title: Proposed changes to designations of medically underserved populations and health professional shortage areas: effects on rural areas.
abstract: This paper reports an analysis of the proposed rule to combine medically underserved population (MUP) and health professional shortage area (HPSA) designations, as published by the Bureau of Primary Health Care (BPHC) in the Federal Register on Sept. 1, 1998 (Department of Health and Human Services, 1998). The effects of the proposed rule overall and on rural communities were examined, particularly with respect to current whole county HPSA designations and eligibility for federal assistance programs. National, county-level estimates of primary care provider counts and other measures included in the proposed rule were used. Different primary care provider sources were compared; results were highly dependent on the data source and the inclusions of counts of nurse practitioners and physician assistants. The projections of losses from the proposed rule were higher than those of the BPHC, probably due to the use of different sources for provider counts. Overall, the authors projected that more than 50 percent of current whole-county HPSAs would lose designation using the proposed rule. The proportion of rural counties that lost designation was not significantly greater than the proportion of urban counties, but because there are many more rural counties, more de-designations were projected to occur in rural areas. The researchers also predicted that 58 percent of rural whole-county HPSAs with National Health Service Corps providers would lose their designation, but most rural whole-county HPSAs with Community and Migrant Health Centers or Rural Health Clinics retained their MUP designation using the proposed rule. The proposed rule likely has a larger effect on current designations than originally projected by the BPHC.
authors.affiliation: Sheps Center for Health Services Research, University of North Carolina at Chapel Hill 27599-7590, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Goldsmith
authors.forename: T C
authors.initials: TC
authors.lastname: Ricketts
mesh_terms: D003627:Data Interpretation, Statistical; D006302:Health Services Research; D006305:Health Status Indicators; D006280:Health Workforce / Q000145:classification*; D006801:Humans; D008507:Medically Underserved Area; D020380:Needs Assessment / Q000458:organization & administration; D009657:North Carolina; D009722:Nurse Practitioners / Q000600:supply & distribution; D009936:Organizational Innovation; D010823:Physician Assistants / Q000600:supply & distribution; D011320:Primary Health Care; D015397:Program Evaluation; D019035:Rural Health Services