Category: Rural Health Research Gateway

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.

Click Here to Read Full Brief

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.

Click Here to Read Full Brief

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.

Click Here to Read More

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.

Click Here to Read More

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.

Click Here to Read Full Research Article

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

Click Here to Read Brief

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.

Click Here to Read More

Geographic and Demographic Correlates of Living in Manufactured Homes: Implications for Health

July 15, 2025

Geographic and Demographic Correlates of Living in Manufactured Homes: Implications for Health

Manufactured homes (formerly known as mobile homes) can provide an affordable housing option, especially in places with few other options. However, manufactured homes are associated with poorer health outcomes and are less well equipped to protect their residents from the effects of natural disasters than more permanent housing structures.

This brief from the University of Minnesota Rural Health Research Center examines rates of living in manufactured homes by rural and urban location, as well as rates among rural residents by region and socio-demographic characteristics. It also examines differences in crowded housing, housing quality, and housing cost burden by manufactured vs. more permanent housing structures.

Click Here to Read Brief

Rural Health Research: Preventing Medical Debt Among Rural Residents: Example Programs from Hospitals in Minnesota and Montana

June 17, 2025

Rural Health Research: Preventing Medical Debt Among Rural Residents: Example Programs from Hospitals in Minnesota and Montana.

Medical debt, which includes unpaid bills, loans, and other debt incurred from health care expenses, affects roughly 15% of adults in the U.S. this is despite more than 90% of U.S. adults having some form of health insurance.

Medical debt is an important social driver of health, with disproportionate impacts for populations already experiencing greater health risks. Overall, rural residents report more problems paying medical bills and are more likely to be unable to pay their medical bills altogether in comparison to urban residents.

This case series from the University of Minnesota Rural Health Research Center examines how two rural hospitals aim to reduce medical debt for their patient populations and address barriers to medical debt relief.

Click Here to Read More

Rural Health Research: rural and Urban Differences in Suicide in the United States

May 14, 2025

Rural Health Research: rural and Urban Differences in Suicide in the United States

National data from the National Vital Statistics System and the American Community Survey were used to explore trends across urban and rural areas. Among the key takeaways in this brief from the ETSU/NORC Rural Health Research Center:

  • Crude suicide rates have remained around 14.5 per 100,000 from 2018 – 2021, with rural areas consistently higher than urban areas overall and across all subgroups of interest.
  • Males have higher crude suicide rates compared to females (23.2 vs. 6.0 per 100,000).
  • Groups aged 25-34 and 45-54 in rural areas have the highest crude suicide rates (28.8 and 25.3 per 100,000, respectively).
  • Western states generally report higher crude suicide rates than other Census regions, while Northeastern and Southern states have lower rates in both urban and rural areas.

Click Here to Read More