AHCRA: Access to Health Care in Rural Appalachia

摘要

ABSTRACT Approximately one-fifth of the United States (US) population lives in rural areas. Americans in rural areas often experience poorer health and engage in fewer health promotion activities compared to their more urban counterparts. Currently there are more healthcare clinicians per capita in urban areas compared to rural areas in the US. Despite a greater need for healthcare in rural areas, the US experiences a paradox regarding access to care in rural areas: Americans with the greatest need for healthcare experience the least access to care. While this clinician maldistribution has been present for decades, relatively little is known about why clinicians choose to locate in a specific area. Even more concerning is that the clinician maldistribution is worsening over time, forcing millions of Americans to drive farther to obtain healthcare. The disparity in access to care increases both morbidity, mortality, and increases health care costs. We propose to evaluate a theoretically-grounded, quantitative experimental approach to studying reasons underlying the maldistribution in the US healthcare clinician workforce, and to identify potential policy approaches to address these disparities. Specifically, we will evaluate the relative importance of job-, community-, and personal-related attributes for medical residents and fellows as well as physician assistant (PA) and nurse practitioner (NP) students using a discrete choice experiment (DCE). The DCE methodology is a rigorous survey method used to elicit preferences, quantify tradeoffs, and understand decision-making. This study is innovative because it will be the first to use DCE methods to identify policy options for increasing the attractiveness of rural jobs in the US. Our proposed study will address three aims: Aim 1 will elicit individual-, community-, and job-related preferences that influence decisions on whether to choose a clinical position from residents and fellows, as well as PA and NP students. Aim 2 will develop, pilot-test, and deliver the DCE survey to characterize the most important attributes and their levels that influence whether to choose a particular clinical position. Aim 3 will estimate the relative importance of the most important attributes and their levels that influence whether a clinician chooses a particular clinical position. This proposed research will provide policy- and decision-makers with an important first step towards designing policy options and incentives that increase the attractiveness of healthcare jobs in rural areas. More broadly, this proposed research will also provide our research team pilot data from which to generate future research with healthcare clinicians and identifying policy options and incentives to retain them in rural areas.