Maine Rural Health Research Center

Knowledge of Health Insurance Concepts and the Affordable Care Act among Rural Residents

Unpublished
Abstract: 

Health insurance literacy is central to identifying eligibility for coverage and subsidies, choosing a plan, and using optimal healthcare services under the Affordable Care Act (ACA) or other insurance reform initiatives. To fully benefit from policy efforts to improve health insurance access, rural residents must have the ability to select the plan that best meets their healthcare needs. However, a higher proportion of rural residents possess characteristics that may put them at risk of lower health insurance literacy, including lower incomes and educational attainment, less experience with private insurance, and historically higher uninsured rates. Using Health Reform Monitoring Survey data from 2013 and 2014, researchers at the Maine Rural Health Research Center examined whether rural and urban residents demonstrated different knowledge and/or use of the ACA Marketplace and subsidies; enrollment information sources (e.g., Healthcare.gov, the Marketplace); the health insurance mandate; and health insurance terms and concepts. Additionally, they examined whether knowledge and use changed between the fourth quarters of 2013 and 2014.

Findings indicate that familiarity with Healthcare.gov and the Marketplace increased dramatically among both rural and urban residents between 2013 and 2014. However, knowledge in rural areas lagged somewhat behind that of urban residents. Rural and urban residents appear to have comparable levels of health insurance literacy. While this study focuses on some concepts that are specific to ACA policy changes, its results have implications for alternative reforms under consideration by Congress that may require consumer awareness and input.

Contact Information: Erika Ziller, PhD, Maine Rural Health Research Center

Suggested Citation: Ziller EC, Lenardson JD, Burgess AR. Knowledge of Health Insurance Concepts and the Affordable Care Act among Rural Residents. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; July, 2017. PB-68.

Publication Type: 
Research and Policy Brief
Publish Date: 
July 25, 2017
URL: 
http://usm.maine.edu/sites/default/files/muskie/PB68_Rural-Health-Insurance-Literacy.pdf

Mental Health Status and Access to Health Care Services for Adults in Maine

Abstract: 

Maine people with poor mental health describe significant challenges with affordability and access to health care.  A new report released by the Maine Health Access Foundation (MeHAF) and the University of Southern Maine, Mental Health Status and Access to Health Care Service for Adults in Maine, describes how adults 18 and older in Maine who report depression and poor mental health have many barriers to getting health care. These results have important implications for planning in a time when major changes in health insurance coverage are expected.

Analyzing data from the ongoing federal/state public health survey, the Behavioral Risk Factor Surveillance System (BRFSS), Dr. Ziller found that adults in Maine experiencing 14 or more mental health bad days are less likely to have a regular health care provider and more likely to report delays in getting needed health care services (for reasons other than cost). Poorer mental health status was associated with higher rates of foregoing needed medical care because of costs; 25 percent those adults experiencing 14 or more mental health bad days reported they were unable to access needed care from a doctor due to cost compared to 7 percent of adults with no mental health bad days.

MeHAF support allows inclusion of additional questions about access to insurance and health care services in the state’s BRFSS, which surveys a random sample of Maine people throughout the year.  Results from the compiled 2012, 2013 and 2014 surveys are included in the report.

 

For more information on the study design and methodology, please contact Erika Ziller, PhD, (207) 780-4615.

Media contact: Barbara Leonard, President & CEO, (207) 620.8266 x102

Suggested Citation: Ziller EC, Leonard B. Mental Health Status and Access to Health Care Services for Adults in Maine. Augusta, ME: Maine Health Access Foundation and USM Muskie School; February, 2017.

The brief is also available for download on the Maine Health Access Foundation website.

Publication Type: 
Research and Policy Brief
Publish Date: 
February 2, 2017
Author: 
URL: 
http://www.mehaf.org/content/uploaded/images/reports-research/MeHAF_MH-Status-Access-Brief-Feb2017_FINAL.pdf

Health Information Exchange: A Strategy for Improving Acess for Rural Veterans in the Maine Flex Rural Veterans Health Access Program

Unpublished
Abstract: 

This paper written by research staff at the Maine Rural Health Research Center reports on the design and implementation of a first in the nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers. The paper reviews key factors that have contributed to implementation challenges and successes and lessons relevant to efforts to create interoperable health IT systems across multiple, complex organizational settings.


Implementation Lessons: Despite significant challenges, the Maine Rural Veterans Health Access Program (MeRVHAP) successfully established bi-directional connections with Maine’s statewide health information exchange (HIE), allowing for the exchange of clinical health information among U.S. Department of Veterans Affairs (VA) and non-VA providers.

Key factors that contributed to success include:
-A strong business case;
-Strong political and organizational commitment and leadership
-Project champions in the VA with enough seniority to overcome bureaucratic and technical hurdles
-Highly structured and detailed design and implementation plan
-Technical flexibility and capacity to adjust strategy mid-stream
-Collaboration and communication strategies developed by the stakeholders in the course of implementing this project which built a strong foundation for sustainability and replicability

 

For more information on this study, please contact Karen Pearson or Andrew Coburn

Suggested Citation: Pearson K, Burgess A, Gale J, Coburn A, Hansen A. Health Information Exchange: A Strategy for Improving Access for Rural Veterans in the Maine Flex Rural Veterans Health Access Program. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2016.

Publication Type: 
Working Paper
Publish Date: 
May 30, 2016
URL: 
http://muskie.usm.maine.edu/Publications/rural/Maine-Rural-Veterans-Health-Access-HIT-Strategies.pdf

Maine Rural Health Research Center FAQ

Innovations in Rural Health System Development

Unpublished
Abstract: 

cover photo for Innovations in Rural Health System Development

In an effort to inform and promote local discussions and strategic planning for transforming health and healthcare in rural communities, the Maine Health Access Foundation commissioned the Maine Rural Health Research Center to develop five issue briefs profiling innovative approaches to rural health. The briefs present innovative approaches from Maine and other parts of the United States to the provision of behavioral health services, recruitment and retention of health care workers, service delivery, governance, and health care payment and financing in rural areas. Examples of innovative approaches profiled in the briefs include: the use of new health workers such as community paramedics and community health workers, rural-focused medical education models, alternative models of emergency care, telehealth, care coordination initiatives, Accountable Care Organizations, and Medicaid Accountable Communities.

The aim of these briefs is to assist rural communities and regions to proactively envision and develop strategies for transforming rural health in the state. In preparing these briefs the Maine Rural Health Research Center consulted experts, interviewed key informants, and reviewed the professional and research literature to find robust and innovative models and strategies that could be replicated in rural Maine.

Suggested citations:

Burgess A, Coburn A. Innovations in Rural Health System Development: Maine’s Behavioral Health Services. Portland, ME: University of Southern Maine, Muskie School of Public Service, MaineRural Health Research Center; November 2016.

Burgess A, Coburn A. Innovations in Rural Health System Development: Recruiting and Retaining Maine’s Health Care Workforce. Portland, ME: University of Southern Maine,Muskie School of Public Service, Maine Rural Health Research Center; November 2016.

Burgess A, Coburn A. Innovations in Rural Health System Development: Service Delivery Advances in Care Coordination, Emergency Care, and Telehealth. Portland, ME: University of SouthernMaine. Muskie School of Public Service, Maine Rural Health Research Center; November 2016.

Kahn-Troster S, Coburn A. Innovations in Rural Health System Development: Governance. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine RuralHealth Research Center; November 2016.

Kahn-Troster S, Coburn A. Innovations in Rural Health System Development: Moving Rural Health Systems to Value-Based Payment. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; November 2016.

Publication Type: 
Report
Publish Date: 
November 10, 2016
URL: 
http://www.mehaf.org/learning-resources/reports-research/

Health Insurance CO-OPs: Product Availability and Premiums in Rural Counties

Abstract: 

Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available.

This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of CO-OP products in rural and urban counties and compare the number of products available in counties with and without CO-OP plans in 2014 and 2015. We also examine the proportion of lowest cost silver products for 27 year olds offered by CO-OPs in both years. To better understand the impact of CO-OP closures on consumer choice in the 2016 Marketplaces, we examine how these closures may have affected the prevalence of CO-OP products in rural versus urban counties and overall product availability.


Key Findings:

  • CO-OPs represented a larger overall share of Marketplace products available in rural versus urban counties in 2014 and 2015.
  • From 2014 to 2015, CO-OP products increased in absolute numbers and grew modestly as a proportion of offerings in both rural and urban counties.
  • In 2014 and 2015, CO-OPs were more likely to offer the lowest cost silver product available for purchase in rural counties than in urban counties.
  • Recent closures of CO-OPs are likely to disproportionately reduce product availability in rural counties.

Suggested Citation:
Ziller EC, Croll Z, Coburn A. Health Insurance CO-OPs: Product Availability and Premiums in Rural Counties. Portland, ME: University of Southern Maine, Maine Rural Health Research Center; October, 2016. PB-66.

 

Publication Type: 
Research and Policy Brief
Publish Date: 
October 28, 2016
URL: 
http://muskie.usm.maine.edu/Publications/rural/Health-Insurance-CO-OPs-Rural-Availability.pdf

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