Cutler Institute for Health and Social Policy

Maine Rural Health Research Center, Population Health and Health Policy

Out-of-Pocket Health Spending and the Rural Underinsured


Higher uninsured rates among rural compared to urban residents have been well documented, but do not adequately provide a full picture of coverage and access to care in rural areas. This study looks at the relative richness of coverage among privately insured rural residents, to determine their rate of "underinsurance" and whether and how it differs from urban residents. The authors found that even with private health insurance coverage, a sizable portion of out-of-pocket costs is borne by the insured, particularly rural residents. Six percent of privately insured urban residents are underinsured compared with 10 percent of rural adjacent and 12 percent of rural nonadjacent residents. Policy implications for coverage expansion, for providers, and for small businesses are discussed.

Suggested Citation: Ziller, E. C., Coburn, A. F., & Yousefian, A. E. (2006). Out-of-pocket health spending and the rural underinsured. Health Affairs, 25(6), 1688-1699.

Publication Type: 
Journal Article
Publish Date: 
November 14, 2006

Nellie Mae Education Foundation nominates Pious Ali for the Lawrence W. O'Toole Award

Pious Ali

Pious Ali, Youth and Community Engagement Specialist in Cutler’s Children, Youth, and Families Programs, has been nominated for the Lawrence W. O’Toole Award by the Nellie Mae Education Foundation. Pious is one of six nominees from the New England states.

The Nellie Mae Education Foundation believes that student-centered learning – where learning is personalized, engaging, competency-based and not restricted to the classroom – will prepare young people to graduate high school ready to contribute to their communities and succeed. This award is given out each year to an individual, school district, or non-profit that has exhibited great leadership in moving student-centered approaches to learning forward in the New England region.

The winner will be selected by online voting and will be awarded a $100,000 grant to help advance student centered learning!


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