Health care reform: Can improved financial access to health care services also improve geographic access to health care services?

By Craig McDermott, cross-posted from Random Musings

 

On Friday, Government Executive, essentially a business newspaper for
people whose "business" is government agency operations, published an
"insider baseball" sort of article.  It relates to areas that are designated as "medically underserved areas" (MUAs).

Federal employees are covered covered under slightly different health insurance reimbursement rules when they work in MUAs.

From the article, written by Eric Katz –

The statute that governs the Federal Employees Health Benefit Program
requires OPM to determine which states have “critical shortages of
primary care physicians.” Employees in these states — known as
“medically underserved areas” — receive reimbursement for covered
services by any licensed provider in the state.

 The next lines in the article are the ones that caught my attention (emphasis added) –

OPM [the federal Office of Personnel Management, basically the federal government's version of an HR department] calculates which states are underserved using data from the Health
and Human Services Departments, as well as the Census Bureau. If at
least 25 percent of the state’s population lives in a “primary medical
care manpower shortage area” — as determined by HHS — the state is
considered underserved.

The 12 states that will receive the distinctive consideration in 2014
are Alabama, Arizona, Idaho, Illinois, Louisiana, Mississippi, Missouri,
New Mexico, North Dakota, Oklahoma, South Carolina and Wyoming.

 After first noticing that most of the states listed are "red" states (hey, this is *political* blog, not a *medical* one...), I noticed that most of the states listed, other than Illinois, are known as being very rural.

Which sent my thoughts off on a tangent (hence, this post.  🙂 )

Health care reform, commonly known as Obamacare, is all about making health care more financially accessible for the average American.

While it is still in its infancy, so to speak, it does seem to set to do just that, notwithstanding the BS storm stirred up by President Obama's haters.

What
is doesn't seem set to do, directly anyway, is address the issue of
people who face physical/geographic impediments when trying to access
health care services. 

As noted above, Arizona is one
of the states that medically underserved enough so that it is subject to
the slightly different reimbursement rules for federal employees.

A map of specific areas within the state that are designated as MUAs, courtesy Arizona Department of Health Services (ADHS) –

 

Looking
at the map, we can see that most of the MUAs in AZ are rural, Native
American tribal lands, or urban areas with high concentrations of racial
or ethnic minorities, or high concentrations of poverty.

Obamacare
directly addresses some of the economic inequities that raise barriers
to access to health care.  The geographic inequities still raise
barriers to access to health care.

Take the examples of the municipalities of Scottsdale and Holbrook, here in Arizona. 

A search of the license database of the Arizona Medical Board
shows 776 licenses issued to medical doctors with a Scottsdale
address.  With a population of 219,713 people, that works out to one
medical doctor for every 287 residents.

Scottsdale has
three general hospitals, with 3.8 hospital beds per 1000 residents. 
Additionally, there are a number of other health care facilities, such
as assisted living and skilled nursing facilities.

Scottsdale
is located in heavily populated Maricopa County and is bordered by
Phoenix (2263 licensed doctors, multiple hospitals, multiple skilled
nursing facilities) and Tempe (111 licensed doctors, 1 hospital, 2
skilled nursing facilities).  It takes less than 20 minutes to drive to
the closest areas

In contrast, a search of the same AZ Medical Board database turns up all of two
licenses issued to medical doctors in Holbrook, a town of 5,038 people
in northeastern Arizona.  That works out to 1 physician for every 2519
residents.  Holbrook has no health care facilities.

Holbrook
is located in sparsely Navajo County and the nearest towns for seeking
health care services are Snowflake and Taylor, and both are more than 30
minutes away.

Snowflake has no health care facilities
and three licensed doctors; Taylor has no health care facilities and no
licensed doctors.

Not to be ignored in this is the fact
that Scottsdale's median income is more than twice that of Holbrook,
meaning that not only are there significantly more people in Scottsdale,
the average person in Scottsdale has far more money to spend on health
care, and doctor's offices are business operations as well as health
care operations.

Interesting factoid:  AZ Medical
Board records show that there are more licensed cosmetic surgeons in
Scottsdale (6) than there are licensed medical doctors in Holbrook,
Snowflake, and Taylor combined (5).

 

Speculation time:

Now,
HCR won't change the basic economics of the health care provider
industry as it relates to population density – doctors and other primary
care providers will still be concentrated where human population is
concentrated.  However, where it could, and should, be able to help with
MUAs is to ameliorate the economic disparity.

With the implementation of HCR and its increased financial access to health care insurance (aka – $ for health care), establishing a medical practice in rural or other underserved areas should become a more fiscally feasible proposition.

 

Snark time:

So
why is some of the strongest opposition to Obamacare in Arizona coming
from federal and state legislators whose districts have many
constituents living in medically underserved areas?  And why do voters
in those areas support candidates and officeholders who actively work
against their constituents' interests?

 

Scottsdale demographic data here, courtesy Arizona Department of Health Services.

Holbrook demographic data here, courtesy ADHS.

Data on other AZ municipalities can be found here, also courtesy ADHS.

Information on medically underserved areas from the US Department of Health and Human Services is available here.

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