Effectiveness of Workforce Programs in Improving Healthcare Access in Maryland Jamilah Shakir, MD PHASE Symposium May 9, 2014
Outline Project Introduction/Overview HPSA designation Workforce Programs Methods/Approach Findings Limitations and Challenges Conclusions/Policy and Practice Implications
HPSA Designations Primary Care (PC) HPSA Provider: population ratio 1:3500 Percent of population with income less than poverty level Travel distance/time to nearest source of accessible care outside the HPSA Infant health index Infant mortality rate Low-birth weight HRSA Primary Medical Care HPSA Designation Criteria 1993 HRSA Mental Health HPSA Designation Criteria 1993 Mental Health (MH) HPSA Psychiatrist: population ratio >1:30,000 Percent of population with incomes less than poverty level Travel distance/time to nearest source of accessible care outside the HPSA Additional factors Youth Ratio Elderly Ratio Substance abuse prevalence Alcohol abuse prevalence
Workforce Programs National Health Service Corp () State Loan Assistance Repayment Program ()
National Health Service Corp Scholarship Enrolled or accepted students committed to primary care 2-4 yr. full-time service requirement at HPSA designated sites Loan Repayment Receive educational loan repayment up to $50,000 2 yr. full-time service at a HPSA designated site U. S. Department of Health and Human Services: National Health Services Corp official website: https://nhsc.hrsa.gov
J-1 Visa Waiver Program Granted for the physician's agreement to work in an underserved area for 3 years Annual state eligibility: 30 J-1 Visa waivers Maryland Department of Health and Mental Hygiene Policy, revised May 2013 http://hsia.dhmh.maryland.gov/opca/j1%20visa%20app%20materials/j 1%20MD%20Policy.doc
Maryland State Loan Repayment Program () Primary Care Physicians ONLY 2-4 yr. full-time service commitment Loan repayment assistance $25,000/yr Maximum assistance $100,000 Maryland Department of Health and Mental Hygiene: State Loan Repayment Program () in Maryland. http://hsia.dhmh.maryland.gov/opca/sitepages/pco larp.aspx
Objectives 1. To determine the effectiveness of federal workforce programs in improving primary care and mental health access in Maryland from 2003-2012 2. To determine trends in primary care and mental health HPSA designations and workforce providers from 2003-2012.
Outcome Measures 1. Healthcare access (primary care and mental health) 1) Provider: population ratios 2) Respondent answer to Maryland BRFSS Healthcare Access question a) Was there a time in the past 12 months when you needed to see a doctor but could not because of the cost? 2. Number of primary care and mental health HPSA designations (2003-2012) 3. Number of primary care and mental health workforce providers per county (2003-2012)
Study Design/ Methodology Four Data Sources HRSA Data Warehouse J-1 Visa Waiver Program, and workforce provider placements HRSA Area Resource file Maryland BRFSS Statistical Analysis T-test Descriptive analysis
Maryland
Maryland HPSA Designations (2003-2012) Primary Care HPSA Mental Health HPSA Total Number 297 Average 29.7 HPSAs/year Total Number 139 Average 13.9 HPSAs/year
140 120 100 80 60 40 20 0 Maryland Primary Care Providers by Workforce Program 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Year No. Primary Care Providers
16 14 12 10 8 6 4 2 0 Maryland Psychiatrists by Workforce Program 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Year No. of Psychiatrists
Maryland Primary Care Provider: Population Ratio (per 100,000 residents) 9 8.5 PP Ratio (per 100,00 residents) 8 7.5 7 6.5 WF WF WF WF WF WF WF WF WF WF WF WF WF WF WF WF 2003 2004 2005 2006 2007 2008 2010 2011 Year
Maryland Psychiatrist: Population Ratio (per 100,000 residents) 1.65 1.6 PP Ratio (per 100,000 residents) 1.55 1.5 1.45 1.4 1.35 1.3 1.25 WF WF WF WF WF WF WF WF WF WF WF WF WF WF WF WF 2003 2004 2005 2006 2007 2008 2010 2011 Year
Maryland BRFSS Survey: Healthcare Access by County Question #3: Was there a time in the past 12 months when you needed to see a doctor but could not because of the cost? 1. Queen Anne's County (7.18%) 2. Calvert County (7.68%) 3. Howard Co. (8.3%) 4. Hartford County (9.14%) 5. Charles County (9.2%) 6. Fredrick County (9.36%) 7. Carroll County (9.38%) 8. Anne Arundel County (9.56%) Worcester County (9.56%) 9. St. Mary's County (9.75%) 10. Montgomery County (10.14%) 11. Talbot County (10.17%) 12. Washington County (10.24%) 13. Dorchester County (10.92%) 14. Kent County (11.07%) Mean Maryland (11.46% +/ 1.15) 15. Baltimore County (11.9%) 16. Cecil County (12.33%) Allegany County (12.33%) 17. Wicomico County (12.63%) 18. Garrett County (14.12%) 19. Prince Georges County (14.13%) 20. Caroline County (15.71%) 21. Baltimore City (15.97%) 22. Somerset County (16.93%)
Limitations and Challenges Having complete data available to answer the proposed question Generalizability of findings Provider: population ratios Cannot infer adequacy of provider resources and improved healthcare access for the population No consideration of services provided by nonphysician providers Maryland BRFSS Healthcare Access Question
Conclusion Little to no impact of workforce programs on improving primary care and mental health access in Maryland More work needs to be done to include nonphysician primary care and mental health providers in workforce programs to improve healthcare access
Acknowledgements Elizabeth Vaidya Kade Patanavanich Raquel Samson, MPH Karen Matsuoka, PhD
References 1. HRSA Primary Medical Care HPSA Designation Criteria. Relevant Excerpts from 42 Code of Federal Regulations (CFR), Chapter 1, Part 5, Appendix C (October 1, 1993 pp34-48). Retrieved from: http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/primarycarehpsa criteria.html 2. HRSA Mental Health HPSA Designation Criteria. Relevant Excerpts from 42 Code of Federal Regulations (CFR), Chapter 1, Part 5, Appendix C (October 1, 1993 pp34-48). Retrieved from: http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhps acriteria.html 3. U. S. Department of Health and Human Services: National Health Services Corp official website. Retrieved on 4/9/14 from: https://nhsc.hrsa.gov 4. Maryland Department of Health and Mental Hygiene Policy, revised May 2013. Retrieved from: http://hsia.dhmh.maryland.gov/opca/j1%20visa%20app%20materials/j- 1%20MD%20Policy.doc 5. Maryland Department of Health and Mental Hygiene: State Loan Repayment Program () in Maryland. Retrieved on 4/8/2014 from http://hsia.dhmh.maryland.gov/opca/sitepages/pco-larp.aspx
Questions??