Innovations in Rural Health System Development: Recruiting and Retaining Maine\u27s Health Care Workforce

This series of briefs were produced by the Maine Health Access Foundation (MeHAF) in conjunction with the Maine Rural Health Research Center to describe robust and innovative models and strategies from Maine and other parts of the country related to the areas of health finance and payment, governance, workforce, and service delivery that have the potential to be replicated or adapted here in Maine. Other briefs in this series: Moving Rural Health Systems to Value-Based Payment Governance Maine\u27s Behavioral Health Services Service Delivery Advances in Care Coordination Emergency Care, and Telehealth Federally Qualified Health Center Initiatives Learn more at www.mehaf.or

Health Care Use and Access among Rural and Urban Nonelderly Adult Medicare Beneficiaries

Little is known about the characteristics and health care use of rural residents with disabilities. Using the Medicare Current Beneficiary Survey (2009-2013), we compared access to and use of health services among rural and urban nonelderly Medicare beneficiaries with a disability, and examined their health and functional status along with sociodemographic characteristics. We found that the characteristics of nonelderly Medicare beneficiaries with a disability reflected the differences observed between rural and urban populations overall: rural recipients were more likely than their urban peers to be older, non-Hispanic white, and have a lower level of educational attainment. Although self-reported access to care appeared comparable among rural and urban nonelderly Medicare beneficiaries, rural Medicare beneficiaries with a disability reported generally poorer health status and greater impairment compared to their urban counterparts, and certain subgroups of rural nonelderly Medicare beneficiaries with a disability reported greater challenges accessing care. Policymakers and clinicians should consider opportunities to improve access for individuals made vulnerable by functional status, access to care barriers, and/or poorer financial coverage for care

Rural Working-Age Adults Report More Cost Barriers to Health Care

Using the 2019-2020 National Health Insurance Survey, researchers at the Maine Rural Health Research Center examined rural-urban differences in affordability of care and cost-saving strategies among working-age adults. Rural adults (18-64) were more likely than their urban counterparts to report problems paying, or being unable to pay, their medical bills. They were also more likely to delay or go without needed care because of the cost. Compared with urban adults, those in rural areas were more likely to engage in prescription drug cost-saving measures such as skipping doses, delaying refills, or taking less medication than prescribed. For all affordability measures, adjusted analyses showed that rural adults who were uninsured, lower income, or in fair or poor health were more likely to experience affordability problems compared with other rural adults. Given that individuals in fair or poor health are more likely to report affordability problems, these barriers may also translate into worse outcomes by exacerbating poor health. More research is needed to understand how affordability problems may be affecting the longer-term health of rural adults and what policy strategies may be optimal for addressing these concerns

Innovations in Rural Health System Development: Federally Qualified Health Center Initiatives

Part of a series of briefs profiling innovative rural health system transformation models and strategies from Maine and other parts of the US, this brief focuses on promising strategies of federally qualified health centers. These strategies include workforce recruitment and retention initiatives, approaches to serving high-need patient populations, services to address the opioid crisis and dental care, and innovations in providing enabling services that address the social determinants of health. This series on Innovations in Rural Health System was funded by the Maine Health Access Foundation. Other briefs in this series include: Moving Rural Health Systems to Value-Based Payment Recruiting and Retaining Maine\u27s Health Care Workforce Governance Maine\u27s Behavioral Health Services Service Delivery Advances in Care Coordination, Emergency Care, and Telehealth Learn more at www.mehaf.or

The Role of Public versus Private Health Insurance in Ensuring Health Care Access & Affordability for Low-Income Rural Children

Medicaid and the Children’s Health Insurance Program (CHIP) have played a critical role in ensuring access to health insurance coverage among children and have been particularly important sources of coverage for rural children. More than 35.5 million children were enrolled in Medicaid or CHIP in September 2016—accounting for just over half of total Medicaid and CHIP enrollment. Given the large proportion of rural children covered by public insurance, it is critically important to understand the role of that coverage in ensuring access to affordable healthcare for rural children. Using data from the 2011-2012 National Survey of Children’s Health, this study examined rural-urban differences in children’s access to care, and their families’ perceived affordability of that care among those enrolled in Medicaid or CHIP and those covered by private insurance. Findings indicate that public coverage supported access to care for low-income rural children and low-income rural families reported fewer problems paying medical bills for their child’s care. CHIP is up for reauthorization in 2017 and decisions about the program’s future should consider the potential implications for affordability of healthcare services among rural children

Rural HIV Prevalence and Service Availability in the United States: A Chartbook

This chartbook examines 2016 HIV prevalence and the availability of HIV prevention, testing, and treatment services across the rural-urban continuum and by US Census region. Publicly available county-level HIV prevalence data from the CDC and state-produced HIV surveillance reports were used to estimate HIV prevalence across the rural-urban continuum. HIV prevalence data include all diagnoses of HIV infection, with or without a stage 3 (AIDS) diagnosis. Geocoded data on organizations that provide prevention, testing, and treatment services related to HIV were obtained from the National Prevention Information Network. HIV prevalence is higher in urban counties than rural counties (399 per 100,000 compared with 149 per 100,000, respectively), with prevalence decreasing with increasing level of rurality. HIV prevalence in urban counties is higher than HIV prevalence in rural counties in all but two states (South Carolina and Hawaii). The Northeast has the highest HIV prevalence (485 per 100,000) followed by the South (429 per 100,000), West (302 per 100,000), and Midwest (205 per 100,000). Analyses of the availability of HIV-related services show that compared with urban counties, a smaller proportion of rural counties have organizations that provided HIV prevention, testing, and treatment services. The findings of this study may help inform policies that augment rural HIV prevention, diagnosis, treatment, and outbreak response efforts

Patterns of Health Care Use among Rural-Urban Medicare Beneficiaries Age 85 and Older, 2010-2017

The purpose of this study was to examine rural-urban differences in health care use among Medicare beneficiaries age 85+. Understanding these differences, and the socioeconomic characteristics that contribute to them, can have important implications for Medicare policies aimed at serving the age 85+ population. Using the Medicare Current Beneficiary Survey 2010-13 Cost and Use and 2015-17 Cost Supplement Files, we examined whether and how rural and urban Medicare beneficiaries age 85+ differ in terms of their: socioeconomic and health characteristics that may inform health care use; trends in health care use, including use of inpatient and emergency department (ED) care; outpatient and prescription services; specialists and dentists; and home health and durable medical equipment. Although the percentage of older adults (age 65+) remains higher in rural areas of the U.S., we found that adults over age 85 comprise a similar proportion of the Medicare population in rural and urban areas. Findings showed that rural and urban beneficiaries age 85+ had similar health (general health, chronic conditions) and functional outcomes (ADLs, and IADLs) across the study years and that the average number of visits to primary care providers for both rural and urban beneficiaries decreased over time. However, compared with urban beneficiaries, rural beneficiaries were significantly less likely to visit specialists, dentists, and receive outpatient services. Rural-urban differences in the percentage of beneficiaries who visited the Emergency Department were higher in all study years, with significant differences in 2011, 2012, and 2017. FMI: Yvonne Jonk, PhD, Deputy Director, Maine Rural Health Research Center

Access to Health Care Services for Adults in Maine [Policy Brief]

This data brief by researchers at the Maine Health Access Foundation and the University of Southern Maine\u27s Maine Rural Health Research Center found ongoing inequality in the ability of people in Maine to get quality health care. The report examines data from 2014-2016 and shows that Maine people, of all income groups, report difficulties in paying medical costs. Research has also found the ability to seek timely and appropriate health care is impacted by income levels, educational background, race and ethnicity. This brief provides an update to the 2016 study (available in Digital Commons: https://digitalcommons.usm.maine.edu/cgi/viewcontent.cgi?article=1038&context=insurance) For more information, please contact Dr. Erika Ziller ([email protected]

Capacity of Rural Counties to Address an HIV or Hepatitis C Outbreak

HIV and hepatitis C (HCV) are major public health concerns in the United States and are a focus of significant federal health policy attention. Rural counties may be potentially vulnerable to an HIV or HCV outbreak among persons who inject drugs due to greater prevalence of high-risk injection practices as well as limited public health capacity to prevent, prepare for, and respond to an HIV or HCV outbreak. This study identified states potentially at risk for an HIV or HCV outbreak and used data from the 2016 Association of State and Territorial Health Officials (ASTHO) Profile Survey, 2016 National Association of City and County Health Officials (NACCHO) National Profile of Local Health Departments (LHD), and 2016-2017 Area Health Resource File to examine rural-urban differences in (1) state-level infectious disease surveillance, prevention activities, and collaboration with stakeholders; (2) LHD-level activities related to preventing, preparing for, and responding to an HIV or HCV outbreak; and (3) socioeconomic characteristics and health resources of counties at potential risk for an HIV or HCV outbreak. LHDs located in rural counties in at-risk states were less likely to offer services that may help address an HIV or HCV outbreak, including HIV testing, HIV services, and infectious disease surveillance. Rural LHDs were also less likely to report a history of partnerships with community-based organizations that may be important resources during an outbreak, including community health centers and faith-based organizations

Vermont: A Health-Focused Landscape Analysis

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the Northern Border Region. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission. For more information, please contact Katherine Ahrens, Ph