Designating Places and Populations as Medically Underserved: A Proposal for a New Approach

This article describes the development of a theory-based, data-driven replacement for the Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA) designation systems. Data describing utilization of primary medical care and the distribution of practitioners were used to develop estimates of the effects of demographic and community characteristics on use of primary medical care. A scoring system was developed that estimates each community's effective access to primary care. This approach was reviewed and contributed to by stakeholder groups. The proposed formula would designate over 90% of current geographic and low-income population HPSA designations. The scalability of the method allows for adjustment for local variations in need and was considered acceptable by stakeholder groups. A data-driven, theory-based metric to calculate relative need for geographic areas and geographically-bounded special populations can be developed and used. Its use, however, requires careful explanation to and support from affected groups.

[1]  R. Andersen.  Revisiting the behavioral model and access to medical care: does it matter? , 1995, Journal of health and social behavior.

[2]  Gary Higgs,et al.  Measuring Potential Access to Primary Healthcare Services: The Influence of Alternative Spatial Representations of Population , 2006 .

[3]  I. S. Falk,et al.  The Development of Standards for the Audit and Planning of Medical Care: Pathways among Primary Physicians and Specialists for Diagnosis and Treatment , 1968 .

[4]  M. Parchman,et al.  Primary care physicians and avoidable hospitalizations. , 1994, The Journal of family practice.

[5]  M. Guagliardo,et al.  International Journal of Health Geographics Open Access Spatial Accessibility of Primary Care: Concepts, Methods and Challenges , 2022 .

[6]  Woodwell Da.  National Ambulatory Medical Care Survey: 1997 summary. , 1999 .

[7]  S D Culler,et al.  Preventable hospitalizations in primary care shortage areas. An analysis of vulnerable Medicare beneficiaries. , 1999, Archives of family medicine.

[8]  Mei-Cheng Wang,et al.  Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis. , 1997, American journal of public health.

[9]  E. Fisher,et al.  Benchmarking the US physician workforce. An alternative to needs-based or demand-based planning. , 1996, JAMA.

[10]  R. Wilson,et al.  Are "medically underserved areas" medically underserved? , 1977, Health services research.

[11]  R. Andersen,et al.  Societal and individual determinants of medical care utilization in the United States. , 1973, The Milbank Memorial Fund quarterly. Health and society.

[12]  L. Berkman,et al.  Neighborhoods and health , 2003 .

[13]  J. House,et al.  Socioeconomic Inequalities in Health: Integrating Individual-, Community-, and Societal-Level Theory and Research , 2000 .

[14]  C. Schur,et al.  Ability to obtain health care: recent estimates from the Robert Wood Johnson Foundation National Access to Care Survey. , 1995, Health affairs.

[15]  T. Ricketts,et al.  How many rural doctors do we have? , 2000, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[16]  G. Albrecht,et al.  The Handbook of Social Studies in Health and Medicine , 2003 .

[17]  Richard A. Wright,et al.  Finding the Medically Underserved: A Need to Revise the Federal Definition , 1996, Journal of health care for the poor and underserved.

[18]  S. Robert.  Neighborhood Socioeconomic Context and Adult Health: The Mediating Role of Individual Health Behaviors and Psychosocial Factors , 1999, Annals of the New York Academy of Sciences.

[19]  R. Cooper.  Perspectives on the Physician Workforce to the Year 2020 , 1995 .

[20]  S V Subramanian,et al.  Race/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures--the public health disparities geocoding project. , 2003, American journal of public health.

[21]  Wei Luo,et al.  Using a GIS-based floating catchment method to assess areas with shortage of physicians. , 2004, Health & place.

[22]  S. Altman,et al.  America's Health Care Safety Net: Intact but Endangered , 2000 .

[23]  Berk Ml,et al.  The use and availability of medical care in health manpower shortage areas. , 1983 .

[24]  Lu Ann Aday,et al.  Development of indices of access to medical care , 1975 .

[25]  T. Ricketts.  Rural health in the United States , 1999 .

[26]  D. Cherry,et al.  National Ambulatory Medical Care Survey: 1999 Summary , 2001 .

[27]  C. Mansfield,et al.  Premature mortality in the United States: the roles of geographic area, socioeconomic status, household type, and availability of medical care. , 1999, American journal of public health.

[28]  T. Ricketts,et al.  Proposed changes to designations of medically underserved populations and health professional shortage areas: effects on rural areas. , 1999, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[29]  S. Schroeder.  Benchmarking the Physician Workforce-Reply , 1997 .

[30]  J. Marshall,et al.  Infant mortality: a multi-level analysis of individual and community risk factors. , 1998, Social science & medicine.