Where are my hospitals and clinics located?

 

Primary components of the health services infrastructure include residential and long-term care facilities, hospitals and rural clinics, and emergency centers. Using the latest data available, Indiana has 692 residential and long-term facilities, 215 hospitals and rural clinics, and 956 emergency centers. Residential/long-term facilities, hospitals and rural clinics tend to concentrate in and around metropolitan areas whereas emergency facilities are dispersed throughout the state. Though hard to quantify the impacts, firms, corporations and citizens value a comprehensive health services infrastructure and include it in their location decisions.

 

Is distance negatively impacting my community's health care services?

 

Unfortunately, populations and health care services are not distributed optimally across the landscape. Long travel times denote a scarcity of health care services that can impede development objectives. To get a better idea of differences in access to health care services in Indiana, Purdue researchers Unal, Chen and Waldorf collected information about health care services in the county of residence, medical services offered in other Indiana counties, and the distances that residents must travel to reach medical services. Their calculations determine how accessible health services are in a county. They assessed access to physician care, access to hospital care, and access to hospital care services, which combined physician and hospital care access. For each assessment, scores were normalized so comparisons could be made across counties. Thus, the county that scored the lowest in each category received a score of zero. The highest scored county received a score of 1. Scores close to one suggest higher quality health care services with respect to distance.

 

Access to physician care varies widely among Indiana's counties. Counties with the highest and lowest access to physician care are shown below. Marion County, which had the best ratio of physicians to residents, received a score of 1. Posey County, which had the lowest access to physicians, received a score of 0.  All remaining counties fell between 0 and 1.

 

Indiana Counties with Highest and Lowest Access to Physician Care
Highest access	County	Physician Access	Lowest Access	County	Physician Access
1	Marion	1.000	83	Ripley	0.051
2	Vanderburgh	0.637	84	Benton	0.048
3	Hamilton	0.632	85	Sullivan	0.046
4	Monroe	0.538	86	Newton	0.037
5	Hancock	0.525	87	Crawford	0.018
6	St. Joseph	0.500	88	Spencer	0.018
7	Allen	0.482	89	Perry	0.010
8	Boone	0.466	90	Ohio	0.010
9	Hendricks	0.462	91	Switzerland	0.005
10	Tippecanoe	0.455	92	Posey	0.000
Table adapted from: Eda Unal, Susan Chen, and Brigitte Waldorf. "How accessible is Health Care in Your County?" June 2007. Purdue Agricultural Economics Report, Department of Agricultural Economics, Purdue University. 26 Aug. 2008. <http://www.agecon.purdue.edu/extension/pubs/paer/2007/june/waldorf.asp>.

 

A state map, "Access to Physician Care in Indiana Counties," (view map) captures the concentration and variability of physician care. The fast growing counties-Boone, Hamilton, Hancock, and Hendricks-surrounding Marion County, Tippecanoe and Monroe counties where Purdue and Indiana universities are located, and regional centers found in Vanderburgh and Allen counties have the most favorable access to physicians. Several counties (Switzerland, Ohio, Perry, and Spencer) that border the Ohio River are only marginally better than Posey, the county with the lowest category of access to physician care. The four northeastern counties of Lagrange, Steuben, Noble and De Kalb also form a pocket of poor access to care.

 

¹Eda Unal, Susan Chen, and Brigitte Waldorf. "How accessible is Health Care in Your County"? June 2007. Purdue Agricultural Economics Report, Department of Agricultural Economics, Purdue University. 26 Aug. 2008. <http://www.agecon.purdue.edu/extension/pubs/paer/2007/june/waldorf.asp>.

 

Access to hospital care is another important indicator of a county’s health services. Counties with the highest and lowest access to hospital care are shown below. Marion County again ranked the highest and received a score of 1. Marion plus Vanderburgh, Monroe, St. Joseph and Allen counties show up in the top-ten list of access to physician care. The remaining 5 counties in the top-ten hospital care list represent regional centers for the surrounding rural areas: Vigo County (Terre Haute), Jefferson County (New Albany), Lake County (Gary), Madison County (Anderson), and Porter County (Portage, Valparaiso).

 

The ten most underserved counties, with the lowest being Ohio, tend to be concentrated in Southern Indiana. Benton is the only northern county, which was ranked 85th in the state. Furthermore, seven of the counties (Benton, Crawford, Spencer, Perry, Posey, Switzerland, and Ohio) on the lowest list for hospital care are also on the lowest list for access to physician care.

 

The primary variables – access to physician care and access to health care – are combined and reclassified into three categories: low access, medium access, and good access. Median and average values of the two skewed distributions were used to assign counties to the categories according to the analysis shown in the figure to the right. Counties assigned to the low access category had scores below each variable’s median value. Counties assigned to the good access category had scores that exceeded each variable’s average value. The remaining counties were assigned to the medium access category.

 

Indiana Counties with Highest and Lowest Access to Hospital Care
Highest access	County	Physician Access	Lowest Access	County	Physician Access
1	Marion	1.000	83	Pike	0.053
2	Vanderburgh	0.936	84	Martin	0.049
3	Vigo	0.706	85	Benton	0.047
4	Jefferson	0.662	86	Franklin	0.047
5	Allen	0.640	87	Crawford	0.009
6	Lake	0.628	88	Spencer	0.006
7	St. Joseph	0.550	89	Perry	0.006
8	Madison	0.541	90	Posey	0.001
9	Monroe	0.536	91	Switzerland	0.001
10	Porter	0.517	92	Ohio	0.000
Table adapted from: Eda Unal, Susan Chen, and Brigitte Waldorf. "How accessible is Health Care in Your County?" June 2007. Purdue Agricultural Economics Report, Department of Agricultural Economics, Purdue University. 26 Aug. 2008. <http://www.agecon.purdue.edu/extension/pubs/paer/2007/june/waldorf.asp>.

A state map (view map) of the variable “access to health care” that combines access to physician and hospital care shows the disparity of health services across Indiana. Of the state’s 92 counties, 40 are “poor access” counties; 22, “medium access;” and 30 “good access.” People have good access to health care in and around the Chicago and Indianapolis-Carmel metropolitan areas, regional centers, and counties of major universities and colleges. The “poor access” counties, many of which are along the Illinois border and Ohio River, comprise almost 15 percent of the state’s population. These “poor access” counties also tend to be slightly smaller and more rural. Further analysis also shows that residents of the “poor access” counties tend to have higher proportions of elderly, children, and poorly educated as shown in the table below. Inadequate health care could prove to be a formidable barrier to development.

 

Characteristics of Indiana Counties by Health Care Accessibility
Characteristic	Poor (n=40)		Medium 9n=22)		Good (n=30)
	Average	Std. Dev	Average	Std. Dev	Average	Std. Dev
Total Population	22,647	10,329	37,537	14,850	144,960	166,945
% Children (0-17 years)	26.76	2.05	25.79	1.63	25.73	2.55
% Elderly (65+)	13.16	1.66	13.90	1.35	11.93	1.94
% Adults with at least Bachelor's Degree	11.37	1.98	13.12	3.25	22.36	8.33
% Adults without a High School Degree	21.03	4.90	19.52	4.05	16.88	3.93
% Hispanic	1.65	1.42	2.10	1.82	4.19	2.65
% Black	0.52	0.77	1.81	1.23	11.29	6.34
% Population in Poverty	8.38	1.90	8.37	2.07	8.84	2.61
Median HH Income ($)	40,117	4,199	40,823	4,321	45,352	8,759
Index of Relative Rurality	0.48	0.06	0.41	0.05	0.29	0.08

 

 

Are there any designated Health Professional Shortage Areas (HPSAs) in my Community?

 

Health Professional Shortage Areas (HPSAs) denote insufficient numbers of primary medical care, dental, or mental health providers, socioeconomic barriers to accessing health care professionals, or both conditions.  An HPSA can be a rural area, urban area, population or facility.  County officials, community officials, and health officials identify the “rational area,” collect the required data, and submit HPSA requests to the Health Resources and Services Administration (http://bhpr.hrsa.gov/shortage/index.htm).   The Federal government and many states have programs to increase access to health professionals in HPSAs.  The major programs include the National Health Service Corps, National Health Service Corps Scholarship Programs, National Health Service Corps Loan Repayment Program, Rural Health Clinics Act, Medicare Incentive Payments for Physician’s Services Furnished in HPSAs, Higher “Customary Charges” for New Physicians in HPSAs, Area Health Education Center Program, and Federal Employees Health Benefits Program.

 

Health Resources and Services Administration officials use several criteria – population to professional services ratio, travel time, availability of professionals in adjacent areas, and economic, social, and cultural barriers –  to determine if shortages warrant one or more HPSA designations.  A geographic area HPSA designation, for example, requires satisfaction of three criteria:  delineation of a “rational area” for the delivery of services, population-to-practitioner ratio that exceeds mandated levels, and a determination that professional services in contiguous areas are over “utilized, excessively distant, or otherwise inaccessible.”  An HPSA population group designation must satisfy the following criteria:  the group resides in a “rational area” and assess barriers prevent the group from receiving adequate professional assistance.  Examples of access barriers include income, language, culture, and unwillingness of providers to accept Medicaid payments or patients for any number of reasons.  Correctional facilities, mental health facilities, public health facilities and private non-profit facilities may be also be designated as HPSAs.  A correctional facility must house at least 250 inmates, and the internee population to practitioner ratio must exceed published minimums.  Public and non-profit health facilities must be serve HPSA-designated areas or population groups, and capacity must be judged insufficient compared to needs of the populations to be designated an HPSA facility.  The criteria used by the Health Resources and Services Administration to denote the different types of HPSAs can be found by going to http://bhpr.hrsa.gov/shortage/index.htm and then clicking on primary care, dental or mental health.

 

Are there any designated medically underserved areas (MUAs) or medically underserved populations (MUPs)?

 

Medically underserved areas (MUAs) and medically underserved populations (MUPs) denote shortages in primary care. County, community, or health officials collect the required data and submit requests to the Health Resources and Services Administration (http://bhpr.hrsa.gov/shortage/index.htm). MUAs and MUPs are eligible to participate in numerous state and Federal programs for improving health services in these designated areas.

 

The first step in the MUA designation process is delineation of the “service area” by the entity submitting the application. The service area may be a whole county in a non-metropolitan area; groups of contiguous counties, minor civil divisions, or census county divisions in non-metropolitan areas provided population centers are within 30 minutes travel time, or a group of census tracts in a metropolitan area that exhibits similar socioeconomic and demographic characteristics. Second, the Health Resources and Services Administration uses the Index of Medical Underservice to determine if a “service area” meets MUA requirements. The Index of Medical Underservice consists of four criteria – percentage of population below the poverty level, percentage of the population age 65 and older, infant mortality rate, and primary care physician to population ratio – that are used to score a “service area.” The lowest possible score is zero; the highest possible score, 100. Any service area rated 62 or lower is designated a medically underserved area.

 

A similar process is used to designate medically underserved populations (MUPs). The targeted population group must reside in a “service area.” The criteria apply only to the population group. Again, the population group must receive a score of 62 or lower from the Index of Medical Underservice. Finally, economic barriers such as low-income or Medicaid-eligible populations or cultural and/or linguistic barriers hamper access to primary care.

 

A population group that does not meet the Index of Medical Underservice cutoff of 62 points may receive an exceptional MUP designation if “unusual local conditions” block the group’s access to or availability of primary care services, and the Governor and local officials request this designation. Specifics for this designation, MUA, and MUP are available at the Health Resources and Service Administration web site.