The National Health Service Corps has sought to improve health and eliminate geographic health disparities in federally designated physician shortage areas for more than three decades. Is NHSC meeting its goals? Well, yes and no.
Health Improves in Areas NHSC Staffs, Says Study
Researchers Find Disparities Persist
By Jane Stoever
7/11/2005
That's the conclusion of researchers led by Donald Pathman, M.D., M.P.H., professor and research director of family medicine at the University of North Carolina at Chapel Hill. His co-authors worked at the Robert Graham Center in Washington at the time of the study. The study results appear in "Changes in Age-Adjusted Mortality Rates and Disparities for Rural Physician Shortage Areas Staffed by the National Health Service Corps: 1984 - 1998" in the summer issue of The Journal of Rural Health.
"We looked at whether the NHSC's mission was being attained," Pathman said of the study, which examined age-adjusted mortality rates in a total of 1,392 counties.
The researchers found mortality rates improved across the board. "The good news is that health was improving in rural counties with NHSC staffing, in other rural health professional shortage areas without NHSC staffing and in non-HPSA rural areas," said Pathman. "That's a wonderful statement about the state of change in health in the United States."
On the down side, the NHSC goal to diminish geographic health disparities was not definitively met, researchers found. The disparity in mortality rates somewhat lessened between rural counties supported by NHSC personnel for 12 to 15 years and rural counties not classified as HPSAs. However, the gap actually widened for rural counties with NHSC staff for shorter time spans (one to seven years and eight to 11 years, specifically) compared with rural non-HPSA counties.
"What we saw was that poverty rates decreased over time, unemployment rates decreased over time. These are known correlates to improving health," said Pathman. "We did see primary care physician availability increase, and studies have shown that areas that have more primary care physicians have better health. So it's reasonable to think that the increasing number of primary care physicians and the NHSC's contribution to that increasing number did contribute something to improving health."
Co-author Robert Phillips, M.D., director of the Graham Center, said, "We found that the NHSC communities also had some of the greatest social disparities -- that is, disparities in income, employment and education -- making the goal of reducing health disparities that much more daunting. The finding of a reduction in mortality disparities in those counties with the longest investment of NHSC resources is certainly good news and identifies a need for further research on NHSC's impact in these communities and the importance of continuous NHSC presence."
NHSC has been a key government program to help alleviate health professional shortages, said Pathman, who in the mid-1980s worked as an NHSC member at Eastport, Maine, an island on the Canadian border.
"Family physicians make up by far the largest proportion of physicians in the program, who make up by far the largest proportion of professionals in the program," Pathman said. "The program has had a very strong family medicine presence -- I imagine perhaps 7,000 family physicians have served in the NHSC, and many feel very passionate about their involvement."
At the conclusion of their study, the authors said: "This study finds that the NHSC's goal for health to improve in rural underserved counties is being realized, but the goal for disparities to diminish is not. … We believe that health disparities in the U.S. will persist as long as substantial income and educational disparities remain: Wealthier and more educated communities will remain healthier."
The summer issue of The Journal of Rural Health will be published online by the National Rural Health Association, which sponsors the journal, later in July.
"We looked at whether the NHSC's mission was being attained," Pathman said of the study, which examined age-adjusted mortality rates in a total of 1,392 counties.
The researchers found mortality rates improved across the board. "The good news is that health was improving in rural counties with NHSC staffing, in other rural health professional shortage areas without NHSC staffing and in non-HPSA rural areas," said Pathman. "That's a wonderful statement about the state of change in health in the United States."
On the down side, the NHSC goal to diminish geographic health disparities was not definitively met, researchers found. The disparity in mortality rates somewhat lessened between rural counties supported by NHSC personnel for 12 to 15 years and rural counties not classified as HPSAs. However, the gap actually widened for rural counties with NHSC staff for shorter time spans (one to seven years and eight to 11 years, specifically) compared with rural non-HPSA counties.
"What we saw was that poverty rates decreased over time, unemployment rates decreased over time. These are known correlates to improving health," said Pathman. "We did see primary care physician availability increase, and studies have shown that areas that have more primary care physicians have better health. So it's reasonable to think that the increasing number of primary care physicians and the NHSC's contribution to that increasing number did contribute something to improving health."
Co-author Robert Phillips, M.D., director of the Graham Center, said, "We found that the NHSC communities also had some of the greatest social disparities -- that is, disparities in income, employment and education -- making the goal of reducing health disparities that much more daunting. The finding of a reduction in mortality disparities in those counties with the longest investment of NHSC resources is certainly good news and identifies a need for further research on NHSC's impact in these communities and the importance of continuous NHSC presence."
NHSC has been a key government program to help alleviate health professional shortages, said Pathman, who in the mid-1980s worked as an NHSC member at Eastport, Maine, an island on the Canadian border.
"Family physicians make up by far the largest proportion of physicians in the program, who make up by far the largest proportion of professionals in the program," Pathman said. "The program has had a very strong family medicine presence -- I imagine perhaps 7,000 family physicians have served in the NHSC, and many feel very passionate about their involvement."
At the conclusion of their study, the authors said: "This study finds that the NHSC's goal for health to improve in rural underserved counties is being realized, but the goal for disparities to diminish is not. … We believe that health disparities in the U.S. will persist as long as substantial income and educational disparities remain: Wealthier and more educated communities will remain healthier."
The summer issue of The Journal of Rural Health will be published online by the National Rural Health Association, which sponsors the journal, later in July.
