Rural-Urban Differences in Employment-Related Health Insurance

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Abstract
Context: Rural residents are disproportionately represented among the uninsured in the United States. Purpose: We compared nonelderly adult residents in 3 types of nonmetropolitan areas with metropolitan workers to evaluate which characteristics contribute to lack of employment‐related insurance. Research Design and Analysis: Data were obtained from the Medical Expenditure Panel Survey, pooled across 3 panels (1996–1998) to enhance the rural sample size. Econometric decomposition was used to quantify the contribution of employment structure to differences in the probability of being offered employment‐related health insurance. Findings: The most rural workers are 10.4 percentage points less likely to be offered insurance compared with urban workers; the difference is smaller for residents of other rural areas. In rural counties not adjacent to urban areas, lower wages and smaller employers each account for about one‐third of the total difference. Conclusions: Health insurance disparities associated with rural residence are related to the structure of employment. Major factors include smaller employers, lower wages, greater prevalence of self‐employment, and sociodemographic characteristics.