Rural Health
Research Gateway

Uninsured and underinsured

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by 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.

2023

  • Rural Working-Age Adults Report More Cost Barriers to Health Care
    Policy Brief
    Maine Rural Health Research Center
    Date: 03/2023
    Using the 2019-2020 National Health Insurance Survey, this study examined rural-urban differences in affordability of care and cost-saving strategies among working-age adults.
  • Community Sociodemographics and Rural Hospital Survival Analysis
    Policy Brief
    Center for Economic Analysis of Rural Health
    Date: 01/2023
    This study examines which community sociodemographic characteristics are associated with increased risk of rural hospital closure between 2010-2019. Results show that rural hospitals at risk of financial distress are more likely to experience closure if their communities have higher unemployment and higher uninsurance for those under 65.

2022

  • Community Sociodemographics and Rural Hospital Survival
    Journal Article
    Center for Economic Analysis of Rural Health
    Date: 12/2022
    This study examines whether community sociodemographic factors are associated with the survival or closure of rural hospitals at risk of financial distress between 2010 and 2019.
  • An Insurance Profile of Rural America: Chartbook
    Chartbook
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2022
    Over the past decade, health insurance coverage has changed in major ways in rural areas with shifts towards public and publicly subsidized coverage among the nonelderly – Medicaid, Marketplace plans – and a shift towards Medicare Advantage among those eligible for Medicare. This chartbook describes these trends in detail.
  • Higher Electronic Health Record Functionality Is Associated With Lower Operating Costs in Urban—but Not Rural—Hospitals
    Journal Article
    Center for Economic Analysis of Rural Health
    Date: 07/2022
    This study examines the relationship between electronic health record use/functionality and hospital operating costs and compares the results across rural and urban facilities.

2021

2020

2019

2018

  • Insuring Rural America: Health Insurance Challenges and Opportunities
    Policy Brief
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 07/2018
    This brief discusses a series of policy considerations in three main categories: policies related to rural insurance risk, policies related to provider networks, and policies related to rural payment rates and structures.

2017

  • Rural Health Snapshot (2017)
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 05/2017
    The Rural Health Snapshot (2017) updates the 2010 Rural Health Snapshot. The document is a data sheet that compares a selection of health and healthcare access indicators for populations in rural and urban areas.
  • Trends in Rural Children's Health and Access to Care
    Chartbook
    Rural and Minority Health Research Center
    Date: 01/2017
    The past ten years have seen positive trends in the availability of health insurance coverage for children. This project examines data from three iterations of the National Survey of Children's Health to see if rural children have benefited equally from any improvements in health insurance, healthcare use, and health status.

2015

  • Rural Adults Delay, Forego, and Strategize to Afford Their Pre-ACA Health Care
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2015
    This study provides detailed information about rural-urban differences among adults younger than age 65 in perceived affordability of health insurance coverage and services prior to implementation of the Affordable Care Act.
  • Uncompensated Care Burden May Mean Financial Vulnerability for Rural Hospitals in States That Did Not Expand Medicaid
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2015
    Explores the differences of rural hospitals in states with Medicaid expansion and those with nonexpansion, in terms of the amount of uncompensated care they provided and their profitability and market characteristics in 2013.
  • Free Clinics in the Rural Safety Net, 2014
    Policy Brief
    Rural and Minority Health Research Center
    Date: 09/2015
    This brief explores two issues. First, it examines where free clinics are located and describes their availability in rural counties across all 50 states. Second, through telephone interviews with leadership at 14 of the 21 state free clinic associations, it explores the issues they face.
  • Rural Provider Perceptions of the ACA: Case Studies in Four States
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2015
    This brief summarizes the perceptions from rural providers in four states regarding the early effects of the Affordable Care Act, including changes to patient populations, financial health, and capacity for rural hospitals and rural federally qualified health centers.

2014

  • Health Insurance Coverage of Low-Income Rural Children Increases and Is More Continuous Following CHIP Implementation
    Policy Brief
    Maine Rural Health Research Center
    Date: 03/2014
    This study found that following the Children's Health Insurance Program's (CHIP) implementation, health insurance coverage and continuity increased among low-income children, particularly for those living in rural areas. By CHIP's maturity, coverage for rural children improved so much that their uninsured rate dropped below that of urban children.
  • The Uninsured: An Analysis by Age, Income, and Geography
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2014
    This brief analyzes the rural/urban uninsured populations by age. Furthermore, we discuss the potential for age differences between rural and urban uninsured populations to drive Health Insurance Marketplace premiums upward, an effect which may be mitigated or compounded by various other factors.

2013

  • Provision of Uncompensated Care by Rural Hospitals: A Preliminary Look at Medicare Cost Report Worksheet S-10
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2013
    This brief is a preliminary assessment of uncompensated care data quality included in Medicare Cost Report Worksheet S-10 for critical access hospitals and other rural hospitals to identify data quality issue implications for research and policy decisions. Worksheet S-10 data were collected from the Healthcare Cost Reporting Information System.
  • The Uninsured: An Analysis by Income and Geography
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2013
    This brief reports that a larger proportion of the rural versus urban population is uninsured and low income and will be eligible for subsidized Health Insurance Marketplace coverage due to income levels and current lack of insurance.

2012

  • 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.

2011

2010

2009

  • A Case Study of Rural Health Care in the Economic Downturn
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2009
    This report describes the economic and healthcare environment in Ashe County, a rural community in the mountains of western North Carolina. The experience in Ashe County exemplifies the healthcare challenges faced in many rural areas across the country.
  • Characteristics of Rural & Urban Children Who Qualify for Medicaid or CHIP but Are Not Enrolled
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2009
    About three-quarters of children who qualify for Medicaid or CHIP are enrolled, with slightly higher rates in rural areas than in urban areas. This leaves one in four qualified children without insurance coverage.
  • Health Insurance Profile Indicates Need to Expand Coverage in Rural Areas (Policy Brief)
    Maine Rural Health Research Center
    Date: 07/2009
    This brief provides information on the health insurance status of rural Americans, summarized from a more detailed chartbook. Analyses are based on the 2004-05 Medical Expenditure Panel Survey.
  • Medicaid & CHIP Participation Among Rural & Urban Children
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2009
    This policy brief describes the characteristics of rural and urban children who qualify for Medicaid or CHIP but are uninsured.
  • Impact of the Recession on Rural America: Rising Unemployment Leading to More Uninsured in 2009
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2009
    This brief presents the results of state and county analysis of unemployment rates nationally in urban and rural (non-metropolitan) areas during the period 2007-February 2009 and discusses the impact of rising unemployment on uninsurance in rural areas.
  • Profile of Rural Health Insurance Coverage: A Chartbook
    Maine Rural Health Research Center
    Date: 06/2009
    Analyses of persons under age 65 from the 2004-05 Medical Expenditure Panel Survey reveal a greater proportion of rural vs. urban residents who are uninsured or covered through public sources. Uninsured rates are highest among adults over age 50 in the most remote rural places.
  • A Rural-Urban Comparison of a Building Blocks Approach to Covering the Uninsured
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2009
    This brief uses a RUPRI health insurance model to compare the effects of a building blocks approach on health insurance coverage and health spending, focusing on the geographic differences (by metropolitan and non-metropolitan) of this approach.
  • Rural Coverage Gaps Decline Following Public Health Insurance Expansions
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2009
    This brief uses the Medical Expenditure Panel Survey (MEPS) to compare the health insurance coverage of rural/urban residents in 1997 and 2005 to assess how uninsured rates and sources of coverage have changed since SCHIP was enacted. The authors also discuss characteristics of the rural uninsured and the implications for health insurance reform.

2007

2006

  • Out-of-Pocket Health Spending and the Rural Underinsured
    Journal Article
    Maine Rural Health Research Center
    Date: 11/2006
    This article estimates underinsurance rates among privately insured rural residents and the characteristics associated with rural underinsurance.
  • Rural Health Research in Progress in the Rural Health Research Centers Program, 10th Edition
    Maine Rural Health Research Center
    Date: 02/2006
    This book provides policy makers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy and provides a context for legislation that affects rural health services and populations.
  • Rural Residents More Likely to Be Underinsured
    Maine Rural Health Research Center
    Date: 2006
    Studies have shown that rural residents have high uninsured rates. However, even those with private health insurance coverage can be at risk of having high out-of-pocket healthcare costs. Understanding the degree to which rural residents are underinsured has important implications for rural health policy and practice.

2005

2004

2003

  • Health Insurance Coverage of The Rural and Urban Near Elderly
    Maine Rural Health Research Center
    Date: 10/2003
    This paper reports the results of a study that used data from the 1996-1998 Medical Expenditure Panel Survey to address two principal research questions related to health insurance coverage for the rural near elderly.
  • Rural Health Research in Progress in the Rural Health Research Centers Program, 7th edition
    Maine Rural Health Research Center
    Date: 03/2003
    This book provides policy makers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current and proposed that affects rural health services and populations.
  • Rural Minority Children
    Fact Sheet
    Rural and Minority Health Research Center
    Date: 2003
    This fact sheet provides data on rural minority children's health insurance coverage, healthcare use, poverty, and education.
  • Rural Minority Elders
    Fact Sheet
    Rural and Minority Health Research Center
    Date: 2003
    This fact sheet provides data on health status, health insurance coverage, education, and income of rural elders.
  • Rural Minority Working Age Adults
    Fact Sheet
    Rural and Minority Health Research Center
    Date: 2003
    Holding demographic considerations equal, rural residents are less likely to report having health insurance than urban residents. African Americans, Hispanics, and persons of other races are all less likely to be insured than whites. The factors placing rural minorities at risk for lacking insurance include low income and low education.

2002

  • 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.

2001

2000

1999

1998