title: Can market-based solutions work for all of Medicare? Barriers to reform in the Medicare population residing in health professional shortage areas.
abstract: The proportion of the Medicare-eligible population living in health professional shortage areas (HPSAs), their demographics, and three health status indicators were examined in relationship to market-based reform proposals. Medicare-eligible residents of Georgia and Kentucky were classified as living in an HPSA (n = 154,812) or non-HPSA (n = 556,602). Chi-squares were computed for demographic variables and health status indicators. A Mantel-Haenszel summary chi-square was computed after stratification of health status indicators by poverty level. Elderly residents of HPSAs accounted for 22% of the study population. Significant differences in all demographic variables except sex were detected. HPSA residents were more likely to have a mobility limitation, self-care limitation, or both a mobility and self-care limitation. Elderly residents in HPSAs are significantly more likely to have poorer health status and mobility limitations. Physician supply in HPSAs may be inadequate to support market-based reforms.
authors.affiliation: Department of Family Practice, University of Kentucky College of Medicine, Lexington 40536-0284, USA.
authors.forename: F P
authors.initials: FP
authors.lastname: Kohrs
mesh_terms: D000368:Aged; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D003710:Demography; D004465:Economic Competition; D005260:Female; D005845:Georgia / Q000453:epidemiology; D018166:Health Care Reform / Q000191:economics*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D008507:Medically Underserved Area; D006278:Medicare / Q000706:statistics & numerical data*; D010820:Physicians / Q000600:supply & distribution; D011203:Poverty / Q000145:classification; D014481:United States