Kviz F J, Flaskerud J H
Med Care. 1984 Oct;22(10):877-89. doi: 10.1097/00005650-198410000-00001.
The validity of the Index of Medical Underservice (IMU) was evaluated by examining the ability of the IMU to discriminate among levels of need for health services reported by rural consumers in response to a mail survey questionnaire. It was hypothesized that if the IMU is a valid indicator of medical underservice, then where the IMU value for an area was relatively low, respondents would report relatively less access and availability of health services, less utilization of health services, a lower health status level, and less satisfaction with available health services. The IMU was not found to be an effective discriminator among levels of need for health services as reported by the survey respondents. Further, the dichotomous designation of areas as medically underserved or not medically underserved according to IMU values was found to display even less discriminatory ability. A comparison of areas at opposite extremes of the range of IMU values accounted for only a small proportion of the variance in six criterion measures. The findings raise serious questions about the utility of the IMU for determining funding priorities for health services programs. It is recommended that use and interpretation of the IMU be made with caution and supplemented by additional data as much as possible.
通过考察医疗服务不足指数（IMU）区分农村消费者在邮件调查问卷中报告的健康服务需求水平的能力，对该指数的有效性进行了评估。研究假设，如果IMU是医疗服务不足的有效指标，那么在某个地区IMU值相对较低的地方，受访者会报告获得健康服务的机会和可及性相对较低、健康服务利用率较低、健康状况水平较低以及对现有健康服务的满意度较低。研究发现，IMU并非调查受访者报告的健康服务需求水平的有效区分指标。此外，根据IMU值将地区划分为医疗服务不足或非医疗服务不足的二分法显示出更低的区分能力。IMU值范围两端的地区比较仅占六项标准指标方差的一小部分。这些发现对IMU在确定健康服务项目资金优先级方面的效用提出了严重质疑。建议谨慎使用和解读IMU，并尽可能用其他数据加以补充。
