Rural-Urban Differences in Health Insurance Coverage and Patterns Among Working-Age Adults in Kentucky

Lü, Ning; Samuels, Michael E.; Kletke, Phillip R.; Whitler, Elmer T.

doi:10.1111/j.1748-0361.2010.00274.x

Cited by 27 publications

(26 citation statements)

References 25 publications

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“…However, out-of-pocket medical expenses – such as health insurance premiums, insurance deductibles, copayments, and medical costs not covered by insurance – may be contributing to financial hardships that lead survivors to forgo medical care. In previous studies, working-age (18–64) rural residents reported having difficulty paying for insurance deductibles and copayments (15, 23). A population-based study of people younger than 65 years old also reported out-of-pocket expenses being more burdensome among people with serious illnesses, and specifically cancer survivors reported out-of-pocket expenses exceeding up to 20% of their total family income (29).…”

Section: Discussionmentioning

confidence: 96%

“…Patients in rural areas tend to have poor access to healthcare compared to urban patients (11–15). Population-based surveys have found that people in rural areas are more likely to delay or forgo healthcare due to cost (12, 14) and to report out-of-pocket costs exceeding 5% of their income (12).…”

Section: Introductionmentioning

confidence: 99%

“…Population-based surveys have found that people in rural areas are more likely to delay or forgo healthcare due to cost (12, 14) and to report out-of-pocket costs exceeding 5% of their income (12). A study by Lu and colleagues (15) reported rural working-age adults in Kentucky were less likely to have overall health insurance coverage, and those who were insured were more likely to have difficulty paying health insurance premiums compared to those in urban areas. Rural cancer survivors are an especially vulnerable population, with higher risk for poor mental and physical health outcomes after cancer (16).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of Rural Residence on Forgoing Healthcare after Cancer Because of Cost

Palmer

Geiger

et al. 2013

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Routine follow-up care is recommended to promote the well-being of cancer survivors, but financial difficulties may interfere. Rural-urban disparities in forgoing healthcare due to cost have been observed in the general population; however, it is unknown whether this disparity persists among survivors. The purpose of this study was to examine rural-urban disparities in forgoing healthcare after cancer due to cost. Methods We analyzed data from 7804 cancer survivors in the 2006–2010 National Health Interview Survey. Logistic regression models, adjusting for sociodemographic and clinical characteristics, were used to assess rural-urban disparities in forgoing medical care, prescription medications, and dental care due to cost, stratified by age (younger: 18–64, older: 65+). Results Compared to urban survivors, younger rural survivors were more likely to forgo medical care (p<0.001) and prescription medications (p<0.001) due to cost; older rural survivors were more likely to forgo medical (p<0.001) and dental care (p=0.05). Rural-urban disparities did not persist among younger survivors in adjusted analyses; however, older rural survivors remained more likely to forgo medical (OR=1.66, 95%CI=1.11–2.48) and dental care (OR=1.54, 95%CI=1.08–2.20). Conclusions Adjustment for health insurance and other sociodemographic characteristics attenuates rural-urban disparities in forgoing healthcare among younger survivors, but not older survivors. Financial factors relating to healthcare utilization among rural survivors should be a topic of continued investigation. Impact Addressing out-of-pocket costs may be an important step in reducing rural-urban disparities in healthcare, especially for older survivors. It will be important to monitor how healthcare reform efforts impact disparities observed in this vulnerable population.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Rural Residence on Forgoing Healthcare after Cancer Because of Cost

Palmer

Geiger

et al. 2013

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Since there may be greater injection drug use in smaller, less populous areas (Zibbell et al, 2015), fewer and less specialized healthcare services in these settings may necessitate greater efforts to engage HIV-infected PWID in medical care. This may particularly be true since overall healthcare use may be lower in less populous settings (Mueller et al, 1998; Reschovsky & Staiti, 2005), potentially due to fewer available resources for comprehensive care, costs associated with healthcare, and lack of insurance coverage (Lu, Samuels, Kletke, & Whitler, 2010; Reschovsky & Staiti, 2005). With HIV-infected PWID being less likely to be engaged in care and virally suppressed (Bradley et al, 2014), prioritizing drug resistance testing at linkage and implementing measures to retain persons in care over time in this population may improve provision of appropriate ART regimens.…”

Section: Discussionmentioning

confidence: 99%

Receipt and timing of HIV drug resistance testing in six U.S. jurisdictions

et al. 2017

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The Department of Health and Human Services recommends drug resistance testing at linkage to HIV care. Because receipt and timing of testing are not well characterized, we examined testing patterns among persons with diagnosed HIV who are linked to care. Using surveillance data in six jurisdictions for persons aged ≥13 years with HIV infection diagnosed in 2013, we assessed the proportion receiving testing, and among these, the proportion receiving testing at linkage. Multivariable log-binomial regression modeling estimated associations between selected characteristics and receipt of testing (1) overall, and (2) at linkage among those tested. Of 9,408 persons linked to care, 66% received resistance testing, among whom 68% received testing at linkage. Less testing was observed among male persons who inject drugs (PWID), compared with men who have sex with men (adjusted prevalence ratio [aPR]: 0.88; 95% confidence interval [CI]: 0.81–0.97) and persons living in areas with population <500,000 compared with those in areas with population ≥2,500,000 (aPR: 0.88; CI: 0.84–0.93). In certain jurisdictions, testing was lower for persons with initial CD4 counts ≥500 cells/mm3, compared with those with CD4 counts <200 cells/mm3 (aPR range: 0.80–0.85). Of those tested, testing at linkage was lower among male PWID (aPR: 0.85; CI: 0.75–0.95) and, in some jurisdictions, persons with CD4 counts ≥500 cells/mm3 (aPR range: 0.63–0.73). Two-thirds of persons with diagnosed HIV who were linked to care received resistance testing, and most received testing at linkage as recommended. Improving receipt and timing of testing among male PWID, persons in less populous settings, and in all jurisdictions, regardless of CD4 count, may improve care outcomes.

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“…8 In small rural counties not adjacent to urban areas, residents had lower rates of employer-based coverage than in urban areas. 13,14 Lower rates of employer-based coverage were a result of higher rates of either self-employment, and among those who were not self-employed, higher rates of not being offered coverage through an employer due to part-time employment or working for a small employer that does not offer insurance to employees. 13 Rural areas also had higher rates of underinsurance compared to urban areas.…”

mentioning

confidence: 99%

Health care eligibility and availability and health care reform: Are we addressing rural women’s barriers to accessing care?

Zimmermann¹,

Carnahan²,

Paulsey³

et al. 2016

Journal of Health Care for the Poor and Underserved

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Background Rural populations in the US face numerous barriers to healthcare access. The Patient Protection and Affordable Care Act (PPACA) was developed in part to reduce healthcare access barriers. We report rural women’s access barriers and the PPACA elements that address these barriers as well as potential gaps. Methods For this qualitative study, we analyzed two datasets using a common framework. We used content analysis to understand rural, focus group participants’ access barriers prior to PPACA implementation. Subsequently, we analyzed the PPACA text. Results Participants described healthcare access barriers in two domains: availability and eligibility. The PPACA proposes solutions within each domain, including healthcare workforce training, Medicaid expansion, and employer-based health care provisions. However, in rural settings, access barriers likely persist. Discussion While elements of the PPACA address some healthcare access barriers, additional research and policy development are needed to comprehensively and equitably address persistent access barriers for rural women.

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Rural-Urban Differences in Health Insurance Coverage and Patterns Among Working-Age Adults in Kentucky

Cited by 27 publications

References 25 publications

Impact of Rural Residence on Forgoing Healthcare after Cancer Because of Cost

Impact of Rural Residence on Forgoing Healthcare after Cancer Because of Cost

Receipt and timing of HIV drug resistance testing in six U.S. jurisdictions

Health care eligibility and availability and health care reform: Are we addressing rural women’s barriers to accessing care?

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