Progess and Problems in Improving the Availability of Primary Care Providers in Underserved Areas
HRD-77-135: Published: Aug 22, 1978. Publicly Released: Aug 22, 1978.
- Full Report:
Congress recognized the importance of making health manpower accessible to the entire population. A disproportionate number of physicians has been concentrated in urban areas, mainly because of professional considerations. During fiscal years 1972 to 1977, more than $430 million in federal funds were obligated in an attempt to increase the supply of physicians in shortage areas.
Federal efforts have had some success, but many problems remain. The National Health Service Corps increased the availability of physicians in shortage areas but, because it has not adequately assessed needs, its physicians are underused in terms of patients served at some sites. The federal loan repayment program has attracted only a small percentage of eligible physicians, most of whom would have established practices in shortage areas anyway. The program for area health education centers has the long-term potential to improve health manpower distribution by meeting some of the professional considerations. The preceptorship program will probably not substantially affect location choices, but the family medicine training program has the potential for increasing the supply of physicians in rural areas and small towns because of the tendency for many family practitioners to locate in such areas. Many states and private organizations have attempted to increase access to primary care medical services in rural areas through programs using nonphysician providers, including nurses and physician extenders. The inability to receive reimbursement from medicare or other sources for physician extender services restricted more widespread use of such services. Recent authorization for such reimbursement may help areas to use physician extenders to meet health care needs.
Matter for Congressional Consideration
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Matter: The Secretary of Health, Education, and Welfare (HEW) should: (1) develop guidelines for assessing the use of Corps health care providers and require studies of potential use by residents; (2) develop projections to assess the number of physicians with scholarship commitments that will be needed to serve in shortage areas; (3) analyze the location of practitioners and specialists in HEW-designated shortage areas and make recommmendations for financially supporting programs with the greatest potential for serving these areas; (4) work with states to identify shortage areas and develop a strategy for establishing an integrated program to appropriately serve each area; and (5) examine programs which rely on physician extenders and consider seeking legislation to assist such programs. Congress should reconsider whether the loan repayment program for physicians needs to be continued and the necessity for HEW to complete its study on physician extender reimbursement in view of recent legislation and questions raised about the validity of study results.