Wright R A, Andres T L, Davidson A J
J Health Care Poor Underserved. 1996 Nov;7(4):296-307. doi: 10.1353/hpu.2010.0246.
The relationship between the primary service area (PSA) of an urban community health center (CHC) program and a federally defined "medically underserved area" (MUA) was assessed. Federal guidelines that most reliably predicted medical underservice were identified. The service area was statistically defined by census tract penetration rates. The MUA was defined by an index of medical underservice (IMU) according to federal parameters of physician supply, poverty level, percentage elderly persons, and infant mortality. An index score was calculated for the country, service area, and each census tract. Analysis by tract determined the most significant discriminating parameters. By excluding two tracts concentrated with managed-care physicians, the service area qualified as an MUA. Tracts that fulfilled MUA and service area criteria were highly associated (p < 0.0001). Only poverty level and infant mortality were useful discriminating parameters. Federal indicators of demand (elderly population) and supply (physicians) did not adequately address issues to access for the medically underserved in urban neighborhoods. Other parameters that might serve as proxies of care access and underserved are discussed.
评估了城市社区卫生中心（CHC）项目的主要服务区域（PSA）与联邦定义的“医疗服务不足地区”（MUA）之间的关系。确定了最能可靠预测医疗服务不足的联邦指南。服务区域通过人口普查区渗透率进行统计定义。MUA根据医生供应、贫困水平、老年人百分比和婴儿死亡率的联邦参数，通过医疗服务不足指数（IMU）来定义。计算了全国、服务区域和每个普查区的指数得分。按普查区进行分析确定了最显著的区分参数。通过排除两个集中有管理式医疗医生的普查区，该服务区域符合MUA的标准。符合MUA和服务区域标准的普查区高度相关（p < 0.0001）。只有贫困水平和婴儿死亡率是有用的区分参数。联邦需求指标（老年人口）和供应指标（医生）未能充分解决城市社区医疗服务不足人群的就医问题。还讨论了可能作为医疗服务可及性和服务不足替代指标的其他参数。
