The relationship of health professional shortage areas to health status. Implications for health manpower policy
F. P. Kohrs and A. G. Mainous 3rd
Department of Family Practice, University of Kentucky, Lexington, USA.
OBJECTIVE: To compare the health status of adult residents of health
professional shortage areas (HPSAs) with adult residents of non-HPSAs.
DESIGN: A random-digit dialing telephone survey. Respondents were
subsequently classified by their county of residence as residing in an HPSA
or non-HPSA. PARTICIPANTS: A sample of 470 adults (18 years or older)
living in Kentucky. MAIN OUTCOME MEASURES: Health status was measured by
the Medical Outcomes Study 20-Item Short-Form Health Survey's six
subscales. RESULTS: Controlling for demographic variables in the multiple
regression analysis, there were significant differences between HPSAs and
non-HPSAs for the social, mental health, and pain subscales. An interaction
between age and HPSAs in relation to health status was observed for the
physical, social, mental health, health perception, and pain subscales.
After stratification by age (18 to 44 years, 45 to 64 years, or 65 years or
older), HPSA-designated areas were associated with poorer health status in
all but the youngest age strata. Elders in HPSAs had the poorest health
status. CONCLUSIONS: Health professional shortage areas are associated with
poorer health status in the older segments of the adult population. Future
policy may need to focus on increasing access not only to primary care
services but also to specific types of services that may promote better
health status of elderly residents of HPSAs.
