Farmers and ranchers spend twice as much on health care, on average, than those who work off the farm, according to a report out Tuesday.

The average farmer or rancher spent $11,200 on health care, compared with $5,600 for non-farmers. That included premiums and out-of-pocket costs.

In Minnesota, 44 percent of farmers and ranchers reported spending more than 10 percent of their income on health care, according to the study, by the Access Project, a Boston-based think tank.

Farmers have a higher average income and are more likely to be insured than other Americans. But many of them buy health insurance directly or through an agent, which often is more expensive than group coverage through a large employer.

The 2007 study surveyed 2,017 non-corporate farm and ranch operators in Iowa, Minnesota, Missouri, Montana, Nebraska, North Dakota and South Dakota. An overview of the data was released a year ago and Tuesday's report provides further analysis.

Nearly a quarter of respondents said medical costs contributed to financial hardship for them or a household member.