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.