Rural Health
Resources by Topic: Medical debt
Disparities in Rural–Urban Cancer Care Outcomes Among Pediatric, Adolescent, and Young Adult Populations: A Comprehensive Narrative Review
Literature review examining research on rural-urban disparities in cancer outcomes and access to care among children aged 0-18 and adolescents and young adults aged 15-39 years. Covers topics including distance to care, cancer incidence, social determinants of health, access to specialized oncology services, mortality, financial toxicity, supportive and survivorship care, and clinical trial access.
Author(s): Olivia C. Burke, Wencesley A. Paez
Citation: Cancer Epidemiology, Biomarkers & Prevention
Date: 06/2026
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Literature review examining research on rural-urban disparities in cancer outcomes and access to care among children aged 0-18 and adolescents and young adults aged 15-39 years. Covers topics including distance to care, cancer incidence, social determinants of health, access to specialized oncology services, mortality, financial toxicity, supportive and survivorship care, and clinical trial access.
Author(s): Olivia C. Burke, Wencesley A. Paez
Citation: Cancer Epidemiology, Biomarkers & Prevention
Date: 06/2026
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Survivor Views on Rural Health
Presents findings from a survey of rural, urban, and suburban cancer patients and survivors on healthcare affordability, medical debt, provider access, cancer screening, patient navigation services, and other topics related to access to care.
Date: 05/2026
Sponsoring organization: American Cancer Society Cancer Action Network (ACS CAN)
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Presents findings from a survey of rural, urban, and suburban cancer patients and survivors on healthcare affordability, medical debt, provider access, cancer screening, patient navigation services, and other topics related to access to care.
Date: 05/2026
Sponsoring organization: American Cancer Society Cancer Action Network (ACS CAN)
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Navigating Dual Burdens: Financial Burdens and Travel Burdens Among Rural-Dwelling Cancer Survivors
Evaluates the significance simultaneous financial toxicity and healthcare-related travel burden among 12 cancer survivors living in rural North Carolina. Details cancer survivors' responses to financial and travel burdens, including discussion of cost-saving methods, travel strategies, shared burden with caregivers, experiences with financial assistance programs, and more.
Author(s): Arrianna Marie Planey, Michelle L. Manning, Mindy Gellin, et al.
Citation: Cancer Control, 33
Date: 04/2026
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Evaluates the significance simultaneous financial toxicity and healthcare-related travel burden among 12 cancer survivors living in rural North Carolina. Details cancer survivors' responses to financial and travel burdens, including discussion of cost-saving methods, travel strategies, shared burden with caregivers, experiences with financial assistance programs, and more.
Author(s): Arrianna Marie Planey, Michelle L. Manning, Mindy Gellin, et al.
Citation: Cancer Control, 33
Date: 04/2026
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Patient-Centered Burdens and Economic Outcomes among Patients Who Are Veterans, People with Intellectual and Developmental Disabilities, and People Living in Rural Areas and Their Caregivers: A Scoping Review
Provides a literature review on patient-centered burdens and economic outcomes (PCBEOs) for military veterans, people with intellectual and developmental disabilities (IDD), and people living in rural areas. Includes 126 studies from 2015-2025 and examines for PCBEOs such as direct medical and non-medical monetary costs, indirect impacts such as unpaid caregiving and time off work, and intangible burdens such as delayed career advancement. Discusses emotional and psychological strain of PCBEOs among these groups.
Author(s): Naomi Buell, Ella Shenkar, Sydney Kirsch, et al.
Citation: Frontiers in Public Health, 14
Date: 04/2026
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Provides a literature review on patient-centered burdens and economic outcomes (PCBEOs) for military veterans, people with intellectual and developmental disabilities (IDD), and people living in rural areas. Includes 126 studies from 2015-2025 and examines for PCBEOs such as direct medical and non-medical monetary costs, indirect impacts such as unpaid caregiving and time off work, and intangible burdens such as delayed career advancement. Discusses emotional and psychological strain of PCBEOs among these groups.
Author(s): Naomi Buell, Ella Shenkar, Sydney Kirsch, et al.
Citation: Frontiers in Public Health, 14
Date: 04/2026
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A Stubborn Problem: Unaffordable Health Costs Continue to Strain Californians' Finances
Examines healthcare affordability in California from 2019 to 2024, comparing pre-COVID-19 pandemic experiences to after the pandemic had subsided, alongside the implementation of related state and federal policy impacting affordability. Provides percentages of Californians who have trouble paying medical bills, who use credit cards to pay medical bills, who have private insurance with deductibles above $2,000, and more, according to coverage type, demographics, region, and rural versus urban location.
Date: 03/2026
Sponsoring organization: State Health Access Data Assistance Center
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Examines healthcare affordability in California from 2019 to 2024, comparing pre-COVID-19 pandemic experiences to after the pandemic had subsided, alongside the implementation of related state and federal policy impacting affordability. Provides percentages of Californians who have trouble paying medical bills, who use credit cards to pay medical bills, who have private insurance with deductibles above $2,000, and more, according to coverage type, demographics, region, and rural versus urban location.
Date: 03/2026
Sponsoring organization: State Health Access Data Assistance Center
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Financial Assistance Policy, Hospital Charity Care, and Medical Debt in Collections
Explores whether Oregon's state-level financial assistance policy (FAP) was associated with a lower percentage of the population with medical debt in collections, increase in hospital charity care, and decrease in bad debt in the first 3 years after implementation. Compares county- and hospital-level data from Oregon with data from a sample of hospitals that expanded Medicaid in 2014 but had not implemented a state-level FAP by 2022. Supplemental content includes data by metropolitan and non-metropolitan status.
Author(s): Tatiane Santos, Richard C. Lindrooth, Gary J. Young, Shoou-Yih Lee
Citation: JAMA Network Open, 9(1), e2555698
Date: 01/2026
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Explores whether Oregon's state-level financial assistance policy (FAP) was associated with a lower percentage of the population with medical debt in collections, increase in hospital charity care, and decrease in bad debt in the first 3 years after implementation. Compares county- and hospital-level data from Oregon with data from a sample of hospitals that expanded Medicaid in 2014 but had not implemented a state-level FAP by 2022. Supplemental content includes data by metropolitan and non-metropolitan status.
Author(s): Tatiane Santos, Richard C. Lindrooth, Gary J. Young, Shoou-Yih Lee
Citation: JAMA Network Open, 9(1), e2555698
Date: 01/2026
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Chronic Health Conditions and Health Care Affordability Issues among U.S. Rural and Urban Adults
Analyzes associations between chronic health conditions and likelihood of experiencing healthcare affordability issues among rural and urban populations, utilizing 2022 National Health Interview Survey data. Examines rural and urban prevalence of individual chronic conditions, chronic condition multimorbidity, problems paying medical bills, and inability to pay medical bills.
Author(s): Ingrid Jacobson, Alexis Swendener, Hannah MacDougall, Carrie Henning-Smith
Citation: Journal of Multimorbidity and Comorbidity, 15
Date: 11/2025
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Analyzes associations between chronic health conditions and likelihood of experiencing healthcare affordability issues among rural and urban populations, utilizing 2022 National Health Interview Survey data. Examines rural and urban prevalence of individual chronic conditions, chronic condition multimorbidity, problems paying medical bills, and inability to pay medical bills.
Author(s): Ingrid Jacobson, Alexis Swendener, Hannah MacDougall, Carrie Henning-Smith
Citation: Journal of Multimorbidity and Comorbidity, 15
Date: 11/2025
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Associations Between Insurance Status, Financial Hardship, and Rurality on Receipt of Guideline-Concordant Mammography
Analyzes associations between receipt of ACS or USPSTF guideline-concordant mammography and factors including healthcare-related financial hardship, insurance status, and rurality, utilizing 2023 National Health Interview Survey data of 11,138 women. Includes data on interactions between healthcare-related financial hardship and rurality within the context of access to mammography.
Author(s): Nicole E. Caston, Lisa P. Spees, Austin R. Waters, Stephanie B. Wheeler
Citation: Cancer Epidemiology, Biomarkers & Prevention
Date: 09/2025
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Analyzes associations between receipt of ACS or USPSTF guideline-concordant mammography and factors including healthcare-related financial hardship, insurance status, and rurality, utilizing 2023 National Health Interview Survey data of 11,138 women. Includes data on interactions between healthcare-related financial hardship and rurality within the context of access to mammography.
Author(s): Nicole E. Caston, Lisa P. Spees, Austin R. Waters, Stephanie B. Wheeler
Citation: Cancer Epidemiology, Biomarkers & Prevention
Date: 09/2025
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Preventing Medical Debt among Rural Residents: Example Programs from Hospitals in Minnesota and Montana
Highlights the ways some rural hospitals are working to reduce medical debt for their patients. Presents a number of strategies from hospitals in Minnesota and Montana that aim to reduce patient medical debts through financial assistance programs and cost-cutting measures. Features case-studies reviewing the structure of each hospital's debt reduction efforts.
Author(s): Katie Rydberg, Sushma Shankar, Mariana Tuttle, Carrie Henning-Smith
Date: 06/2025
Sponsoring organization: University of Minnesota Rural Health Research Center
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Highlights the ways some rural hospitals are working to reduce medical debt for their patients. Presents a number of strategies from hospitals in Minnesota and Montana that aim to reduce patient medical debts through financial assistance programs and cost-cutting measures. Features case-studies reviewing the structure of each hospital's debt reduction efforts.
Author(s): Katie Rydberg, Sushma Shankar, Mariana Tuttle, Carrie Henning-Smith
Date: 06/2025
Sponsoring organization: University of Minnesota Rural Health Research Center
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The Relationship Between Low Social/Emotional Support and Health Care Affordability Among Rural and Urban Residents
Highlights a study examining rural and urban differences in the effect social and emotional supports have on the health and financial impacts of healthcare costs. Breaks down data by feelings about medical bills, age, insurance type, and rural versus urban location, among other measures.
Author(s): Ingrid Jacobson, Katie Rydberg, Alexis Swendener, et al.
Citation: Journal of Rural Health, 41(2), e70034
Date: 05/2025
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Highlights a study examining rural and urban differences in the effect social and emotional supports have on the health and financial impacts of healthcare costs. Breaks down data by feelings about medical bills, age, insurance type, and rural versus urban location, among other measures.
Author(s): Ingrid Jacobson, Katie Rydberg, Alexis Swendener, et al.
Citation: Journal of Rural Health, 41(2), e70034
Date: 05/2025
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