A method for identifying places in rural America at risk of not being able to support adequate health services.

Context: Public policymakers and their advisers struggle with the problem of specifying criteria by which health care providers in rural areas are eligible for special consideration in payment policies and for special grant programs. A means of designating places can provide a basis for assistance and can help target public resources for any providers who deliver services in those places.

Purpose: This paper provides the details underlying a place-based approach to identifying rural areas that are at risk for not being able to provide requisite health services.

Methods: A population size criterion is utilized first to eliminate metropolitan areas and other large agglomerations from consideration. Any territory not included in a place of 3500 or more people, including a 25-mile buffer around that place, is a priori considered to be at risk. All places, including buffers, that have populations between 3500 and 100,000 are further analyzed using population compositional data and principal components analysis.

Findings: In 10 states and 24 bordering states selected for developing and testing the method, there were 1907 block groups outside the boundaries of any place with a population of at least 3500. In addition, the analysis suggested that 66 out of 236 places and buffers with populations between 3500 and 100,000 also should be classified as vulnerable.

Conclusions: The results are discussed in regard to how a place-based approach can advance the study of rural health needs. By focusing on the needs of the people residing in a defined area, as determined from the aggregate characteristics of the population, a model is generated that can be used to predict special circumstances confronting any service provider. The public policy implications of the findings are also considered. Special payment policies could be written on the basis of place instead of provider characteristics, and grant programs providing technical assistance could be targeted to places of greatest need.