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. With the authorization of vaccines for COVID-19, plans for administering those vaccinations across the U.S. are being implemented. The Department of Health and Human Services (HHS) has partnered with 19 “large chain pharmacies and networks that […]

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 […]

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

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 […]

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 […]

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

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 […]

Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective

View Report This Policy Paper assesses legislative proposals to add an outpatient prescription drug benefit to the Medicare program and their implications for the delivery of services and the welfare of beneficiaries in rural areas. Included are comments on five proposals introduced in the 107th Congress: one that was passed by the House of Representatives, […]

Comments on the June 2001 Report of the Medicare Payment Advisory Commission: “Medicare in Rural America”

View Policy Paper The Rural Health Panel is publishing this policy paper to provide a foundation for a discussion of the recommendations and findings presented in the June 2001 report (Report) of the Medicare Payment Advisory Commission (MedPAC), Medicare in Rural America. In this paper, the Panel comments on MedPAC’s recommendations and offers a critique […]

Redesigning Medicare: Considerations for Rural Beneficiaries and Health Systems

View report The enactment of the Balanced Budget Act of 1997 (BBA) dramatically changed the context for discussions of Medicare policy. Two major pathways for discussion were identified: Appropriate and equitable payment for services, either through traditional fee-for service (FFS) Medicare payments or through Medicare+Choice monthly premiums; and Appropriate and necessary changes to the program […]

Rural Implications of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000

View Report This paper summarizes provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) and assesses the impact of those provisions on rural health care delivery. Congress passed BIPA on December 15, 2000, and President Clinton signed it on December 21. This report was written by Health Panel members: […]

Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria and Assessment

View Report This paper was jointly prepared by the Maine Rural Health Research Center and the RUPRI (Rural Policy Research Institute) Rural Health Panel to offer a rural perspective on the current debate over the design and implementation of a Medicare prescription drug benefit. Background information on rural Medicare beneficiaries’ need for, and access to, […]

Redesigning the Medicare Program: An Opportunity to Improve Rural Health Care Systems?

View Draft Report The enactment of the Balanced Budget Act of 1997 (BBA) changed dramatically the context for discussions of Medicare policy. Policy discussions since the BBA have sharpened two major pathways for dialogue/debate: appropriate and equitable payment for services, either through traditional Medicare fee-for-service payments or through Medicare+Choice monthly premiums; and appropriate and necessary […]

The Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System

The Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices View Policy Paper This policy paper discusses the positions of various rural health advocates on the wage index and recording the actions taken by Congress and the Health Care Financing Administration (HCFA) to improve the wage index.Finally, it outlines […]

Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives For Legislative Proposals

View Policy Paper This Policy Paper combines the work from current projects of the Maine Rural Health Research Center (MRHRC) and the Rural Health Panel of the Rural Policy Research Institute (RUPRI) to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare […]

Calculating and Using the Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System

View policy brief This policy brief explains how the area wage index is calculated and used, and identifies the major unresolved issues related to its calculation and use. This report was written by Anthony Wellever (Delta Rural Health Consulting and Research) in collaboration with RUPRI Health Panel Members: Andrew Coburn, Charles Fluharty, J. Patrick Hart, […]

A Rural Assessment of Leading Proposals to Redesign the Medicare Program

View Report This Policy Paper provides a critique of two proposals to redesign the Medicare program: the “Medicare Preservation and Improvement Act of 1999” (S. 1895, introduced by Senator Breaux and others) and “The President’s Plan to Modernize and Strengthen Medicare for the 21st Century.” Rural implications of the proposals are discussed, specifically how they […]

A Report on Enrollment: Rural Medicare Beneficiaries in Medicare+Choice Plans

View Report This policy brief describes the experience to date with the Medicare+Choice program, focusing on changes in enrollment and plan formationthrough Fall 1999. We include a particular focus on changes occurring inrural counties. This updates previous reports by the RUPRI Health Panelon the progress of the Medicare+Choice program. This report was written by Health […]