Impact of the National Health Service Corps on Health Disparities

国家卫生服务团对健康差异的影响

• 批准号: 10318659
• 负责人: HAO YU
• 金额: $ 43.12万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-22 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10318659
• 关键词: Address; Adult; Affordable Care Act; American; Area; Budgets; Caring; Charge; Child; Congresses; Data; Data Files; Dental Care; Disadvantaged; Econometric Models; Ensure; Funding; Funding Agency; Geographic Distribution; Geographic Locations; Geography; Goals; Growth; Health; Health Professional; Healthcare; Heterogeneity; Intervention; Investments; Literature; Medicaid; Mental Health Services; Methods; Minority Groups; National Health Service Corps; Natural experiment; Oral health; Patients; Physician Shortage Areas; Physicians; Policies; Primary Health Care; Privatization; Provider; Psyche structure; Public Policy; Quality of Care; Recovery; Reduce health disparities; Reporting; Research; Scholarship; Structure; Students; Subgroup; Time; Urban Community; Work; base; care outcomes; experience; health care disparity; health care quality; health disparity; health professional shortage areas; medical specialties; novel; programs; recruit; residence; rural area; skills; underserved area

Abstract One of the most serious concerns that have historically dominated discussions of the health care workforce in the US is the persistent, unequal distribution of providers, especially deep shortages of physicians in disadvantaged urban communities, small towns, and rural areas. To address this concern, policymakers have taken considerable efforts during the past half-century. Among the efforts, the National Health Service Corps (NHSC) is the largest and most significant public policy intervention that has been initiated to address the geographic maldistribution of clinician workforce in the nation. The NHSC aims to place health professionals in underserved areas by providing scholarships to students and by repaying educational loans for recent graduates who commit to work in health professional shortage areas (HPSAs). The past decade has witnessed a dramatic increase in federal investment in the NHSC, first through the American Recovery and Reinvestment Act in 2009, and then by the Affordable Care Act in 2010. Several studies have observed that these two Acts have more than doubled the NHSC’s annual budget and led to substantial expansion of the NHSC’s clinician workforce, which has also become more diverse and more evenly distributed across states. However, no study to date has considered the potential effect of the NHSC expansion on disparities in health care and health across geographic areas. Since the NHSC expansion has brought more clinicians to HPSAs, one may expect to see a reduction in health disparities between HPSAs and other areas. Further, while the increased investment has resulted in overall growth of the NHSC’s workforce, the growth varied significantly across specialties, including primary care, mental health, and dental care workforce. Consequently, the effects of the NHSC expansion on health and health care disparities are likely to differ by clinician specialty. This proposed project aims to examine these issues and fill the gap in the literature. To our knowledge, it will be the first study to assess the effect of the recent NHSC expansion on health and health care disparities. The project has the following Specific Aims: Aim 1. To assess the effect of the recent NHSC expansion on disparities in primary care and outcomes. Aim 2. To assess the effect of the recent NHSC expansion on disparities in mental health care and outcomes. Aim 3. To assess the effect of the recent NHSC expansion on disparities in dental health care and outcomes. Aim 4. To assess the effect of the recent NHSC expansion on disparities in patient-reported quality of care. To examine these aims, we will use novel and state-of-the-art data and methods to ensure our findings are robust and valid. The proposed study is unique and timely, and the study findings will be of direct use to policymakers engaged in assessing and modifying the NHSC as part of their efforts to right the maldistribution of the US provider workforce and reduce health disparities.

摘要 历史上主导卫生保健劳动力讨论的最严重问题之一 在美国，医疗服务提供者的分布持续不平等，特别是在 贫困城市社区、小城镇和农村地区。为了解决这一问题，政策制定者 在过去的半个世纪里，我们付出了巨大的努力。在这些努力中，国家医疗服务队 （NHSC）是最大和最重要的公共政策干预，已启动，以解决 全国临床医生劳动力的地理分布不均。NHSC旨在将卫生专业人员安置在 通过向学生提供奖学金和偿还最近的教育贷款， 毕业生谁承诺在卫生专业人才短缺地区（HPSAs）工作。在过去十年有 联邦对国家高速公路公司的投资急剧增加，首先是通过美国复苏和再投资 2009年通过《平价医疗法案》，2010年通过《平价医疗法案》。 若干研究报告指出，这两项法案使国家保健委员会的年度预算增加了一倍多 并导致NHSC临床医生队伍的大幅扩张，这也变得更加多样化， 更均匀地分布在各州。然而，迄今为止，还没有研究考虑到 国家保健中心扩大了各地理区域在保健和健康方面的差距。自NHSC扩张以来 HPSA带来了更多的临床医生，人们可能会期望看到HPSA之间的健康差异减少 和其他领域。此外，虽然投资的增加导致了NHSC的整体增长， 劳动力，不同专业的增长差异很大，包括初级保健，心理健康和牙科 护理劳动力。因此，扩大国家保健中心对健康和保健差距的影响是 可能因临床医生专业而异。 本项目旨在研究这些问题，填补文献中的差距。据我们所知， 将是第一个研究，以评估最近的NHSC扩大对健康和医疗保健差距的影响。 该项目的具体目标如下： 目标1.评估最近NHSC扩展对初级保健和结果差异的影响。 目标二。评估最近NHSC扩展对精神卫生保健和结果差异的影响。 目标3.评估最近NHSC扩展对牙科保健和结果差异的影响。 目标4。评估最近NHSC扩展对患者报告的护理质量差异的影响。 为了检验这些目标，我们将使用新的和最先进的数据和方法，以确保我们的研究结果是 稳健有效。建议的研究是独特和及时的，研究结果将直接用于 政策制定者参与评估和修改国家卫生服务委员会，作为纠正分配不均的努力的一部分 美国供应商的劳动力和减少健康差距。