LENGTHENING SPELLS OF UNINSURANCE AND THEIR CONSEQUENCES

The lengths of time adults are without health insurance have increased since 1988, as shown by data from 1,235 household interviews complete d during 1992 in Nebraska. Rural residents without insurance have expe rienced longer such spells than their urban counterparts. Thus, while rates of uninsurance are nearly the same between urban and rural resid ents, important differences exist. The relationship between insurance status and physician utilization is consistent during the five years ( 1989 to 1993) covered in this study. Continuously insured persons have the most physician visits, followed by those intermittently insured, followed by those continuously uninsured. The number of physician visi ts was expected to increase when respondents moved from uninsured to i nsured status. However, among urban respondents, the number of visits declined; among residents in rural frontier counties (fewer than six p ersons per square mile) and for respondents in rural nonfrontier count ies, there was no significant difference. This study points out some d ifferences between rural and urban populations regarding insurance sta tus, even when the overall rates of uninsurance are equal.