Abstract:
Context: Healthcare service areas allow for the measurement of health outcomes, assessment of health care services utilization and healthcare shortage area designation. Healthcare service areas have been at the center of policy decisions and are vital for the efficient distribution of federal and state funds.
Objective: This research compared rural Primary Care Service Areas (PCSAs) to estimated 30-minute drive-time polygons centered on a primary care service access point within each PCSA.
Design: Rural PCSAs were compared to estimated 30-minute drive-time polygons created in ArcGIS based on average drive times along a road network to primary care access points. Population counts from the 2010 Census at the block level were used to calculate the population coverage of the PCSA and the estimated drive-time polygons. A quantitative comparison was made based on the difference in area and population coverage by each corresponding drive-time and PCSA polygon and the percent of population that was included in the PCSA, but outside of an estimated 30-minute drive time.
Setting: Rural Missouri, Oregon and North Carolina
Results: 72 percent of the PCSAs in the sample contained people that live outside of the 30-minute estimated drive-time polygon accounting for 14 percent of the total population living in the sample PCSAs. When considering the PCSAs that had the most people living outside the 30-minute drive-time polygon, 42.4 percent of the population lived outside of that drive-time polygon. An additional 18.1 percent of the people in these PCSAs were covered when considering 40-minute estimated drive-time coverage, but an additional 28.4 percent fell outside of the drive time when assessing the 20-minute estimated drive-time coverage.
Conclusions: The utilization of estimated drive, or travel, times may be an effective addition to the creation process for PCSAs and the evaluation of geographic access to primary health care, utilization and health outcomes.
