Mueller Keith J, Stoner Julie A, Shambaugh-Miller Michael D, Lucas Woodrow O, Pol Louis G
Department of Preventive and Societal Medicine, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE 68198-4350, USA.
J Rural Health. 2003 Fall;19(4):450-60. doi: 10.1111/j.1748-0361.2003.tb00582.x.
Public policymakers and their advisers struggle with the problem of specifying criteria by which health care providers in rural areas are eligible for special consideration in payment policies and for special grant programs. A means of designating places can provide a basis for assistance and can help target public resources for any providers who deliver services in those places.
This paper provides the details underlying a place-based approach to identifying rural areas that are at risk for not being able to provide requisite health services.
A population size criterion is utilized first to eliminate metropolitan areas and other large agglomerations from consideration. Any territory not included in a place of 3500 or more people, including a 25-mile buffer around that place, is a priori considered to be at risk. All places, including buffers, that have populations between 3500 and 100,000 are further analyzed using population compositional data and principal components analysis.
In 10 states and 24 bordering states selected for developing and testing the method, there were 1907 block groups outside the boundaries of any place with a population of at least 3500. In addition, the analysis suggested that 66 out of 236 places and buffers with populations between 3500 and 100,000 also should be classified as vulnerable.
The results are discussed in regard to how a place-based approach can advance the study of rural health needs. By focusing on the needs of the people residing in a defined area, as determined from the aggregate characteristics of the population, a model is generated that can be used to predict special circumstances confronting any service provider. The public policy implications of the findings are also considered. Special payment policies could be written on the basis of place instead of provider characteristics, and grant programs providing technical assistance could be targeted to places of greatest need.
公共政策制定者及其顾问在确定农村地区医疗服务提供者有资格在支付政策和特殊拨款计划中获得特殊考虑的标准这一问题上颇费周折。指定地点的方法可为援助提供依据，并有助于将公共资源定向用于在这些地点提供服务的任何提供者。
本文详述了一种基于地点的方法，用于识别可能无法提供必要医疗服务的农村地区。
首先采用人口规模标准，将大都市地区和其他大型聚居区排除在外。任何未包含在人口为3500人或以上的地点（包括该地点周围25英里的缓冲区）内的区域，都被预先视为有风险区域。所有人口在3500至100000之间的地点（包括缓冲区），都使用人口构成数据和主成分分析进行进一步分析。
在选定用于开发和测试该方法的10个州和24个接壤州中，有1907个街区组位于人口至少为3500人的任何地点的边界之外。此外，分析表明，在236个人口在3500至100000之间的地点和缓冲区内，有66个也应被归类为易受影响地区。
讨论了基于地点的方法如何能够推进农村医疗需求研究的结果。通过关注根据人口总体特征确定的特定区域内居民的需求，生成了一个可用于预测任何服务提供者所面临特殊情况的模型。还考虑了研究结果对公共政策的影响。可以根据地点而非提供者特征制定特殊支付政策，并且提供技术援助的拨款计划可以针对最需要的地区。
