Healthcare financing

Current Projects

• Changes in Access to Care During the Public Health Emergency: Examining Rural-Urban Disparities by Insurance Type
  Using the Behavioral Risk Factor Surveillance System data, this study will compare key access to care indicators among adult beneficiaries residing in rural and urban areas before and after the Public Health Emergency by types of health insurance. Researchers will explore state-level policy variations, such as the Affordable Care Act Medicaid expansion and COVID-19-related Medicaid coverage for uninsured adults.
  Research center: Rural and Underserved Health Research Center
  Topics: Health disparities and health equity, Healthcare access, Healthcare financing, Medicaid and CHIP, Uninsured and underinsured
  
• Changes in Rural Health Insurance Coverage, 2020-2023
  This project uses secondary data sources to characterize changes in health insurance coverage during the public health emergency (2020-2023) for rural and urban people according to demographic, employment, and geographic characteristics, and to describe how changes in federal policies impacted coverage. Researchers also assess the potential impact of maintaining more robust marketplace subsidies on rural and urban coverage rates once the "unwinding" of continuous Medicaid enrollment is complete.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Health reform, Healthcare financing, Medicaid and CHIP, Medicare, Medicare Advantage (MA), Private health insurance, Rural statistics and demographics, Uninsured and underinsured
  
• Comparing Utilization and Quality of Home Health Care Between Medicare Fee-for-Service and Medicare Advantage Beneficiaries by Rural-Urban Status
  This project examines differences in home health use and quality by enrollment in Medicare Fee-for-Service (FFS) versus Medicare Advantage (MA) plans. Findings will include information on rural-urban and intra-rural variation in home health care to inform policies on access, payment, and quality for Medicare FFS and MA plans.
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Allied health professionals, Health disparities and health equity, Health services, Healthcare access, Healthcare financing, Home health, Medicare, Medicare Advantage (MA), Post-acute care, Quality
  
• Did Hospitals That Converted to Rural Emergency Hospital (REH) Avoid Closure?
  The goal of the Rural Emergency Hospital (REH) is to preserve access to essential services for rural residents, and to decrease the likelihood of hospital closures; some worry that the REH offers an option for otherwise financially strong hospitals to shed services. This study will investigate whether hospitals that converted to an REH in 2023 and 2024 would have likely closed in the absence of the REH designation.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Healthcare access, Healthcare financing, Hospitals and clinics, Medicare, Rural Emergency Hospitals (REHs)
  
• Differences in Rural and Urban Hospital Cost Structures: Evidence and Implications
  The project will compare fixed-to-variable cost ratios in U.S. rural and urban hospitals. We hypothesize that rural hospitals will realize proportionally greater fixed costs than urban hospitals, suggesting important hospital payment system implications.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Health reform, Healthcare financing, Medicare
  
• Evaluating the Impact of Inflation Reduction Act Provisions on Medicare Advantage Prescription Drug Costs
  Using Merative MarketScan data, this study will evaluate changes in the affordability of prescription drugs for urban and rural Medicare beneficiaries before and after the recent Inflation Reduction Act (IRA). The primary outcome will be an assessment of whether the IRA succeeded in reducing costs and identifying any remaining health disparities.
  Research center: Rural and Underserved Health Research Center
  Topics: Health disparities and health equity, Healthcare financing, Medicare Advantage (MA), Pharmacy and prescription drugs
  
• Evaluating the Variation in Rural and Urban Hospital Wages and Wage Index Pre- and Post-COVID-19 Pandemic
  The primary purpose of the wage index is to address the differences in labor costs that hospitals experience based on their geographical location.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Healthcare financing, Hospitals and clinics, Medicare, Workforce
  
• Financial Consequences of Growth in the Number of Rural Referral Centers
  Since Centers for Medicare & Medicaid Services amended its regulations to allow hospitals in urban areas to reclassify as rural, over 400 hospitals have obtained status as a Rural Referral Center. This project will estimate the costs to hospital Medicare payment and profitability.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Healthcare financing, Hospitals and clinics, Medicare
  
• Impact of High Deductible Health Plans on Rural Populations
  Using data from Merative MarketScan insurance claims, this study will investigate utilization, spending, and care patterns of rural members enrolled in high deductible health plans (HDHP) compared to traditional plans. Trends in health outcomes before and after HDHP growth will be assessed to inform policy design tailored to rural residents.
  Research center: Rural and Underserved Health Research Center
  Topics: Health disparities and health equity, Healthcare access, Healthcare financing, Private health insurance, Rural statistics and demographics
  
• Out-of-Pocket Spending Among Privately Insured Rural and Urban Residents
  Out-of-pocket spending for healthcare services has been on the rise as deductibles and other cost-sharing requirements among the privately insured increase. This study compares rural and urban out-of-pocket healthcare spending to identify whether rural residents have been disproportionately affected by this trend.
  Research center: Maine Rural Health Research Center
  Topics: Healthcare access, Healthcare financing, Private health insurance, Public health, Uninsured and underinsured
  
• RHCs and CAHs Participating in SSP: Characteristics of the Providers and Communities
  This project describes characteristics of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the Medicare Shared Savings Program (SSP), and the communities they serve. Comparisons will be made to RHCs and CAHs not participating in the SSP.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Critical Access Hospitals (CAHs), Healthcare financing, Medicare, Rural Health Clinics (RHCs)
  
• Rural Implications of Increased Medicare Beneficiary Enrollment in ACOs and MA Plans
  This project will leverage Centers for Medicare & Medicaid Services data showing the number of Medicare beneficiaries assigned to Accountable Care Organizations, in combination with enrollment in Medicare Advantage in rural counties, to describe implications for rural health care organizations.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Health reform, Healthcare financing, Medicare, Medicare Advantage (MA)
  
• Rural-Urban Differences in Medicare Advantage Plan Quality Scores
  This project updates previous RUPRI Center publications focused on rural-urban differences in access to, and enrollment in, Medicare Advantage plans with four- and five-star quality ratings.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Health services, Healthcare financing, Medicare, Medicare Advantage (MA)
  
• Third Party Negotiated Pricing in Rural and Urban Hospitals
  We will use third party negotiated pricing information to compare prices in urban and rural hospitals, across a variety of common services. Because there has been poor compliance with the Centers for Medicare & Medicaid Services (CMS) requirement to publish third party negotiated pricing, we will also examine if the availability of this information differs for rural and urban hospitals.
  Research center: Rural and Underserved Health Research Center
  Topics: Critical Access Hospitals (CAHs), Federally Qualified Health Centers (FQHCs), Healthcare financing, Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS), Private health insurance
  
• Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder Across the U.S.
  This study describes and compares the treatment that rural and urban patients with opioid use disorder (OUD) receive, documenting the workforce providing care, distance that patients travel to receive care, and cost of care. Findings will inform policies to ensure that rural patients with OUD have access to care from local healthcare providers.
  Research center: WWAMI Rural Health Research Center
  Topics: Health services, Healthcare access, Healthcare financing, Mental and behavioral health, Nurses and nurse practitioners, Pharmacy and prescription drugs, Physician assistants, Physicians, Substance use and treatment, Telehealth
  
• Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder and Medicaid Insurance Across the U.S.
  This project will analyze Medicaid claims data to compare the treatment that rural and urban patients with opioid use disorder receive, documenting the workforce providing care, the distance that patients travel to receive care, and the cost of care. Findings from this study can be used to improve policies regarding opioid use disorder treatment.
  Research center: WWAMI Rural Health Research Center
  Topics: Health disparities and health equity, Health services, Healthcare access, Healthcare financing, Legislation and regulation, Medicaid and CHIP, Mental and behavioral health, Nurses and nurse practitioners, Pharmacy and prescription drugs, Physician assistants, Physicians, Substance use and treatment, Telehealth, Workforce
  
• Understanding Rural Health Clinic Services, Use, and Reimbursement
  This study describes the scope and intensity of services provided to Medicare beneficiaries by independent and provider-based Rural Health Clinics. It will also assess the adequacy of the Centers for Medicare & Medicaid Services' changes to the outpatient evaluation and management codes in 2021 compared to the 2021 per-visit reimbursement cap.
  Research center: Maine Rural Health Research Center
  Topics: Health services, Healthcare financing, Hospitals and clinics, Medicare, Rural Health Clinics (RHCs)