Maine Rural Health Research Center
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.
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
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.
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 public health insurance in ensuring access to affordable health care for rural children. Using data from the 2011-2012 National Survey of Children’s Health, researchers from the Maine Rural Health Research Center 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 reauthorization in 2017 is an important step in protecting low-income rural children’s access to affordable health care. In the event that CHIP funding ends, even those families that successfully transition to private health insurance are likely to face greater challenges in affording care for their children. Rural children who gain coverage through Qualified Health Plans in the Marketplace or who move into employer-sponsored insurance after losing public insurance will likely experience higher out-of-pocket costs compared with their experience in CHIP.
For more information on this study, please contact Erika Ziller, PhD
Suggested Citation: Ziller EC, Lenardson JD, Burgess AR. The Role of Public Versus Private Health Insurance in Ensuring Health Care Access & Affordability for Low-Income Rural Children. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; January, 2017. PB-67.
Maine Rural Health Research Center FAQ
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.
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.
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.
- 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.
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.