The sickest rural Americans may be the least able to afford care

Photo by Charles Deluvio, Unsplash

A new study by the University of Southern Maine shows that in the two years prior to the pandemic, rural residents who were the most in need of medical care often did not seek it because of costs, reports Liz Carey of The Daily Yonder. The study revealed a disturbing lack of care-seeking among ill rural residents; its abstract says: "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 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."

"Most concerning, said Erica Ziller, one of the study’s authors, was that rural adults with the worst health were more likely to report not getting the care they needed because of the cost," Carey writes. Ziller told her, "It's almost like a grotesque Catch-22, right? We're talking about the people who need health care the most, presumably, and also who are experiencing the most difficulty in getting the services they need."

Researchers used National Health Insurance Survey data from 2019-20 and "examined rural-urban differences in affordability of care and cost-saving strategies among . . . 36,000 adults between the ages of 18 and 64 with nearly 5,000 of whom lived in a rural county," Carey reports. "The study found that nearly a fifth of the rural residents (18%) said they were uninsured and 13% said they delayed getting care or went without because of the cost. . . . Ziller said the research showed that women were more likely to report that they had trouble paying for medical care. . . . Rural residents are more likely to have trouble regardless of their income, she said."

Since data were collected mainly outside pandemic years, there are more questions to be researched. Carey writes, "The study results are concerning, Ziller said, for what will happen when emergency pandemic measures to make healthcare more affordable expire." Ziller told Carey, "This is an important thing to be thinking about as we go into ending the public-health emergency because certainly people who have been relying on Medicaid, once the continuous eligibility provisions go away, we're going to see a rise in the number of uninsured. . . Whether that's going to be more dramatic in rural or urban places, I don't think we know. . . . But, I'm certainly concerned for people in rural America who are struggling with the cost of inflation and then facing the prospect of losing health insurance benefits."