The Effects of Medically Underserved Area Designation on Access to Care DESCRIPTION: Medically Underserved Areas (MUA) are considered to have available health care resources that are insufficient to meet the needs of the local population. Being designated as underserved makes communities eligible to receive public funds to establish and maintain a Federally Qualified Health Center (FQHC) or Rural Health Clinics (RHC) in rural areas. Other benefits of MUA designation include 10% reimbursement bonuses for primary care physicians delivering care to Medicare patients and the ability to recruit primary health care providers (e.g. physicians, nurse practitioners, physician assistants). MUAs are designated using the Index of Medical Underservice (IMU), a composite scoring mechanism based upon an area's 1) percent living in poverty, 2) percent aged 65 and older, 3) population to primary care physician ratio, and 4) infant mortality rate. The IMU score ranges from 100 (least underserved) to 0 (most underserved), and a score of 62 or below makes one eligible to be designated as a MUA. Strict adherence to the rule, however, does not occur and many areas receive the designation despite being ineligible to do so. As a result, I will utilize a "fuzzy" RD design to identify the effects of MUA designation on the receipt of public funding for CHCs, RHCs, or the receipt of a new NHSC scholar. My primary research question will address the value of underserved area designation as a tool to allocate public resources to improve access to care. The goal of the proposed research will answer how MUA designation immediately affects the availability of health care resources, and conclusions will be developed to determine the relationship how MUA designation affects health outcomes such as preventable hospitalizations.
The proposed study will address an important issue in the allocation of public funding to address the unmet health care needs of the medically underserved. Using a regression- discontinuity design based approach to identify the causal effects of Medically Underserved Area designation to increase access to care among low - income, uninsured, and racial/ethnic minority groups in underserved communities. The study is expected to generate new evidence valuable to health care planners and policy makers by evaluating the utility in designating places as underserved as a means to distribute resources to invest in the health care safety net.