June 29, 2004

LINCOLN, Neb. — Most rural Nebraskans generally are satisfied with their medical care, but costs are a worry and more than a quarter have had trouble paying for care, according to the University of Nebraska's ninth annual Nebraska Rural Poll.

More than 80 percent of people polled said they were satisfied with their physician's care and the condition of medical facilities. Seventy-six percent were satisfied with the variety of medical services available, 73 percent with the level of technology available at medical offices and 70 percent with their distance from medical services.

"As long as people are content with their relationship with their doctor, they're almost always satisfied with the whole system," said Randy Cantrell, a rural sociologist in the university's Institute of Agriculture and Natural Resources. Surveys were mailed in February and March to 6,300 randomly selected households in Nebraska's 84 rural counties. Results are based on 2,915 responses.

Costs top the dissatisfaction list. Seventy-eight percent of respondents were dissatisfied with health insurance costs, 68 percent with medical costs and 55 percent with health insurance coverage.

While 7 percent of rural Nebraskans were uninsured, according to the poll, more than a quarter faced a medical financial hardship in the past year.

Twenty-eight percent said they had trouble paying for necessary medical care, didn't see a doctor when needed because of cost or had difficulty paying for prescriptions, the poll showed. Nearly 20 percent reported reducing a prescribed drug dosage to save money and 16 percent said they quit taking prescriptions because of cost.

"Almost one in three is having difficulty," said John Allen, the IANR rural sociologist who conducts the rural poll. "The seniors are having trouble paying for prescriptions and the young people are having trouble paying for care."

The uninsured aren't the only ones struggling will costs, Allen said, which may indicate some rural residents are underinsured.

The poll found that more than half of rural Nebraskans have health insurance through work, 30 percent have insurance through a government program, such as Medicare or Medicaid, and 21 percent buy their own. For comparison, U.S. Census data for 2002 indicated 61 percent of all Americans are insured through work, 25 percent receive federal insurance and 9 percent buy it themselves.

Nationwide, 15 percent of Americans are uninsured as are nearly 10 percent of all Nebraskans. Rural Nebraska's lower proportion of uninsured residents is primarily because of its large population of elderly who are covered by Medicare, Allen said.

"My concern is that people will look at this and say 'Nebraska is doing better,' when it's really just that we have lost a lot of young people," he said. "The status quo works because we have an aging population."

Health care cost concerns are tied to age, the poll found. While 2 percent of people over 65 are uninsured, 18 percent of people ages 19-29 have no insurance. Among people 19 to 29, 44 percent said costs prevented them from seeing a doctor for needed care compared with 10 percent for those 65 and older. Among people under 65, at least 70 percent said they were dissatisfied with medical costs compared with 56 percent for those 65 and older.

"If we manage to recruit younger people to rural areas, they may not have access to care and will be more dissatisfied, especially if we are creating low-paying jobs," Allen said.

Rural Nebraskans already earn less, on average, than their urban neighbors, Cantrell pointed out.

"The poorer you are, the harder it is to get health care, the harder it is to pay for it if you get it, the more difficult traveling will be and the more likely you are to forego treatment because of cost," he said.

People's concerns about holding onto health insurance have economic implications. A fifth of rural Nebraskans kept or took a job in the past year for health insurance, the poll found.

"If we see entrepreneurship as a driving force in the economy and we have this high number of people holding onto jobs for the insurance, there's a chance that we are stifling what we need most," Cantrell said, which is people willing to launch new businesses on their own.

"The new wage in rural Nebraska may be health care, if you look at the number of people taking or keeping jobs for insurance," Allen agreed.

Pharmacies are the most accessible health care service for rural Nebraskans, the poll found. Within 15 miles, 76 percent of respondents had access to a pharmacy, 68 percent had a doctor or health clinic and 66 percent had a dentist. Statewide, nearly a quarter of respondents said they had to drive more than 60 miles for specialized health care and 11 percent were that distance from mental health services.

"Right now, we still have access to medical care in rural areas," Allen said. "With the aging rural physician population and the difficulty with recruiting new doctors, this could change over time."

The scientific poll is the largest annual survey of rural Nebraskans' perceptions on quality of life and policy issues. This year's response rate was 47 percent. The margin of error is plus or minus 3 percent.

Complete results are available online at Nebraska Rural Poll.

The poll is conducted by the university's Center for Applied Rural Innovation with funding from the Partnership for Rural Nebraska and IANR's Cooperative Extension Division and Agricultural Research Division.

6/29/04-VM

Contacts:

Becky Vogt
Center for Applied Rural Innovation
Nebraska Rural Poll Project Manager
(402) 329-4821

John Allen - Ph.D.
Rural Sociology
Professor
(402) 472-1772

Randy Cantrell - Ph.D.
Center for Applied Rural Innovation
Professor
(402) 472-1772

Vicki Miller
Research Communications Coordinator
(402) 472-3813

Department:
Center for Applied Rural Innovation