Health reform

Completed Projects

Listed by project completion date. You can also view these projects alphabetically.

2024

• How Does Participation in Medicare Accountable Care Organizations Affect Rural Hospital Financial Outcomes?
  This project examined the impact of Medicare Accountable Care Organizations' (ACOs') participation on rural hospitals' financial outcomes. Findings from this project provided policy-relevant information on how ACO participation affects rural hospitals' financial bottom lines, contributing to further program design.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Care management, Health reform, Health services, Hospitals and clinics, Medicare
  
• Rural Premiums, Issuer Participation, and Enrollment in Health Insurance Marketplaces: An Updated Analysis
  The project described variations in Health Insurance Marketplace plan design and availability, total and net-of-subsidy premium trends, and enrollment over time between rural and urban areas and identified associations between these factors and several key policy differences and changes, controlling for economic and demographic variation.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Health disparities and health equity, Health reform, Healthcare access, Private health insurance, Rural statistics and demographics, Uninsured and underinsured
  

2023

• Financial Risk Assumption Among Rural Healthcare Providers
  This project assessed rural/urban providers' participation in different payment models and assumption of financial risk in the Medicare Quality Payment Program. We conducted qualitative interviews to examine rural providers' motivations and preparedness for participating in different risk-bearing payment models.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Health reform, Healthcare financing, Rural Health Clinics (RHCs)
  
• Rural Health Access: Affordability and Barriers to Care
  Rural-urban comparisons of healthcare access and affordability predate many policy reform efforts aimed at increasing access and decreasing costs—ongoing concerns of rural families. This study used national health survey data to examine rural-urban differences in access to medical care, access to insurance, and affordability of care.
  Research center: Maine Rural Health Research Center
  Topics: Health disparities and health equity, Health reform, Health services, Healthcare access, Healthcare financing, Private health insurance, Public health, Social determinants of health
  

2022

• Rural Hospital Closure and Effect on Local Economies
  Several research projects have analyzed the health effects of rural hospital closures. However, highly cited evidence on the economic effects of rural hospital closures is more than a decade old. The purpose of this study was to quantify the economic impact rural hospital closures have on communities.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health disparities and health equity, Health reform, Healthcare access, Healthcare financing, Hospitals and clinics, Medicare
  

2021

• Comparison of Rural Hospital Closures and the Communities Served, 1990-2020
  This project examined rural hospital closures during three decades to profile community characteristics, health status, health care services, and resources available in communities where rural hospitals have closed.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health disparities and health equity, Health reform, Healthcare access, Healthcare financing, Hospitals and clinics, Medicare
  
• Current and Longer Term Challenges of Rural Hospitals: A Survey of Rural Hospital Executives
  This project involved surveying rural hospital executives about how they will respond to current and long-term challenges related to financial and regulatory burdens.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health reform, Healthcare financing, Hospitals and clinics, Medicare
  
• Estimating the Number of Hospitals that Might Convert to Rural Emergency Hospitals
  This project reviewed the literature to establish what is known about freestanding emergency centers (FECs) and implications for a rural community. The number and types of rural hospitals that would be eligible to convert to an FEC as an alternative to closure of acute inpatient care was estimated.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health reform, Healthcare access, Healthcare financing, Hospitals and clinics, Medicare
  
• Rural and Urban Sources of Insurance Coverage: the Role of Public and Private Coverage over Time
  We estimated the percent of rural residents obtaining insurance coverage under each of the major options available to them using multiple data sets and a methodology that accounts for multiple sources of coverage. We compared rural and urban coverage sources and changes in coverage over time.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Health reform, Healthcare financing, Uninsured and underinsured
  

2020

• What Factors Influence Rural Hospitals' Participation in Accountable Care Organizations?
  This project examined rural hospitals' participation in Accountable Care Organizations (ACOs), identified factors that influenced ACO participation, compared whether different factors influenced rural/urban hospital participation in ACOs, and analyzed factors influencing Critical Access Hospitals' participation in the Medicare Shared Savings Program.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Health reform, Healthcare financing, Medicare
  

2017

• Knowledge of Health Insurance Concepts and the Affordable Care Act Among Rural Residents
  Using the Health Reform Monitoring Survey (HRMS), this project will produce two briefs examining rural-urban comparisons in insurance status, open enrollment knowledge and perceptions, and perceived affordability of coverage available through the Health Insurance Marketplaces.
  Research center: Maine Rural Health Research Center
  Topics: Health reform, Private health insurance, Rural statistics and demographics
  

2016

• How Have Changes in Insurance Coverage Under Health Reform Affected Uncompensated Care and Financial Performance in Rural Hospitals?
  This two-year project will explore the effects of changes in insurance coverage under health reform on the following outcomes in rural hospitals: (1) bad debt; (2) charity care; (3) payer mix (Medicare, Medicaid, other); (3) financial performance; and (4) hospital revenue cycle management. Results will inform federal and state agencies, rural providers and communities as to how implementation of the Patient Protection and Affordable Care Act is impacting reimbursement and financial performance of rural hospitals, allowing the Office of Rural Health Policy to identify emerging challenges and develop strategies or policy changes needed to deal with any unintended consequences.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health reform, Hospitals and clinics, Private health insurance, Uninsured and underinsured
  
• How Have Changes in Insurance Coverage Under Health Reform Affected Uncompensated Care and Financial Performance in Rural Hospitals? (Year 2)
  The second year of this two-year project will explore the effects of changes in insurance coverage under health reform on the following outcomes in rural hospitals: (1) bad debt; (2) charity care; (3) payer mix (Medicare, Medicaid, other); and (4) financial performance.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health reform, Healthcare financing, Medicaid and CHIP, Medicare, Private health insurance, Uninsured and underinsured
  

2014

• Will Health Insurance Marketplaces Deliver Affordable Options in Rural America
  This project analyzes early Health Insurance Marketplaces plan and premium data by geographic region, controlling for state policy decisions, to assess the degree to which affordable health insurance will be available through individual and/or small business marketplaces.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Health reform, Private health insurance
  

2012

• How Would Health Insurance Exchanges Work in Rural America?
  The passage of the Patient Protection and Affordable Care Act (PPACA) of 2010 has created the potential for states to create Health Insurance Exchanges (HIEs). This project will assess the potential of these plans to meet the needs of rural residents. Empirical work will establish baseline measures of choices available to rural residents and literature reviews will yield prospective analysis of how exchanges could operate to benefit rural residents.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Health reform, Private health insurance
  

2009

• Expanding Rural Health Insurance Coverage: How Do Insurance Reform Strategies Stack Up?
  This purpose of this study is to inform policymakers about the current state of health insurance coverage in rural America, and to assess how specific reform strategies may differentially affect rural residents. Using a combination of analytic strategies, we will provide policymakers and rural health advocates with the necessary tools to develop reform strategies that meet the needs of rural residents.
  Research centers: Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
  Topics: Health reform, Private health insurance, Uninsured and underinsured