title: Access to rural mental health services: service use and out-of-pocket costs.
abstract: OBJECTIVE
  To examine rural-urban differences in the use of mental health services (mental health and substance abuse office visits, and mental health prescriptions) and in the out-of-pocket costs paid for these services.
  
  
  METHODS
  The pooled 2003 and 2004 Medical Expenditure Panel Surveys were used to assess differences in mental health service use by rural and urban residence and average per person mental health expenditures by payer and by service type.
  
  
  RESULTS
  Study findings reveal a complicated pattern of greater need among rural than urban adults for mental health services, lower rural office-based mental health use and higher rural prescription use, and no rural-urban differences in total or out-of-pocket expenditures for mental health services.
  
  
  CONCLUSIONS
  These findings raise questions about the appropriateness and quality of mental health services being delivered to rural residents. Lower mental health spending among rural residents is likely explained by lower use of psychotherapy and other office-based services, but it may also be related to these services being delivered by lower-cost providers in rural areas. Findings suggest that an approach focusing on reducing underinsurance for all health services among rural residents may help to reduce unmet mental health needs among the rural privately insured.
authors.affiliation: Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine 04101, USA. eziller@usm.maine.edu
authors.forename: Erika C
authors.initials: EC
authors.lastname: Ziller
authors.forename: Nathaniel J
authors.initials: NJ
authors.lastname: Anderson
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Coburn
mesh_terms: D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D005260:Female; D005382:Financing, Personal / Q000191:economics / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D014481:United States; D019037:Urban Health Services / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D055815:Young Adult