The Ohio State University, 208 Cunz Hall, 1841 Neil Ave, Columbus, OH 43210. Email:
Am J Manag Care. 2021 May;27(5):212-216. doi: 10.37765/ajmc.2021.88581.
To determine whether enough primary care providers are in close proximity to where dual-eligible beneficiaries live to provide the capacity needed for integrated care models.
Secondary data analysis using dual-eligible enrollment data and health care workforce data.
We determined the density of dual-eligible beneficiaries per 1000 population in 2017 for each of 3142 US counties. County-level supply of primary care physicians (PCPs), primary care nurse practitioners, and physician assistants was determined.
One-third of the 791 counties with the highest density of dual-eligible beneficiaries had PCP shortages. Counties with the highest density of dual-eligible beneficiaries and the fewest primary care clinicians of any type were concentrated in Southeastern states. These areas also had some of the highest coronavirus disease 2019 outbreaks within their states.
States in the Southeastern region of the United States with some of the most restrictive scope-of-practice laws have an inadequate supply of primary care providers to serve a high concentration of dual-eligible beneficiaries. The fragmented care of the dually eligible population leads to extremely high costs, prompting policy makers to consider integrated delivery models that emphasize primary care. However, primary care workforce shortages will be an enduring challenge without scope-of-practice reforms.
确定是否有足够数量的初级保健服务提供者在双重合格受益人居住的附近，以提供综合护理模式所需的能力。
使用双重合格登记数据和医疗保健劳动力数据进行二次数据分析。
我们确定了 2017 年美国 3142 个县中每 1000 名居民中双重合格受益人的密度。确定了初级保健医生（PCP）、初级保健护士从业者和医师助理的县级供应情况。
在受益密度最高的 791 个县中，有三分之一的县 PCP 短缺。受益密度最高且任何类型的初级保健临床医生最少的县集中在东南部各州。这些地区在其州内也爆发了一些 COVID-19 疫情。
美国东南部一些实施范围最严格的执业法的州，提供初级保健服务的提供者数量不足，无法为高度集中的双重合格受益人提供服务。双重合格人群的分散护理导致极高的成本，促使政策制定者考虑强调初级保健的综合交付模式。然而，如果不进行执业范围的改革，初级保健劳动力短缺将是一个持久的挑战。
