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Rural vulnerability in health care delivery: A geographic information systems analysis
Public policymakers and their advisors struggle with the problem of specifying criteria by which health care providers in rural areas are eligible for special consideration in payment policies and for special grant programs. A geographic means of designating places can address that problem and can help target public resources for providers who deliver services in those places. The goal is not to develop a decision support system that would designate places outright but to provide policymakers with a starting point in determining communities potentially at risk of, or vulnerable to, no being able to support requisite health services. ^ This dissertation achieves the above goal by first establishing the need for this research by examining the pertinent literature and government policies that have influenced access to the past, current, and proposed health care system in rural areas of the United States. The particular track followed for this research is then justified through a thorough examination of the relationship between health services research and medical geography. The dissertation then provides the details underlying the development of a place-based approach using a geographic information system (GIS) to identify rural areas that are at risk of (i.e., vulnerable) to not being able to support requisite health services. ^ Methodologically, a population size criterion was utilized to eliminate metropolitan areas and other large agglomerations from consideration. Any territory not included in a place of 3,500 or more persons, including a 25-mile buffer around that place, was a priori considered vulnerable. Places with populations in excess of 100,000 persons were considered to have a population sufficient to support a physician based solely on size. All places, including those within the buffers, having populations between 3,500 and 100,000 persons were further analyzed using population compositional data and principal components analysis. The communities were further analyzed based upon cultural and demographic characteristics to determine the influence of selected variables upon overall community economic status. ^ There were 2,138 block groups covering over 675,000 square miles outside the boundaries of any census designated place with at least 3,500 persons. Due to the lack of sufficient population density, these areas were a-priori vulnerable. Principal components analysis suggested that 138 out of 447 census designated places and their buffered areas (health service communities) with populations between 3,500 and 100,000 were also vulnerable. ^ The results are discussed in regard to how a place-based approach can advance the study of rural health needs. The public policy implications of the findings are also considered along with recommendations for future research in this area. ^
Shambaugh-Miller, Michael, "Rural vulnerability in health care delivery: A geographic information systems analysis" (2004). ETD collection for University of Nebraska - Lincoln. AAI3116607.