Rural-urban differences in employment-related health insurance.
BACKGROUND
Rural residents are disproportionately represented among the uninsured in the United States.


OBJECTIVE
We compared nonelderly adult residents in 3 types of nonmetropolitan areas with metropolitan workers to evaluate which characteristics contribute to lack of employment-related insurance. RESEARCH DESIGN AND ANALYSIS: Data were obtained from the Medical Expenditure Panel Survey, pooled across 3 panels (1996--1998) to enhance the rural sample size. Econometric decomposition was used to quantify the contribution of employment structure to differences in the probability of being offered employment-related health insurance.


RESULTS
The most rural workers are 10.4 percentage points less likely to be offered insurance compared with urban workers; the difference is smaller for residents of other rural areas. In rural counties not adjacent to urban areas, lower wages and smaller employers each account for about one-third of the total difference.


CONCLUSIONS
Health insurance disparities associated with rural residence are related to the structure of employment. Major factors include smaller employers, lower wages, greater prevalence of self-employment, and sociodemographic characteristics.
Larson
Sharon L
SL
Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD 20850, USA. slarson@ahrq.gov
Hill
Steven C
SC
D000328:Adult; D016009:Chi-Square Distribution; D003669:Deductibles and Coinsurance / Q000706:statistics & numerical data; D005260:Female; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007342:Insurance Benefits / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*