Politzer R M, Hardwick K S, Cultice J M, Bazell C
J Rural Health. 1999 Winter;15(1):11-20. doi: 10.1111/j.1748-0361.1999.tb00594.x.
Most policy-makers and researchers agree that although the United States is headed for a significant physician surplus, problems of equity in access to care still remain. To help meet this challenge, Title VII of the Public Health Service Act focuses on producing generalist physicians to serve in medically underserved areas (MUAs). This study estimates the impact Title VII support for generalist training has on reducing and eliminating health professional shortage areas (HPSAs) under multiple scenarios that vary either the Title VII funding level or the percentage of Title VII-funded program graduates who practice in MUAs. For each scenario, the number of Title VII-funded residency graduates who initially practice in MUAs and the time it would take to eliminate HPSAs are estimated. Using 1996 rates, the analysis predicts that 1,214 generalist physicians will enter practice in HPSAs annually, leading to elimination of HPSAs in 24 years. In 1997, Title VII-funded programs increased the rate of graduates entering HPSAs, resulting in 1,357 providers and reducing the time for HPSA elimination to 15 years. Doubling the funding for these programs would increase the number of Title VII-funded generalist physicians entering MUAs and could decrease the time for HPSA elimination to as little as 6 years. The study concludes that eliminating HPSAs requires broader Title VII influence and continuous improvement in rates of production of graduates who practice in MUAs. Without Title VII graduates and continuous improvement of Title VII program, MUA rates, the number of HPSAs and the number of Americans with reduced access to essential health care will continue to expand.
大多数政策制定者和研究人员都认为，尽管美国即将面临严重的医生过剩问题，但获得医疗服务的公平性问题依然存在。为应对这一挑战，《公共卫生服务法》第七章着重培养全科医生，以服务于医疗服务欠缺地区（MUA）。本研究评估了在多种情景下，《公共卫生服务法》第七章对全科医生培训的支持对减少和消除卫生专业人员短缺地区（HPSA）的影响，这些情景包括改变《公共卫生服务法》第七章的资金水平，或改变在MUA执业的由该章资助项目毕业生的比例。对于每种情景，都估计了最初在MUA执业的由《公共卫生服务法》第七章资助的住院医师毕业生数量，以及消除HPSA所需的时间。根据1996年的比率，分析预测每年将有1214名全科医生进入HPSA执业，24年后可消除HPSA。1997年，由《公共卫生服务法》第七章资助的项目提高了毕业生进入HPSA的比率，使得有1357名医疗服务提供者进入，将消除HPSA的时间缩短至15年。将这些项目的资金翻倍将增加进入MUA的由《公共卫生服务法》第七章资助的全科医生数量，并可能将消除HPSA的时间缩短至仅6年。该研究得出结论，消除HPSA需要《公共卫生服务法》第七章发挥更广泛的影响，并持续提高在MUA执业的毕业生产出率。如果没有《公共卫生服务法》第七章的毕业生以及该章项目和MUA比率的持续改善，HPSA的数量以及获得基本医疗服务机会减少的美国人数量将继续增加。
