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State Service-Contingent Programs For Health Providers: An Effective Part Of The Medical Safety Net

Study and Results: This research documents the varying education support for health service programs among the states. The Sheps Center of the University of North Carolina at Chapel Hill, with contract support from the Agency for Healthcare Research and Quality, surveyed 82 programs that offer health professionals, students, residents and practitioners funding in exchange for service in medically under-serviced areas. The goal in most of these programs was to influence the distribution of the health care workforce. The report concluded that there existed five structurally different types of programs (scholarships, loans, resident support, loan repayment and direct financial incentive) in 41 states. Moreover, program participants have dramatically increased since the mid 1980s.

What's Important: Although the study was forced to omit several programs that lacked the required eligibility criteria, the report concluded that the growth in the state support for service programs has had a considerable effect on the U.S. health care safety net during the last 15 years. The report recommends that a governing body be established to monitor these programs, thereby preventing duplication and harmful competition.

Find This Study: "State Scholarship, Loan Forgiveness, and Related Programs: The Unheralded Safety Net" can be found in the Journal of the American Medical Association 284, no. 16.

The Public Health Workforce: Enumeration 2000

Study and Results: This research study collected data to delineate the size and composition of the public health workforce in the 21st century. It proved difficult to obtain workforce information because complications due to varying definitions and duties of the public health staff amongst the different states. The positions were divided into four major categories: administrators, professionals, technicians and clerical staff. The study found that the United States has a national public health workforce of approximately 448,254 individuals. Epidemiologists comprised less than .5 percent, while public health nurses were the largest professional group, consisting of 11percent of the total workforce.

What's Important: The study found that trend analysis of the public health workforce was impossible due to gaps in the data. However, researchers recommended more training in response to emergency needs for clerical staff, further study on the number of public health educators, and identified a need to build an institutional memory of process and enumeration. This institutional memory will help provide a solid basis for policymaking and can help in planning for education, recruitment and retention of a qualified public health workforce.

Find This Study: The Public Health Work Force: Enumeration 2000 is published by the Bureau of Health Professions. Contact Marilyn Biviano, Health Resources and Services Administration, (301) 443 - 9792.

Increasing Racial Diversity In The Nursing Workforce

Study and Results: The National Advisory Council on Nurse Education and Practice researched ways to increase racial diversity in the nursing workforce. The Council concluded that a unified effort by all sectors of society would be needed to promote diversity through improved workforce settings, education and practice. The report recommends goals and actions that can serve as a national action agenda.

What's Important: The report identified minority nurses as leaders in the development of models of care that address unique needs of minority groups. The promotion of minority nurses thus could help facilitate care to these groups. The council recommends enhanced efforts to increase the recruitment, retention and graduation of minority students by increased education and use of minority faculty. Furthermore, minority nurse leadership must be promoted by reducing the social isolation of minority nurses and increasing the number of minority nurses in policy and leadership positions. It will be important to develop practice environments that promote diversity.

Find This Study: A National Agenda for Nursing Workforce: Racial/Ethnic Diversity, (data as of April 2000) was published by the National Advisory Council on Nurse Education and Practice. For more information contact the Division of Nursing in the Bureau of Health Professions at (301) 443-5786. 

Getting Less Care: The Uninsured with Chronic Health Conditions

Study: Families USA and The Lewin Group analyzed data from the 1996 Medical Expenditure Panel Survey (MEPS) and the 1988-1994 National Health and Nutrition Examination Survey (NHANES) to determine how access to and utilization of care differ between insured and uninsured populations. The 1996 MEPS is a national survey of 10,000 families and 24,000 individuals. The NHANES is a national survey of 40,000 people.

Significant Findings: Individuals without health insurance face more barriers to care and see their physicians less than individuals with insurance. Uninsured individuals who suffer from chronic health conditions such as heart disease, hypertension, arthritis, and chronic back pain face more barriers to accessing health care than their insured counterparts. They visit the doctor less often, go without medication more often, and are more likely to forgo needed care due to cost than then their insured counterparts.

What's Important: While the uninsured with chronic illnesses have some protection under federal law to gain access to emergency care, their ability to receive routine healthcare services is dependent on the availability of a local community health care safety net.

Caveats: Insurance status was determined at the point in time when the interview took place. The length of time that the respondent was uninsured cannot be determined. As a result, effects of health insurance on access to care maybe understated. Also, the researchers were unable to determine severity of chronic conditions.

Find This Study: This report is available online at http://www.familiesusa.org/pub.htm#reports
Source: Families USA, Getting Less Care: The Uninsured with Chronic Health Conditions
(Washington, DC: Families USA, 2001).

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