ML20040E030
ML20040E030 | |
Person / Time | |
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Site: | Clinch River |
Issue date: | 11/30/1977 |
From: | ENERGY, DEPT. OF |
To: | |
Shared Package | |
ML20040E028 | List: |
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BHM-OPD-MAB, BMH-OPD-MAB, NUDOCS 8202020502 | |
Download: ML20040E030 (5) | |
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Report on Development of Criteria for Designation of Health Manpower Shortage Areas i
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l BFN/0PD/MAB November 1977 l
Report No. 78-03 l
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INTROCUCTION l
on Octcber 12, 1976,. a new sectim 332 entitled " Designation of Health Msnpower Shortage Areas" was added to the Public Health Service Act by
.puolic Iz.w 944S4, the Health Professions Educational Assistance-Act of.
1976., This section required that the Secretary of. Health, Education, and Welfare establish, by regulation, criteria for the designation of health manpower shortage areas.
Regulations implementing this provisim have been developed as 42 CFR Part % " Designation of Health Manpower Shortage Areas."
This report sets forth the considerations upon which the numerir*1 criteria contaired in the regulations are based.
Th'e criteria are being published as Interim-Final Regulations, and cor:::ents are welcome on both the criteria themselves and the methods used to develop them..%ese corw3nts will be considered in finalizing the Regulations and also in ongoing work to improve the shortage criteria, which will be revised at least annually.
As required by section 332(b), the regulations include criteria for the designation of areas, population groups, medical facilities, and other public facilities as health manpower shortage areas. As also required, practitioner-to-population ratios, infant mortality rates, health status, access to health services, other indicators of need, and the percentage of r physicians who are foreign medical graduates have been considered as factors in establishirs these criteria.
ne selection of specific criteria for health manpower shortages atterr.pt to reflect trajor Congressional objectives, as expressed in the House and Senate reports and in the specific wording of the Health Professions Educational Asristance Act of 1976.
Frm an examination of these sources, i
it appeared clear that Corgress intended that the new criteria for designation should:
o Permit designation of urban arees as well as rurcl areas (Senate Report No.94-887, p.196).
" Broaden the concept of shortage," by defining. shortage less o
stringently and by " going beyond ratios alone" (ibid, p. 197, paragraph 1).
Provide for designation.of population groups and facilities o
with shortages, as well as for ge graphic areas with shortages (Sec. 332 (a) (1)).
i Insure that " areas, population groups, and medical o
f acilities with a more severe need for the assignment of i
Corps pers nnel te assigned personnel on a priority basis" o
(Senate Report No.94-887, p.197, parrgraph 2).
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These ' objectives suggested the fonowing approach to developing new criteria for shortage area designation:
- 1) Liberalization of the ratio criteric previously used for the designation of " critical" medical and dental manp Ner shortage areas eligible to r.pply for National Health Service Corps personnal (cnder section 129(b) of the Public Health Service Act).
- 2) Inclusion of indicators of special health services need in the criteria. Although population-to-practitioner ratios remain the primst'y consideration, 8ection 132(b) requires. consideration of I
" indicators '.sf a need, notwithstanding the supply of health manpower, for health services...with special consideration to L
indicators.of (A) infant mrtality, (B) access to health services, and (C) health 8tstum. 2neretore, where suen incaicators show unusual 1Tmgn neea, the criteria set more liberal population-to-practitioner ratio levels for designation and indicate a high degree of shortage, suggesting higher priority for placement of personnel.
- 3) Inclusion of provisims for designation of population grrmps with special problems of access to health manpower and services within geograghic areas which, taken as a whole, might not have a health manpower shortage. 'Ibe approach used here, in general, was to apply the same criteria, as far as possible, to identifiable population groups as are applied to geographic areas. However, o
special provisim is included for designation of Indian ' ribes t
because of the special Federal obligation in that case.
- 4) Inclusion of provisions for designation of facilities serving designated areas or population groups and having a shortage of manpower to meet the needs of tne area or group. Because of their unique nature, special provisims are included for prisons and also for State mental hospitals.
- 5) Inclusion of provisims for dividing uesignated areas, population groups, or facilities into groupings by degree of shortage.
The selection of the specific factors and values contained in the criteria reflect a variety of considerations. Much of the follwing discussim is directed towards providing information on the sources of the selected
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. values for particulsr indicators rather than twards providing detailed O
. explicit justification for their selection. In a number of instances, examination of the distribution of values observed in dif ferent areas was the primary basis for determining criteria values. In some cases, a y
definitive study had been carried out.snd is simply referenced here. Where
- i no base data or definitive studies existed, the shortage criteria reflect
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program experience and professional judgement, as well as an intent to k
identify those areas with the most serious shortages.
Frequently, " ideal" 5
target ratios were mcdified so that program resources would be concentrated on areas with the most serinus shortages.
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ne report is divided into seven sections, one for each type of manpower for which criteria are presented in Part 5 i
A.
Primary Care Manpower Shortage Criteria
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1.
Population-to-Primary Care Physician Ratio Pcpulation-to-primary care physician ratios, by county, were obtained using 1974 Buresu of Census estimates of population and data on the ntrnber of non-Federal primary care physicians (M.D. and D.O.) active 'in patient care in 1974. Frczn these ratios, the following representative values were obtained:
mean 2,360:1 medi'an 2',475i1
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150% of mean 3,540:1 lowest quartile 3,580:1 ne value of 3,500:1 was chosen to indicate shortage for two reasons.
nis valt.e is approximately 1.5 times the mean value, and picks out approximately the lowest quarter of the country on a' county basis.
It was assumed that an area with a ratio 50 percent worse than the national county average muld not be providing adequate care.
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The value. of 2,500:1, approximataly the median, was chosen to indicate a relative adequacy level, those counties with more favorable ratioc (less than 2,500:1) probably do not place significant demands on the health care resources of==rhv =. raw. and some may have excess capacity which could hey Cc. a.: w.'.us a
.;:nr.igous c:caties. nose covnties with less favorable ratios (creater than 2,500:1), on the other hand,_prv. ably have no such 'c'xcess capacity."De criteria tiseYefore call' f6F prinary care ~
resources in contiguous areas with ratios lower than 2,500:1 to be taken into consideration.
' A value midway between these two, 3,000:1, was chosen 'as the value to which the shortage criterion may be reduced for areas where unusually high needs for primay medical care services or insufficient capacity of existing primary care providers is indic,ated.
2.
Rational areas.for the delivery of primary medical care services A number of studies suggest that utilization of medical services is seriously affected by travel times greater than 30 minutes. These include:
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4 Shannnn, G. W., Bashshur, R.t.., and Metzner, C. A.'
The concept of distunee as a fcctor in acce sibility of health care..Med. Care Rev.
, 26:14), 1969.
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Wisconsin Governor's Health Planning and Policy Task Force: ' Final Report. Madison, Wisconsin,1972.
Ccamorrsealth of Penn8ylvania Department of Health: 1975 Public I
Hearirgs on Critical Health Issues Towards Development of a State Comprehensive Health Plan. State Advisory Council on Comprehensive
- Health Planning, Harrisburg, Pennsylvania,1975.
Bai:ianac, E. M., Parkinson, M. A., and Hall, D. S. :. Gecgra@ic Access to hospital care: A 30-minute travel tirre standard. Med. Care 14:516, 1976.
,Preposed service areas should generally be defined to include alternative care mources which are located within short distances. For major urban areas, the population is so densely settled that such areas w:>uld contain large prpulation bases. The population figure of 20,000 suggested in the criteria as the minimum for urban neighborhoods is the minimu:n population used by the Bureau of the Census for aggrecating low-income census tracts into low-ineme neighborhoods.
(This would normally correspond to aboLit five census tracts.)
3.
Population Count Population adjustmen-J reflect visit rates to all office-based @ysicians, derived for 12 different ege-sex groups frcm the 1975 Health Interview Survey (HIS).. It was assumed that visit rates by age and sex to all office-based physicians are direct.ly related to the visit rates of primary care physicians for these age-sax groups.
In counting tourist populations, it is assumed that tourists do not have as heavy an impact as their numbers would suggest, because of their mobility, their ability to obtain routine, elective health care where they permanently reside, and their limited susceptibility to econanic and sociodemngrs@ic barriers in obtaining access to available health services.
The eriteria therefore call for inclusion of tourist populations in the total area population with a weight of 0.5 The impact of migrants is substantially different from that of tourists.
In addition to the innediate health problems which may arise while they are located in an area, migrant f armworkers and their dependents frequently have a backlog of unmet health care needs. However, they may well be uitable nr un.illing to utilize services in proportion to these needs while in a particular area, dde to scheduling difficulties and other problems related to their mobility. 'Ihe criteria therefore assume that migrant Q: 3 *.
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