Impact of the National Health Service Corps on Health Disparities

摘要 历史上主导卫生保健人员讨论的最严重的担忧之一 在美国，提供者的持续不平等分配，特别是#年医生的严重短缺 弱势城市社区、小城镇和农村地区。为了解决这一担忧，政策制定者已经 在过去的半个世纪里付出了相当大的努力。在这些努力中，国家卫生服务总队 (NHSC)是已经启动的最大规模和最重要的公共政策干预，以解决 全国临床医生队伍的地理分布不均。NHSC的目标是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几年的教育贷款来解决服务不足的地区 承诺在卫生专业人员短缺地区工作的毕业生。过去的十年见证了 联邦政府对NHSC的投资大幅增加，首先是通过美国的复苏和再投资 2009年通过了《平价医疗法案》，2010年通过了《平价医疗法案》。 几项研究已经观察到，这两项法案使NHSC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和 更均匀地分布在各州。然而，到目前为止，还没有研究考虑到 NHSC扩大了不同地理区域在医疗保健和健康方面的差距。自NHSC扩容以来 为HPSA带来了更多的临床医生，人们可能会看到HPSA之间的健康差距缩小 以及其他领域。此外，虽然增加的投资导致了NHSC的整体增长 劳动力方面，不同专业的增长差异很大，包括初级保健、心理健康和牙科 护理人员。因此，NHSC扩大对健康和医疗保健差距的影响是 可能会因临床医生的专业而有所不同。 这个拟议的项目旨在研究这些问题并填补文献中的空白。据我们所知，它 将是第一个评估最近NHSC扩大对健康和医疗保健差距影响的研究。 该项目有以下具体目标： 目的1.评估最近NHSC扩大对初级保健和结果差异的影响。 目的2.评估最近的NHSC扩展对精神卫生保健和结果的差异的影响。 目的3.评估最近的NHSC扩展对牙齿保健和结果的差异的影响。 目的4.评估最近NHSC扩大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来确保我们的发现是 健壮而有效。拟议的研究是独特和及时的，研究结果将直接用于 作为纠正分配不均的努力的一部分，政策制定者参与了对国民健康保险制度的评估和修改 减少美国医疗服务提供者的劳动力数量，减少健康差距。

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.