Category: Rural Health Research Gateway

Rural Health Research: Rural-Urban Differences in Homebound Status by Health and Functional Limitations

January 14, 2026

Rural Health Research: Rural-Urban Differences in Homebound Status by Health and Functional Limitations

Without access to adequate institutional or home and community-based care, older adults may become homebound, a state that is associated with poorer health outcomes, higher rates of hospitalization and emergency department use, and greater risk of social isolation, functional decline, and mortality. Yet, little is known about how rates of being homebound differ between rural and urban older adults by specific health indicators. This brief from the University of Minnesota Rural Health Research Center addresses that gap.

Key Findings:

  • Rural and urban Medicare beneficiaries age 65 and older reported similar rates of being homebound (5.7% and 6.1%).
  • Rural older adults in very good health (on a scale from poor to excellent) were less likely than their urban counterparts to be homebound (0.4% vs. 2.1%). However, rural older adults in poor health were more likely to be homebound than urban older adults in poor health, although the difference was not statistically significant (35.7% vs 27.1%).
  • Among both rural and urban older adults, the highest rates of being homebound were among people with diagnoses of dementia (26.6% and 26.2%, respectively) and stroke (24.0% and 13.3%).

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Rural Health Research: Transportation for Rural People with Disabilities: Example Programs from Minnesota and Idaho

January 14, 2026

Rural Health Research: Transportation for Rural People with Disabilities: Example Programs from Minnesota and Idaho

Transportation is a well-documented social driver of health with particularly unique features and challenges in rural communities. Beyond being an important driver of health for rural residents generally, transportation at the intersection of rurality and disability is especially vital.

This case series from the University of Minnesota Rural Health Research Center examines how two rural organizations in Minnesota Rural Health Research Center examines how tow rural organizations in Minnesota and Idaho provide transportation services to individuals with disabilities in their areas.

Key Findings:

  • The United Community Action Partnership in Marshall, Minnesota provides accessible transportation through public transportation and volunteer driver services, as well as mobility management services to help individuals with disabilities coordinate transportation.
  • Mountain Rides in Ketchum, Idaho provides accessible transportation to rural residents through their Americans with Disabilities Act services as well as their Community Health Transit Program, which provides accessible transportation to medical appointments in neighboring cities for individuals with disabilities.

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Research Alert: Availability of Hospital-Based Obstetric Services in the United States by County, 2010-2023: A State-by-State Report

January 9, 2026

Research Alert: Availability of Hospital-Based Obstetric Services in the United States by County, 2010-2023: A State-by-State Report

Between 2010 and 2023, there have been continued declines in access to hospital-based obstetric services in both rural and urban U.S. communities. During this time, 269of the 3,144 counties (8.6%) in the U.S. lost all hospital based obstetric services; 26 of the counties that lost these services (21 of which were rural) experienced a recent loss, between 2022 and 2023. These losses have resulted in 60% of rural counties and 38% of urban counties not having any hospital-based obstetric services by 2023. Access to obstetric care is especially limited in less populated rural counties. Among rural noncore counties (counties without a town population >10,000), 148 counties (11%) lost all hospital based obstetric services between 2010 and 2023(15 of these losses occurred recently, between 2022 and 2023), resulting in only 24% of rural noncore counties having any hospital-based obstetric services by 2023.

Additionally, there is variation across states in county-level hospital based obstetric services availability. Between 2010 and 2023, there were nine states where more than ten counties lost all hospital-based obstetric services. In Iowa, 20 counties lost all hospital-based obstetric services during this time. In the most recent year of data available (between 2022 and 2023), obstetric service losses at the county level were concentrated in California, Idaho, Indiana, Minnesota, and Nebraska, which lost services in tow counties each. Illinois and Kansas lost services in three counties (all of which were rural), and Ohio experience recent losses in four counties (two of which were rural). Only one state (North Dakota) recently gained hospital-based obstetric services in 2023 in a county without those services in 2022. This gain was in a rural noncore county.

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Rural Health Research Alert: Rural-Urban Differences in Barriers to Care and Utilization of Preventive Care Among Traditional Medicare and Medicare Advantage Beneficiaries

December 11, 2025

Rural Health Research Alert: Rural-Urban Differences in Barriers to Care and Utilization of Preventive Care Among Traditional Medicare and Medicare Advantage Beneficiaries

This policy brief examined rural and urban differences in barriers to care and use of preventive care services among enrollees in traditional Medicare and Medicare Advantage. Medicare Current Beneficiary Survey data was used to examine barriers to care, such as flu shots and cholesterol tests, comparing rural and urban Medicare Advantage enrollees, rural and urban traditional Medicare enrollees, and rural traditional and Medicare Advantage enrollees.

Key Findings:

  • Rural Medicare Advantage enrollees faced more barriers in accessing health services due to cost, compared to their urban counterparts and to all traditional Medicare enrollees, urban and rural.
  • A lower proportion of rural enrollees in both traditional Medicare and Medicare Advantage received a flu shot compared to their urban counterparts.
  • Female traditional Medicare enrollees living in rural areas were the least likely to utilize health care services compared to both their urban counterparts and Medicare Advantage enrollees.

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Rural Health Research Alert: Availability of Higher-Level Neonatal Care Services in Rural U.S. Counties, 2010-2022

December 11, 2025

Rural Health Research Alert: Availability of Higher-Level Neonatal Care Services in Rural U.S. Counties, 2010-2022

Infant mortality is elevated in rural, compared with urban, communities. Neonatal health care includes basic well-infant/level 1 services, available at health care facilities that offer childbirth services, as well as higher-level care (neonatal intermediate and intensive care services, at level II or higher).

Access to higher-level neonatal care can be lifesaving for infants with high acuity clinical needs, and access to childbirth-related care has been declining in rural communities.

The purpose of this policy brief is to show the changes in the availability of higher-level neonatal care in rural United States (U.S.) counties from 2010 to 2022, and how this availability differs by rural county type (micropolitan vs. noncore).

Key Findings:

  • Researchers examined availability of higher-level neonatal care (intermediate level II or intensive level III or IV care) at short-term acute care hospitals in rural counties of the U.S., including all hospitals not involved in mergers between 2010 and 2022.
  • In the U.S., availability of any higher-level neonatal care declined from 2010-2022 in rural counties. Overall, 7.5% of rural counties (147/1958) had higher-level neonatal care in 2010, and 6.9% of rural counties (136/1958) had this care in 2022. In 2022, 93.1% of rural counties (1822/1958) had no higher-level neonatal care.
  • Among rural counties, researchers distinguished between noncore and micropolitan counties. Among noncore counties, the percentage with higher-level neonatal care declined from 2.1% (27/1300) in 2010 to 1.2% (16/1300) in 2022. In 2010, 18.2% of micropolitan counties (120/658) had higher-level neonatal care, remaining similar in 2022 (18.2%; 120/658).
  • Only about 1% of noncore rural counties had higher-level neonatal care availability in 2022; 20 of the 27 noncore counties that had higher-level neonatal care in 2010 lost this service by 2022.

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Rural Health Research: Rural-Urban Comparisons of Nursing Staff Turnover Among Skilled Nursing Facilities

September 26, 2025

Rural Health Research: Rural-Urban Comparisons of Nursing Staff Turnover Among Skilled Nursing Facilities

This study from the University of South Carolina Rural Health Research Center assessed facility-level turnover rates for nursing and registered nurse (RN) personnel across levels of rurality and by region.

A total of 14,986 facilities were included in the August 2023 data released by the Centers for Medicare & Medicaid Services. Of those facilities, 72.3% were in urban areas.

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Rural Health Research: Health Insurance Coverage in Rural and Urban Areas in the U.S., 2023

September 26, 2025

Rural Health Research: Health Insurance Coverage in Rural and Urban Areas in the U.S., 2023

This brief from the RUPRI Center for Rural Health Policy Analysis outlines the health insurance status of people in the U.S., by residence (rural and urban) in 2023, with additional breakdowns by age groups.

The analysis is based on data from the 2024 American Community Survey (ACS), released September 2024 by the U.S. Census Bureau, providing a snapshot of coverage for a point-in-time with national data.

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Research Alert: Comparing Utilization of Home Health Care Between Traditional Medicare and Medicare Advantage by Rural-Urban Status

September 12, 2025

Research Alert: Comparing Utilization of Home Health Care Between Traditional Medicare and Medicare Advantage by Rural-Urban Status

This report describes differences in utilization of home health care between beneficiaries enrolled in Traditional Medicare (TM) and Medicare Advantage (MA), a publicly-funded, privately managed option for Medicare beneficiaries, and by rural-urban status. Researchers examined differences in use of home health overall, provision of specific services during home health, and receipt of care from high-quality home health agencies by enrollment in TM and MA, including plan type (e.g., preferred provider organization, health maintenance organization), and by rural-urban status, including intra-rural variation.

Key Findings:

  • Beneficiaries enrolled in MA who are also living in rural communities may be underutilizing home health.
    • Compared to beneficiaries enrolled in MA, regardless of type of MA plan.
    • Utilization of home health was also significantly lower among beneficiaries living in rural versus urban communities, with progressively decreasing likelihood of home health utilization as rurality increased.
  • Beneficiaries enrolled in MA were also significantly less likely to receive care form a high-quality home health agency compared to beneficiaries enrolled in TM, regardless of MA plan type, but there was no association between receiving care from a high-quality home health agency and rural-urban status.
  • Utilization of specific services during home health varied based on enrollment in MA versus TM and rural-urban status.
    • In general, utilization of specific services was significantly lower for beneficiaries enrolled in MA compared to TM, but this pattern was not consistent for all services across all types of MA plans.
    • Beneficiaries living in rural communities generally had significantly lower utilization of physical therapy, occupational therapy, speech-language pathology, and medical social work services, but significantly higher utilization of home health aide services.

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Rural Health Research: Interstate Occupational Licensure Arrangements to Expand Access to Behavioral Health Services

July 25, 2025

Rural Health Research: Interstate Occupational Licensure Arrangements to Expand Access to Behavioral Health Services

This policy brief from the WWAMI Rural Health Research Center describes state-based provisions to expand behavioral health services through interstate licensure arrangements for:

  • Psychologists,
  • Social workers,
  • Licensed professional counselors,
  • Marriage and family therapists, and
  • School psychologists

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The Impact of High Hospital Fixed-Cost Ratios on Rural Populations

July 15, 2025

The Impact of High Hospital Fixed-Cost Ratios on Rural Populations

This brief from the RUPRI Center for Rural Health Policy Analysis describes the regional variation in Critical Access Hospital (CAH) and Low-Volume Hospital (LVH) status with respect to average fixed-to-total-cost ratios, finding that CAHs tend to have the highest ratios, followed by LVHs. However, the average ratio for each status differs regionally across the United States.

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