Distribution of Healthcare

Distribution of Healthcare

The implementation of the Affordable Care Act (ACA) placed a large emphasis on the delivery on preventative care and coordination of services. With more individuals having access to healthcare a greater strain has been placed on the primary care infrastructure. Only 32 percent of physicians currently practice primary care, which is below the recommended minimum of 40 percent (Shi & Singh, 2015). This shortage can further compound the issue of maldistribution. Maldistribution refers to either a surplus of shortage of the type of physicians needed to maintain the health status of a given population at an optimum level (Shi & Singh, 2015).

Rural communities are greatly affected by the maldistribution of healthcare professionals. Rural areas tend to suffer from geographic maldistribution. Locations outside of metropolitan areas are more likely to have physician shortages. Non-metropolitan areas have 59 PCPs/100,000 population compared to 94 PCPs/100,000 population in metropolitan areas. According to the Agency for Healthcare Research and Quality (AHRQ) only 9 percent of physicians practice in rural areas (Shi & Singh, 2015). Why actual shortage levels exist can be difficult to determine. In a policy brief entitled, Primary Care Workforce in the United States, the Robert Wood Johnson Foundation found that areas with low-income residents and minorities tend to suffer most from lower physician supply (Goodell, 2013). The reasons for the occurrence of these shortage problems are diverse and are related to physical/infrastructural, professional, educational, socio-cultural, economic and political issues. The need for general and specialized healthcare has steadily increased, particularly in the face of an aging population. The delivery of sophisticated healthcare requires technology, which in addition to being expensive also requires a qualified workforce. Many restrictions also exist in rural areas, which leads to serious challenges regarding health care delivery (Weinhold & Gurtner, 2014).

Although national headlines tend to focus on the dearth of PCPs, the undersupply of non-primary care specialties affects rural areas as well. With a decreasing obstetrician/gynecologist (OB/GYN) workforce, by 2010 Georgia had the nation's highest maternal mortality rate, sixteenth highest infant mortality rate. These alarming numbers led to the Georgia Maternal and Infant Health Research Group assessing each Georgia region's obstetric provider workforce to identify service-deficient areas. It identified 63 birthing facilities in the 82 Primary Care Service Areas (PCSAs) outside metropolitan Atlanta and interviewed nurse managers and others to assess the age, sex, and expected departure year of each delivering professional. What they found was that of the 82 surveyed PCSAs, 52 percent (43) were deficient in obstetric care; 16 percent (13) had a shortage and 37 percent (30) lacked obstetric providers entirely. There were no delivering family medicine physicians in 89 percent (73) of PCSAs and no certified nurse midwives in 70 percent (56). If Georgia fails to recruit delivering providers, 72 percent (58/77) of PCSAs will have deficient or no obstetric care by 2020 (Spelke, 2016).