older adults in non-metro areas.
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.
Changing Rural Populations and Impact on Public Policy
RUPRI Center for Rural Health Policy Analysis
Date: 10/2002
This document is from a presentation on population movement in rural areas and health policy issues.
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.
Demand for Medical Services Among Previously Uninsured Children: The Roles of Race and Rurality (Report)
Rural and Minority Health Research Center
Date: 10/2002
This report examined the use of medical services over nearly two years among newly insured and continuously insured children, ages 6 through 12, in the CHIP and Medicaid programs in West Virginia and South Carolina.
Family Medicine Training in Rural Areas
Journal Article
WWAMI Rural Health Research Center
Date: 09/2002

Letter to the Editor: The discipline of family medicine was created in the 1970s, in part, as a way to address the chronic shortage of US rural physicians. It was predicted that the new discipline would augment the supply of rural clinicians because family physicians are much more likely than other physicians to settle in rural areas.

There is also empirical evidence that training family physicians in rural areas increases the likelihood that residency graduates will choose to settle in rural places. However, the exact proportion of family medicine residency programs located in truly rural parts of the United States remains unknown, as does the extent to which training rural physicians is a priority of existing family medicine residency programs.
Perinatal and Infant Health Among Rural and Urban American Indians/Alaska Natives
Journal Article
WWAMI Rural Health Research Center
Date: 09/2002
Provides a national profile of rural and urban American Indian/Alaska Native (AI/AN) maternal and infant health.
Rural Populations and Health Care Providers: A Map Book
North Carolina Rural Health Research and Policy Analysis Center
Date: 09/2002
This book uses 2000 Census data to reassess and provide a picture of where rural people live, how the racial and ethnic nature of rural populations are changing, and whether the distribution of healthcare providers matches the population distribution.
Arguing for Rural Health in Medicare: A Progressive Rhetoric for Rural America
North Carolina Rural Health Research and Policy Analysis Center
Date: 09/2002
This paper examines how rural health policy is treated in the broader field of public policy, discusses the role of advocacy in developing rural health policy, and suggests ways to make advocacy more effective.
Achieving Equity in Medicare Disproportionate Share Payments to Rural Hospitals: An Assessment of the Financial Impact of Recent and Proposed Changes to the Disproportionate Share Hospital Payment Formula
Journal Article
NORC Walsh Center for Rural Health Analysis
Date: 09/2002
Examines how Benefits Improvement and Protection Act revisions to the Medicare disproportionate share hospital (DSH) program are likely to affect rural hospital financial performance. The study shows that paying rural hospitals based on the rules used for urban hospitals could improve access to care in rural communities.
Use of the Hospice Benefit by Rural Medicare Beneficiaries
University of Minnesota Rural Health Research Center
Date: 08/2002
This publication identifies urban-rural differences in hospice use in rural service areas.
Tracking Medicaid Managed Care in Rural Communities: A Fifty-State Follow-Up
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 08/2002
This article updates a 1997 study examining implementation of rural Medicaid-managed care programs.
Update on Medicare+ Choice: Rural Medicare Beneficiaries Enrolled in Medicare+ Choice Plans Through September 2001
RUPRI Center for Rural Health Policy Analysis
Date: 08/2002
This rural policy brief provides an update on Medicare+ Choice Plans, counties enrolled, and data available.
Implementing Quality Assessment and Performance Improvement Systems in Rural Health Clinics: Clinic and State Agency Responses
University of Minnesota Rural Health Research Center
Date: 08/2002
This paper assesses the potential of a diverse set of rural health clinics (RHCs) to comply with the quality assessment and performance improvement program (QAPI) requirements and the capacity of state agencies to provide RHCs with technical assistance in their QAPI implementation.
Rural-Urban Differences in the Public Health Workforce: Findings From Local Health Departments in Three Rural Western States
Journal Article
WWAMI Rural Health Research Center
Date: 07/2002

Most local health departments or districts are small and rural; two thirds of the nation's 2832 local health departments serve populations smaller than 50,000 people. Rural local health departments have small staffs and slender budgets, yet they are expected to provide a wide array of services during a period when the healthcare system of which they are a part is undergoing change.

This study provided quantitative, population-based data on the supply and composition of the rural public health workforce in 3 extremely rural states: Alaska, Montana, and Wyoming. The study focused on the relative supply of personnel in the principal public health occupational categories, differences across states in staffing levels, and difficulties experienced in recruiting and retaining personnel.
Federal Funding for Emergency Medical Services
NORC Walsh Center for Rural Health Analysis
Date: 07/2002
This report includes recent trend data from 1994 to the present on aggregate federal spending on emergency medical services (EMS) and funding targeted explicitly to rural areas. It also discusses the role various federal agencies have played and traces the history of federal legislation to support EMS programs.
Rural Hospital Access to Capital: Issues and Recommendations
University of Minnesota Rural Health Research Center
Date: 07/2002
This paper identifies programs that have assisted/could assist rural hospitals in meeting capital needs; assesses whether rural hospital borrowers have difficulty in meeting capital needs under existing grant, loan, and mortgage insurance programs; and discusses potential options for improving access to capital for rural hospitals.
Understanding Rural Hospital Bypass Behavior
University of Minnesota Rural Health Research Center
Date: 06/2002
This study provides a descriptive analysis of rural hospital bypass behavior. It focuses on the extent to which patients admitted from rural areas are bypassing local facilities and whether there are changes in bypass patterns over time.
Financial Incentives for Rural Hospitals to Expand the Scope of Their Services
University of Minnesota Rural Health Research Center
Date: 06/2002
This paper examines the financial incentives that rural hospitals have to conduct surgery and treat more complex medical conditions. The objective is to evaluate whether rural hospitals that offer broader services are more profitable than hospitals with limited inpatient services.
Are Fundamental Changes to Medicare's Disproportionate Share Methodology Needed?
NORC Walsh Center for Rural Health Analysis
Date: 06/2002
This study examines whether the Medicare disproportionate share percentage is a useful predictor of Medicare costs per adjusted discharge and whether it is a good predictor of uncompensated care burdens.
State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
Maine Rural Health Research Center
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.
Rural Research Focus: Rural Physician Shortages
WWAMI Rural Health Research Center
Date: 05/2002
This paper discusses a model for understanding how many physicians a rural community can support, based on research at the WWAMI Rural Health Research Center.
The Role of Community Mental Health Centers as Rural Safety Net Providers
Maine Rural Health Research Center
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.
Impacts of Multiple Race Reporting on Rural Health Policy and Data Analysis
North Carolina Rural Health Research and Policy Analysis Center
Date: 05/2002
The paper examines some of the impacts to rural health analysis of new federal policy that allows people to choose one or more race categories when classifying themselves.
Capital Needs of Small Rural Hospitals
NORC Walsh Center for Rural Health Analysis
Date: 05/2002
This report examines the capital situation of rural hospitals with fewer than 50 beds to determine the total cost of bringing each facility into compliance with current laws, as well as the facilities' cost of borrowing and ability to borrow.
Variance in the Profitability of Small-Town Rural Hospitals (Policy Brief)
NORC Walsh Center for Rural Health Analysis
Date: 04/2002
This policy brief discusses why some rural small-town hospitals are financially successful and others struggle with persistent financial difficulties.
The Immediate and Future Role of the J-1 Visa Waiver Program for Physicians: The Consequences of Change for Rural Health Care Service Delivery
RUPRI Center for Rural Health Policy Analysis
Date: 04/2002
This paper examines the consequences for the delivery of healthcare services in rural underserved areas if current policies governing the granting of J-1 visa waivers are changed and increases or decreases the numbers of physicians affected.
How State Rural Health Directors Obtain Policy-Relevant Research Information
NORC Walsh Center for Rural Health Analysis
Date: 03/2002
This policy brief summarizes how information pertinent to rural health policy activities of the state offices is obtained.
Family Medicine Residency Training in Rural Areas: How Much Is Taking Place, and Is It Enough to Prepare a Future Generation of Rural Family Physicians?
WWAMI Rural Health Research Center
Date: 03/2002
This paper examines how much rural family practice training is taking place in the United States. The report concludes that to the extent that there is a link between the place of training and future practice, the lack of rural training contributes to the shortage of rural physicians.
Essential Research Issues in Rural Health: The State Rural Health Directors' Perspective
NORC Walsh Center for Rural Health Analysis
Date: 03/2002
This policy brief describes the key issues confronting state rural health directors. Issues repeatedly raised by directors from a wide variety of states included workforce, telemedicine, emergency medical services, mental health, and lack of local data.
Inequitable Access: Medicare+ Choice Program Fails to Serve Rural America
RUPRI Center for Rural Health Policy Analysis
Date: 02/2002
This brief discusses the Medicare+ Choice plan and how it has failed to meet the health issues of Americans.
Variance in the Profitability of Small-Town Rural Hospitals (Full Report)
NORC Walsh Center for Rural Health Analysis
Date: 02/2002
This report documents the variance in profitability among small-town rural hospitals and evaluates the characteristics that distinguish highly profitable small-town hospitals from struggling ones. It also reports on strategies that small-town hospital administrators are using to achieve financial success.
Access to Emergency Medical Services in Rural Areas: The Supporting Role of State EMS Agencies
University of Minnesota Rural Health Research Center
Date: 02/2002
This paper reports on a survey of state emergency medical services (EMS) directors about access to rural EMS; programs/initiatives by state EMS agencies to target rural/volunteer EMS providers; integration initiatives by rural EMS providers; issues in medical direction for rural EMS; and anticipated effects of the new Medicare fee schedule.
Minorities in Rural America: An Overview of Population Characteristics
Rural and Minority Health Research Center
Date: 01/2002
This report presents an overview of demographic and economic statistics pertaining to rural minority populations.
Diabetes and the Rural Safety Net
Maine Rural Health Research Center
Date: 01/2002
This paper investigates the extent to which the rural safety net is able to meet the needs of people with diabetes.
Comments on Regulatory and Contractor Reform Legislation
RUPRI Center for Rural Health Policy Analysis
Date: 01/2002
This rural policy brief informs policy and reports on the rural issue of contractor reform following the passage of the Medicare Regulatory and Contracting Reform Act of 2001. The findings consist of responses from interviews with a range of healthcare professionals and experts.
Minorities in Rural America: Appendix C Economic Patterns in Non-Metro America
Rural and Minority Health Research Center
Date: 2002
This appendix to a report on an overview of demographic and economic statistics pertaining to rural minority populations focuses on economic status and health services infrastructure.
Minorities in Rural America: Appendix B Map Supplement
Rural and Minority Health Research Center
Date: 2002
This appendix to a report on an overview of demographic and economic statistics pertaining to rural minority populations includes maps.
Minorities in Rural America: Appendix A Description of Method and Supporting Tables Tables Ordered by Chapter
Rural and Minority Health Research Center
Date: 2002
This is the appendix of a report that gives an overview of demographic and economic statistics pertaining to rural minority populations.