Collaborative Research: A Spatial Analysis of the Distribution and Consequences of Health Care Policy Implementation in a Federal System

联邦政府与各州以及联邦合格医疗中心（FQHCs）、私营部门实体和非营利组织合作，实施旨在促进美国人健康和福祉的政策。通过将资源从联邦政府转移到各州以及地方组织，那些最接近公众的人可以根据居民的需要制定卫生政策。然而，公众在获取这些资源时可能面临的障碍类型有所不同。在低收入的农村和城市地区尤其如此。这个合作项目通过使用标题X的案例来研究各种因素如何影响公共资源的分配，标题X是一个独特的项目，其资源在美国50个州以多种方式分配。该项目还评估了有效和公平的资源分配与地方卫生成果之间的联系。该项目为政策制定者提供了见解，以确保最需要支持的美国居民能够获得旨在提高健康公共成果的资源。来自公共政策、地理、城市和区域规划以及卫生政策等广泛学科的见解和方法上的进步有助于该项目对获得专业医疗资源的机会进行细致、准确的衡量，以确定州和地方政府以有效和公平的方式分配联邦资源的程度，并检查公共卫生结果如何响应各种政策实施模式。该项目结合了地理信息系统（GIS）和统计/空间分析——特别是综合两步浮动集水区（I2SFCA）方法——以及回归和因素分析，以利用多种形式的数据（例如美国人口普查数据、州立法机构的人口变量、公共卫生措施）。这些分析强调了在美国各地公平获得联邦批准的生殖保健资源的决定因素，以及对那些生活在无法获得高质量资源的地方的人的后果。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

The federal government works alongside states as well as Federally Qualified Health Centers (FQHCs), private sector entities, and non-profit organizations to implement policies aimed to promote the health and well-being of Americans. By shifting resources from the federal government to the states as well as local organizations, those who are closest to the public can tailor health policy to the needs of its residents. However, there is variation in the types of barriers the public may face in accessing these resources. This is especially true in low-Income rural and urban localities. This collaborative project examines how various factors influence the allocation of public resources by using the case of Title X, a unique program whose resources are allocated in many ways across the 50 U.S. states. The project also assesses the link between efficient and equitable resource allocation and local health outcomes. The project provides insights for policymakers to ensure that the American residents who are most in need of support are able to obtain the resources intended to enhance healthy public outcomes. Insights and methodological advances from a wide array of disciplines—public policy, geography, city and regional planning, and health policy—contribute to the project’s development of a nuanced, accurate measurement of access to specialized healthcare resources to ascertain the extent to which state and local governments allocate federal resources in efficient and equitable ways and examine how public health outcomes respond to various modes of policy implementation. The project incorporates geographic information systems (GIS) and statistical/spatial analysis—specifically the integrated two-step floating catchment area (I2SFCA) method—as well as regression and factor analysis to gain leverage over multiple forms of data (e.g. U.S. Census data, demographic variables of state legislatures, public health measures). These analyses highlight the determinants of equitable access to federally-approved reproductive healthcare resources across United States as well as the consequences for those who live within spaces where high-quality resources are not accessible.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.