Kolimaga J T, Konrad T R, Ricketts T C
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill 27599-7590.
J Health Care Poor Underserved. 1994;5(2):124-41. doi: 10.1353/hpu.2010.0419.
One reason for the shortage of primary care physicians in rural areas may be these physicians' reluctance to compete for patients with federally subsidized Community Health Centers (CHCs). Yet little is known about the relationship between private practice physicians and physicians in federally subsidized practices who share service areas. We used surveys from a two-state subset of a nationally representative sample to compare practice characteristics of three types of physicians: those who work in CHCs; those in private practice within CHC service areas; and private practice physicians in other rural areas. We found that rural physicians who compete with CHCs earn incomes comparable to physicians in rural areas who do not compete with CHCs, and that the percentage of Medicaid and uninsured patients seen in private physician practices does not increase when a CHC is not in the county. We conclude that CHCs do not provide competitive barriers to physicians in private practice, although we do not know if the presence of a CHC inhibits new private physicians from entering practices in these communities.
农村地区初级保健医生短缺的一个原因可能是这些医生不愿与联邦补贴的社区卫生中心（CHC）争夺患者。然而，对于在同一服务区域内的私人执业医生与联邦补贴医疗机构的医生之间的关系，我们知之甚少。我们使用了来自全国代表性样本中两个州子集的调查数据，来比较三种类型医生的执业特征：在社区卫生中心工作的医生；在社区卫生中心服务区域内私人执业的医生；以及其他农村地区的私人执业医生。我们发现，与社区卫生中心竞争的农村医生收入与不与社区卫生中心竞争的农村地区医生相当，并且当县里没有社区卫生中心时，私人医生诊所中医疗补助患者和未参保患者的比例并不会增加。我们得出结论，社区卫生中心并未给私人执业医生造成竞争障碍，尽管我们不知道社区卫生中心的存在是否会抑制新的私人医生进入这些社区执业。
