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Methodologies for Measuring Healthcare Infrastructure Needs

 

The purpose of this special collection of web pages, maps and spreadsheets is to identify the top counties in the state with the greatest healthcare infrastructure needs.

Supply of and demand for health care, and its corollary access to care, is measured in three different ways. The first, and most common, is measuring the ratio of health care practitioners to the population in a county. The more people per health care profession, the greater the demand on the individual provider.

The advantages to this physician-to-population ratio measure are:

  •  The data are readily available for number of licensed providers and the resident population.
  • The methodology is fairly simple to perform.

The disadvantages to this physician-to-population ratio measure are:

  • The formula for HPSAs (the best known physician-to-population ratio measure) has not be significantly changed since 1967.
  • The methodology assumes that everyone in the population has full and equal access to health care in their county.
  • It does not take into account individual patients crossing county lines to obtain health care.

The second way in which supply and demand is measured is from health care surveys such as the National Health Interview Survey (NHIS) (see: http://www.cdc.gov/nchs/nhis.htm). Individuals are asked if they have not been able to obtain the necessary health care in the last year.

The advantages of this survey-based measure are:

  • Data are collected annually.
  • Results from the sample can be extrapolated to a larger population.
  • Very detailed questions are asked of the respondents.

The disadvantages of this survey-based measure are:

  • The results are based on a survey, which are sample results extrapolated to thegeneral population.
  • It relies on the individual being surveyed to make a determination of “adequate” access to care.
  • The results are aggregated to the region and nationallevel, unmet demand for health care in states and counties cannot be measured.

The third methodology, in which access to health care can be measured, is to survey health care professional’s offices and ask how soon a new patient could be seen by the professional. The longer the wait for a routine visit, the lower the level of access. Additionally, access can be measured how many health care professionals do not accept new patients with certain kinds of private health insurance, Medicare or Medicaid. Our Mississippi Center for Health Workforce is completing just such a study of access to health care in Mississippi.

The advantages of this survey-based measure are:

  • It can be completed quickly.
  • It provides county-level information.
  • It “ground truths” the actual number of practitioners who are available to provide health care.

The disadvantages of this survey-based measure are:

  • A telephone survey to call every health care professional’s office is time consuming and costly.
  • Health care offices might not be fully truthful about the next available appointment due to office-specific patient loads.
  • Scheduling of appointments can be very flexible and a last minute cancelation shortly before the survey call could yield an unusually short wait time for an appointment.

Broadly, these are the three methods by which we measure the supply of health care, demand for health care and access to health care. Confounding factors that also affect this relationship include the differing kinds of health insurance, the individual ability to pay out-of-pocket expenses, individual access to transportation, individual freedom during the day to visit a doctor, and the individual health knowledge and social norms to visit a health care professional.

Return to Introduction of Healthcare Infrastructure Shortage Areas

Last updated: 8/24/2015