The Relationship between the Supply of Primary Care Physicians and Measures of Health

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Whether patients have access to adequate medical care is a question frequently discussed in journals, Congress, and the popular press. Having access to adequate care can mean many different things, but the discussion often focuses on insurance coverage, the availability of physicians, and the proximity of inpatient and physician care. In general, studies find that medical care utilization increases when patients have greater access to medical care. The evidence for whether having better access to care improves health outcomes, however, is mixed. This paper re-examines the relationship between medical care access and health, with an emphasis on how the availability of physicians and the distance to care affect individuals’ health status. Public health policy has long been concerned with the availability of health care providers, particularly in rural areas. In line with this concern, much attention has been given to identifying areas that are under-served by providers. Designations include Health Professional Shortage Areas (HPSAs), Medically Under-served Areas, and Nurse Shortage Areas [Lee, 1991]. HPSAs, for example, must meet several requirements including having less than one primary care physician per 3,500 residents. Government responses to a perceived lack of medical care resources include the development of the National Health Service Corps (NHSC), which offers medical students scholarships in exchange for future service in under-served areas. Spending on the NHSC has risen considerably: funding for the loan and scholarship portion of the program increased from $11 million in 1990 to $98 million in 2002. The availability of physicians and the proximity of care are important issues for many reasons. Living near a clinic or physician’s office may promote better preventive care and more continuous care in the event of an illness. For example, there is some evidence that NHSC sites improve access to care [Stone, Brown, and Sidel, 1991]. The opening of a NHSC site in a rural Utah county led to increased physician utilization in the county, and residents identified the doctors at the NHCS site as their family physicians [Kane, et al., 1978]. Such results suggest that government policy should continue to encourage the placement of physicians in HPSAs. An alternative argument suggests that the NHSC might not improve health care utilization and outcomes. Residents of rural areas often travel to other communities to receive medical care when care is not available in their community [Buczko, 2001; Holahan and Zuckerman, 1993]. Berk, Bernstein, and Taylor [1983] find that living in an HPSA has no important effect on whether individuals visit a physician or the number of physician visits. Individuals, however, did travel farther to receive care. The authors question the HPSA designation since individuals residing in shortage areas do not under-utilize care. Public programs may increase the supply of providers in rural areas, and reduce the amount of travel to other communities for care, but whether health outcomes improve is unclear. If health outcomes do not improve, policy makers may wish to reconsider the efficacy of budget increases for programs such as the NHSC. To address this issue, we examine the relationship between the availability of physicians in a community and the health status of residents.

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Eastern Economic Journal, v. 30, issue 3, p. 467-486