Pharmacy Vaccination Service Availability in Nonmetropolitan Counties

The RUPRI Center for Rural Health Policy Analysis releases this report on Pharmacy Vaccination Service Availability in Nonmetropolitan Counties. In February 2021 the White House announced the launch of the first phase of the Federal Retail Pharmacy Program for COVID-19 Vaccination. The “public-private partnership with 21 national pharmacy partners and networks of independent pharmacies” is […]

Rural Cultural Wealth Research Priorities. RUPRI Rural Cultural Wealth Lab. February 2021.

This paper follows an extensive review of the research literature at the intersection of three broad areas—1) rural wealth creation and distribution 2) rural arts and culture, and 3) creativity, innovation, and entrepreneurship. The primary goal of the literature review was to identify the most critical issues that are NOT fully understood about these concepts […]

Characteristics & Challenges of Rural Ambulance Agencies. RUPRI Health Panel. January 2021.

The RUPRI Health Panel has released a new brief, Characteristics and Challenges of Rural Ambulance Agencies. Every year, nearly 10 million rural Americans receive EMS care. There are 23,272 ambulance agencies in the U.S. and 73 percent of those agencies report serving rural areas. Thus, rural Americans rely on EMS professionals to deliver life-saving emergency […]

Advancing Population Health in Rural Places: New from RUPRI Health Panel. January 2021.

The RUPRI Health Panel has released a new paper, Advancing Population Health in Rural Places: Key Lessons and Policy Opportunities. This paper advances policy discussion of population health in rural places, focusing on the role of rural health care organizations. Lessons from ongoing programs provide policy considerations. Medicare and Medicaid programs should prioritize staff and […]

The Evolving Landscape of National Telehealth Policies during a Public Health Emergency: Responsiveness to Rural Needs

The coronavirus pandemic precipitated significant but temporary changes in telehealth policy and the use of telehealth services to ensure access to needed health services during a public health emergency (PHE). Extending the temporary policy changes will require statutory and regulatory action. This paper takes stock of current telehealth policies and assesses options for expanding the […]

Considerations for Defining Rural Places in Health Policies and Programs

The RUPRI Health Panel has released a new brief that identifies key questions to ask when creating, modifying, or using a definition. Rural definitions in statute and policy are used to direct resources to underserved peoples. But changes in population behavior and Census processes have led to concern about historic methods of defining rural. This […]

Behavioral Health in Rural America: Challenges and Opportunities

The prevalence of mental health and substance use diagnoses and unmet treatment needs are not equally distributed, with rural residence being one factor associated with these differences. Moreover, the rural context has proven challenging for ensuring the availability of and access to prevention, diagnosis, treatment, and recovery services in rural areas. This paper reviews the […]

A New Conceptual Framework for Rural Cultural Wealth. A product of the NEA RUPRI Rural Cultural Wealth Lab. November 2019.

The New Conceptual Framework for Rural Cultural Wealth describes a conceptual framework within which the arts, culture, and cultural wealth can be understood, measured, and compared. While such a framework can be applied equally well in any geographic context, the focus in this document is on the rural and small city context. Examples and specific […]

Fiscal, Economic, and Social Effects of Immigration in the Hoosier State

View Study This study details the current realities and implications of immigration in Indiana as a whole, including effects on demographics, education, wealth and poverty, employment, and the labor market. Study sponsored by Conexus Indiana. Written at Ball State University by Emily J. Wornell, PhD and Michael J. Hicks, PhD; published May 13, 2019. To […]

Community Asset Inventory and Rankings: Changes in Indiana Counties

View Report In this report, we summarize the major changes in rankings for all categories of CAIR between 2012 and 2018. In addition, we also develop a ‘housing barometer’ tool for each county based on a county’s home prices relative to the state and its growth.  Visit the CAIR website at to explore the full features […]

Toward a High Performing Rural Health Care System: Key Issues and Recommendations from Rural Health Care System Innovators. Roundtable with Rural Health Innovators. RUPRI Rural Health Panel. December 2018.

Toward a High Performing Rural Health Care System: Key Issues and Recommendations from Rural Health Care System Innovators View Report On December 6-7, 2018, the Rural Health Policy Research Institute’s (RUPRI) Health Panel convened a meeting in Washington, DC, of rural health leaders from around the country to discuss strategies and models for rural health […]

Existing Conceptual Models of Arts & Culture: An Inventory. Rural Cultural Wealth Lab. January 2019.

The Existing Conceptual Models of Arts & Culture: An Inventory describes and compares conceptual models of arts and culture, creativity, innovation, entrepreneurship, and well-being. Each model attempts to capture a different aspect of this very complex system. Each model therefore provides important insights that help us understand the role and dynamics of arts and culture […]

The Rural Differential: A Literature Review at the Nexus of Arts & Culture, Creativity, Entrepreneurship, and Innovation

Our review of the literature reveals that: Current research in arts and culture, creativity, and innovation has a significant metropolitan bias. Most research either focuses solely on metropolitan issues or assumes the arts and culture issues are uniform across the rural-urban continuum. More research on the effect of rural arts and culture on the vitality […]

RUPRI Research on Rural Pharmacy Closures featured in US New & World Report

Ongoing research on rural pharmacy closures by the RUPRI Center for Rural Health Policy Analysis was featured in a US News & World Report article, Rural Pharmacies and Closing: Where Does That Leave Patients. “IN RURAL AND SMALL-TOWN America, independent pharmacies play a vital role for the customers who rely on them. However, U.S. rural pharmacies are dwindling. Since […]

RUPRI’s Rural Health Research Findings included in new GAO Report on Rural Hospital Closures

The United States Government Accountability Office was asked by Members of Congress to examine Rural Hospital Closures and the Number and Characteristics of Affected Hospitals and Contributing Factors. Research and policy considerations from the RUPRI Health Panel, the RUPRI Center for Rural Health Policy Analysis and Rural Health Value, in partnership with Stratis Health, were included in the report. GAO’s analysis […]

Dr. Bruce Weber featured on ERS for Research on SNAP Participation in Oregon

ERS explores the relationship between local economic conditions and the duration of able-bodied adults’ enrollment in SNAP. Researchers, including Dr. Bruce Weber, examine whether improvements in local labor market conditions in Oregon shorten enrollment times for these SNAP recipients.  View Report

Primary Care: The Foundation for a High-Performance Rural Health Care System

This paper will review elements of a robust rural primary care system, including development and maintenance of a high performance rural primary care system and workforce as well as policy considerations and opportunities that address the sustainability of rural primary care. Written by Keith J. Mueller (PhD), Charlie Alfero (MA), Andrew F. Coburn (PhD), Jennifer […]

Insuring Rural America: Health Insurance Challenges and Opportunities

This paper discusses the realities and challenges of designing a market structure that will result in affordable health insurance being offered in rural markets, and reviews the rural implications of policies affecting rural health insurance markets and health systems. Written by Keith J. Mueller (PhD), Charlie Alfero (MA), Andrew F. Coburn (PhD), Jennifer P. Lundblad […]

Taking Stock: Policy Opportunities for Advancing Rural Health

This paper examines the progress of health system transformation and the gaps that remain as they affect rural people, places, and providers. The health system transformation activities examined here are not limited to the Patient Protection and Affordable Care Act of 2010 (PPACA), but also touch upon activities undertaken by states, insurance plans, and public […]

Primer on Rural Long-Term Services and Support

 Rural Long-Term Services and Supports: A Primer provides policymakers and other interested stakeholders a primer on rural long-term services and supports (LTSS): (1) the fundamentals of the rural LTSS system, (2) rural access to and use of LTSS, and (3) discussion of the opportunities within and limitations of current Federal and State LTSS policy for advancing […]

RUPRI Rural Cultural Wealth Lab highlighted in NEA press release: New Research Highlights Economic Impact of the Arts in Rural Communities National Endowment for the Arts Releases Rural Arts, Design, and Innovation in America Online Conversation at #NEArural

Washington, DC—Rural arts organizations draw more non-local audiences to their venues and report greater civic leadership and customer connectedness than their urban peers, according to a new research report, Rural Arts, Design, & Innovation in America: Research Findings from the Rural Establishment Innovation Survey. Published by the National Endowment for the Arts (NEA), the report is […]

Assessing Indiana’s E-Readiness in the Development of the Digital Society

View Report This study seeks to bridge the gaps in research on the relationship between broadband accessibility and human development by assessing the e-readiness of Indiana counties. Written by Srikant Devaraj, PhD; Sushil Sharma, PhD; Emily J. Wornell, PhD; and Michael J. Hicks, PhD (Ball State University); published Oct. 5, 2017.

After Hospital Closure: Pursuing High Performance Rural Health System without Inpatient Care

The RUPRI Health Panel describes opportunities for rural communities to develop a high-performance rural health system after hospital closure, including three case studies that describe real-world transitions from a hospital-based locus of care to new models of care delivery in rural places. After Hospital Closure: Pursuing High Performance Rural Health System without Inpatient Care This paper describes […]

RUPRI Leader – Interview with Mario Gutierrez on the future of healthcare

We sat down to talk about the future of healthcare with Mario Gutierrez, who serves as the Executive Director of the Center for Connected Health Policy (CCHP). Last year, Gutierrez participated in a panel with TSC Director Pamela Villacorta at the Governor’s Conference on Aging and Disabilities. We asked him about his perspective on the state of […]

An unsung farm bill hero, rural development needs more champions: Agri

WASHINGTON, March 19, 2017 – U.S. farmers are getting grayer, their national numbers are on the decline and fewer young people are moving back to farms and ranches. The average age of a principal operator of a U.S. farm is now over 58 years old. Absent opportunities for manufacturing, recreation or other industries, many of […]

RUPRI Rural Cultural Wealth Lab: A Conceptual Design

The Rural Cultural Wealth Lab unites the knowledge and experiences of a diverse array ofscholars and practitioners to address some of the most critical issues and opportunities facingrural people and places. It fulfills this need by building innovative metrics that will strengthenpolicymakers’ understanding of the various relationships and assets that define and reveal ruralcommunity wealth.To […]

Medicaid Payment and Delivery System Reform: Challenges and Opportunities for Rural Health Systems

Medicaid has grown significantly in its importance to rural health systems and communities; a higher proportion (22 percent) of rural residents was enrolled in Medicaid than Medicare (20 percent) in 2014. At the same time, the use of payment and delivery innovations has grown significantly, but varies across the U.S. As a result of expansions […]

Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems

View Report | Related: View Policy Brief In recognition of unsustainable healthcare cost growth and sub-optimal delivery system performance, the Patient Protection and Affordable Care Act of 2010 (ACA) contains provisions that redesign healthcare payment and delivery. ACA payment change provisions are driving delivery system reform by making healthcare organizations more accountable for patients’ health […]

Human Development & Technology in US Counties

View Policy Paper In this study, the authors expand the scope of their previous research using the Human Development & Technology Index (HDTI) to assess geographic trends in the access to and the quality of broadband technology across all US counties. This work includes considerations for policy makers. Written by Srikant Devaraj, PhD; Sushil Sharma, […]

The Human Development Index of Indiana Counties: A Policy Perspective

View Policy Paper Three factors comprise the Human Development Index—health, education, and living standards. We examine those factors and provide a framework for policy considerations. This study is a research contribution to Primacy of Place, an interdisciplinary initiative at Ball State University (home of the RUPRI Center for State Policy). Primacy of Place focuses on […]

Accountable Care Communities in Rural: Laying the Groundwork in Humboldt County, CA – 2015

This joint paper was authored by members of both the Health and Human Services Panel in June 2015. The paper presents a case for the viability of Accountable Care Community (ACC) models in rural communities, including in rural Humboldt County, California. Accountable Care Communities reflect a unified approach to improving the health and reducing the […]

Appalachia starts long, scary slog beyond mining Manuel Quiñones

COAL:Appalachia starts long, scary slog beyond miningManuel Quiñones, E&E reporterGreenwire: Tuesday, March 17, 2015Chuck Fluharty parachutes into busted rural economies and tries to figure out how to get them out of the ditch. His latest challenge: Appalachia. Fluharty’s Rural Policy Research Institute is focused on eastern Kentucky, whose coal fields have bled thousands of jobs […]

Philanthropic Investment in Rural America: The Real Story and How We Can Change It

This presentation touches upon the rural need and the rationale for philanthropic investment. It also discusses the place of the public sector in private philanthropy. Presented by Charles W. Fluharty (President and CEO, Rural Policy Research Institute) to the 2014 HAC Rural Housing Conference on December 4, 2014 in Washington, D.C. View Presentation

Advancing the Transition to a High-Performance Rural Health System. RUPRI Health Panel. November 2014.

In Advancing the Transition to a High-Performance Rural Health System, the RUPRI Health Panel discusses strategies and options for creating a pathway to a transformed, high-performing rural health system. This paper builds on the RUPRI Health Panel’s earlier paper that conceptually defined the core elements of a high-performance rural health system. We have also incorporated […]

Access to Rural Health Care – Literature Review and New Synthesis

This report reviews important access definitions and frameworks from the literature. The review serves as a concept map to create a unique synthesis of perspectives that may be used by researches and policy makers to design or clarify access to health care providers. Prepared in August 2014 by the RUPRI Health Panel: A. Clinton MacKinney, […]

The Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: 2010 First and 2014 Second Look

These two policy documents from 2010 and 2014 take a first and second look at the implementation of the Patient Protection and Affordable Care Act of 2010 and how it contributes to reshaping the health care delivery landscape, particularly in rural areas. Prepared in September 2010 and April 2014 by the RUPRI Health Panel: Andrew […]

The Current and Future Role and Impact of Medicaid in Rural Health

This brief outlines and describes the current Medicaid program and its importance to rural America. It also discusses rural implications of program expansion, including whether and how states choose to implement changes. View Report This report was written by Health Panel Members Keith Mueller, Andrew Coburn, Jennifer Lundblad, A. Clinton MacKinney, Timothy McBride, Sidney Watson […]

The High Performance Rural Health Care System of the Future

The RUPRI Health Panel offers an aspirational vision, for a highperformance rural health care system. The RUPRI Health Panel envisions rural health care that is affordable andaccessible for rural residents through a sustainable health system thatdelivers high quality, high value services. A high performance rural healthcare system informed by the needs of each unique rural […]

Place-Based Policies and Public Health

Place-Based Policies and Public Health: The Road to Healthy Rural People and Places View Report This joint paper by the RUPRI Health Panel and Human Service Panel examines how effective place-based policies can influence how rural and metropolitan areas develop, how well they function as places to live, work, operate a business, preserve heritage, and […]

Securing High Quality Health Care in Rural America: The Impetus for Change in the Affordable Care Act

View Report The ACA calls for the development of a National Health Care Quality Strategy and Plan (National Quality Strategy) that, by definition, will affect health care that is delivered to millions of Americans who live in rural areas and thousands of health care providers who care for them. The goal of this paper is […]