Health Care Access and Use Among the Rural Uninsured [Policy Brief]

In a landmark series of reports, the Institute of Medicine’s Committee on the Consequences of Uninsurance noted the policy significance of the “cascading” effects of uninsurance on patients, families, and communities.1 Multiple studies confirm that rural residents are more likely to be uninsured than their urban counterparts.2-4 Additionally, there is ample evidence that the uninsured have poorer access to care, delay care, and obtain care at levels of greater acuity than those with health insurance.5 However, the impact of being uninsured versus insured in rural areas, particularly compared to urban areas, is largely unknown. Using data from the 2002-2007 Medical Expenditure Panel Survey (MEPS), this study examines access to care and service use among non-elderly, uninsured rural and urban residents compared to each other and to their insured counterparts using a combination of bivariate and multivariate analyses. For the purposes of this study we defined uninsured as lacking any health insurance coverage for a full year. Rural and urban designations are based on the rural-urban continuum codes; for some analyses we divide rural counties into those that abut an urban county (adjacent) and those that do not (non-adjacent)