Betting the farm: health coverage, behaviors and concerns among South Dakota farmers.
BACKGROUND
This research investigates the health and health insurance status of South Dakota farmers before the onset of the Affordable Care Act of 2010 (ACA) health insurance mandate set to begin Jan. 1, 2014.


METHODS
After Institutional Review Board (IRB) approval, surveys were sent to 1,400 randomly selected rural addresses in nine South Dakota counties. The surveys used both qualitative and quantitative means to inquire about the health usage, status and insurance status. Quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS), and qualitative data were analyzed for thematic content.


RESULTS
With an overall return of 205 surveys (135 farmers), the rate of insurance was 90.6 percent. Four-fifths of farmers (80.2 percent) reported having an established provider, and 84.6 percent reported visiting a provider in the past year. Those with non-group insurance coverage were significantly more likely to report using high deductibles and limiting insurance use due to cost, but maintained a high self-reported health and preventative care use. Farmers under 50 had significantly higher rates of decreasing usage and increasing deductibles in order to afford coverage. Farmers over 65 had high health care utilization. Farmers ages 51-64 had both a high rate of using strategies to cut cost along with having an increasing utilization of care. Qualitative themes included concerns about obtaining health insurance, high deductibles and lack of coverage.


CONCLUSIONS
The health insurance and usage among farmers is high. Farmers ages 51-64 experience increased burden due to increasing health care needs along with need for health insurance coverage. Respondent comments suggest concern with increasing rates and financial loss.
Department of Sociology, Augustana College, Sioux Falls, USA.
Michael
M
Dulitz
Susan L
SL
Schrader
D000368:Aged; D000383:Agriculture; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D007348:Insurance, Health / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D013023:South Dakota