Goldsmith L J, Ricketts T C
Sheps Center for Health Services Research, University of North Carolina at Chapel Hill 27599-7590, USA.
J Rural Health. 1999 Winter;15(1):44-54. doi: 10.1111/j.1748-0361.1999.tb00597.x.
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.
本文报告了对初级卫生保健局（BPHC）于1998年9月1日在《联邦公报》上发布的关于合并医疗服务不足人群（MUP）和卫生专业人员短缺地区（HPSA）指定的拟议规则的分析（美国卫生与公众服务部，1998年）。研究了拟议规则对整体以及农村社区的影响，特别是关于当前全县范围的HPSA指定情况以及联邦援助项目的资格。使用了拟议规则中包含的全国和县级初级保健提供者数量估计以及其他指标。对不同的初级保健提供者来源进行了比较；结果高度依赖于数据源以及执业护士和医师助理数量的纳入情况。拟议规则导致的损失预测高于BPHC的预测，这可能是由于提供者数量使用了不同的来源。总体而言，作者预计使用拟议规则将有超过50%的当前全县范围的HPSA失去指定。失去指定的农村县的比例并不显著高于城市县的比例，但由于农村县数量更多，预计农村地区会有更多的取消指定情况发生。研究人员还预测，有国家卫生服务队提供者的农村全县范围的HPSA中有58%将失去其指定，但使用拟议规则，大多数有社区和流动卫生中心或农村卫生诊所的农村全县范围的HPSA保留了其MUP指定。拟议规则对当前指定的影响可能比BPHC最初预测的更大。
