Graduate Thesis Or Dissertation


Health Service Utilization among Medicaid Enrollees in Oregon : Assessing Variation by Level of Rurality Public Deposited

Downloadable Content

Download PDF


Attribute NameValues
  • Research Objective: Nearly 60 million people in the United States reside in a rural area. Residents in rural areas have higher rates of chronic disease, risky health behaviors, disability, infant mortality, and age-adjusted mortality than their urban counterparts. Health insurance and access to care mitigate those risks, in part because insured persons are more likely to receive preventive care. Before implementation of the Affordable Care Act (ACA), 16% of the US population was uninsured. By 2016 the uninsured rate dropped to 10.5%. Many of those obtained coverage through state Medicaid expansion. It is important to understand how those newly enrolled in Medicaid are utilizing care, especially in more rural parts of the US where access may be more challenging. This study examined whether there were differences across levels of rurality in preventive and behavioral health service utilization among new expansion enrollees in Oregon compared to those previously enrolled. Study Design: This study used a quasi-experimental, retrospective cohort design utilizing: Oregon Medicaid claims and eligibility, as well as Rural Urban Commuting Areas (RUCAs), American Community Survey, and Health Resources and Services Administration Primary Care Service Area data. Linear probability models were used to estimate the effect of rurality on preventive and behavioral health service utilization among new versus previous Medicaid enrollees. Additionally, this study examined the effects of continuity of coverage on health service utilization by level of rurality among those newly enrolled and previous enrollees. Models controlled for age, sex, race, ethnicity, eligibility category, chronic conditions, and enrollment in a Medicaid accountable care organization (Coordinated Vare Organization or CCO) as well as the number of primary care providers per population, and median home value.
Resource Type
Date Issued
Degree Level
Degree Name
Degree Field
Degree Grantor
Commencement Year
Committee Member
Academic Affiliation
Rights Statement
Peer Reviewed
Embargo reason
  • Pending Publication
Embargo date range
  • 2018-06-29 to 2018-09-28



This work has no parents.

In Collection: