A methodology for shortage area designation of physicians : selected applications

Abstract

"This dissertation is concerned with the forces leading to the passage of the legislation Public Law 92-585 and the introduction of Senate Bill 3585 and House Bill 17084, as well as the rationale behind Congress' choice of criteria for the designation of shortage areas. An attempt is made to examine the strengths and weaknesses of the various components of the allocation formula used. The sensitivity of a model is demonstrated by changing the various components utilized and by changing the weighting systems assigned to the variables included in the model. The Federal Government has taken a series of steps during the past few years in an attempt to increase the supply of health personnel in the United States. The availability of medical services, and of physician services in particular, is a controversial topic which occupies a prominent place in any discussion concerning the current and future health of the citizens of the United States. While it is clearly understood that the physician is not the sole provider of medical services in our health care delivery system, it is recognized that due to the organizational structure of our system the other providers of health care often fall within the purview of the physician. The manner in which physician services are distributed often affects the distribution of the other suppliers of health care as well as the other medical resources of our society. By limiting the discussion which follows to physicians only, the complex topic of the adequacy of the supply of health personnel is made somewhat more manageable. While many of the arguments expressed are applicable to all providers of health care, they will be discussed in terms of physicians only. Chapter I presents an overview of the legislative background on a physician shortage and the attempts made by legislators to define and remedy the situation. Chapter II reviews several of the methodologies currently being used to determine a physician shortage and discusses the strengths and weaknesses of each method. In Chapter III, the Federally designated shortage areas are identified, the criteria for their designation presented and discussed, and the sensitivity of the methodology illustrated. A multivariate model for the determination of a physician shortage is presented in Chapter IV. An example of the model is given followed by an analysis of the results. Chapter V presents an overview of recent legislation and its impact on the future. A reiteration of the purpose and a summary of the findings conclude the dissertation."--Page 4.