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Briefing
Declining access to health care in northern New England
Access to health care is a major concern across the northern New England states?Maine, New Hampshire, and Vermont?where rising operating costs and population loss threaten the stability of hospitals and other medical facilities that serve their surrounding rural communities. New analysis of financial data shows that many rural hospitals are operating at losses that are predictive of financial distress or even closure. Consequently, the communities served by these hospitals may be at risk of losing the benefits they provide to public health and the local economy. Addressing the financial ...
Briefing
Aging and declining populations in northern New England: is there a role for immigration?
In hundreds of communities across northern New England, the population is aging rapidly and becoming smaller. The entire country is aging, but northern New England stands out: Among the populations of all US states, those of Maine, New Hampshire, and Vermont have the top-three highest median ages, respectively. The situation is even more extreme in northern New England?s rural counties, where the populations of the smallest towns generally are substantially older than those of the rest of the region. These communities also have seen the slowest, or even negative, population growth over the ...
Working Paper
The Consequences of Medicare Pricing: An Explanation of Treatment Choice
Primary care physicians (PCPs) provide more specialty procedures in less-urban areas, where specialists are fewer. Using a structural random-coefficient model and the demographic and time variation in the data, this paper shows that changes in policy-set reimbursements lead to a reallocation of the suddenly-more-remunerative procedures away from specialists and toward PCPs, and this effect is stronger, the more rural an area is. A reimbursement-unit increase for a given procedure leads to outside-metro PCPs gaining 7-15% market share more than metro PCPs in that procedure, at the expense of ...
Working Paper
Rural Affordable Rental Housing : Quantifying Need, Reviewing Recent Federal Support, and Assessing the Use of Low Income Housing Tax Credits in Rural Areas
Recently, there has been significant interest in the high levels of rental cost burden being experienced across the United States. Much of this scholarship has focused on rental cost burdens in larger urban areas, or at the national level, and has not explored differences in the prevalence of rental cost burden in urban versus rural communities. In this paper, I find that rental cost burdens are a challenge facing both urban and rural communities. However, despite the need for affordable rental housing in rural communities identified, I find the amount of resources made available by the ...
Briefing
School Quality as a Tool for Attracting People to Rural Areas
Many rural localities are interested in strategies for retaining residents and attracting newcomers. Recent research indicates that one promising strategy for rural development is maintaining and improving the quality of an area’s public schools. In this research, which is the first national study of the relationship between school quality and migration flows in and out of rural areas, better outcomes for students in a rural county’s schools were associated with higher migration into that county.