Document Type

Policy Brief

Publication Date



rural, affordability, access, health care, cost, uninsured, prescription drugs, research, MRHRC


Using the 2019-2020 National Health Insurance Survey, researchers at the Maine Rural Health Research Center examined rural-urban differences in affordability of care and cost-saving strategies among working-age adults. 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 needed 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. For all affordability measures, adjusted analyses showed that rural adults who were uninsured, lower income, or in fair or poor health were more likely to experience affordability problems compared with other rural adults. Given that individuals in fair or poor health are more likely to report affordability problems, these barriers may also translate into worse outcomes by exacerbating poor health. More research is needed to understand how affordability problems may be affecting the longer-term health of rural adults and what policy strategies may be optimal for addressing these concerns.


For more information on this study, please contact Erika Ziller, PhD,

This study was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement #U1CRH03716. The information, conclusions and opinions expressed in this brief are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.

Funding Organization

Federal Office of Rural Health Policy, HRSA

Grant Number




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