One persistent problem that faces state and federal health policy-makers is determining the level of primary care needs of the citizens they serve. To refine the decision making process in Illinois, a model was developed to compare the 84 rural counties of Illinois and their potential need for additional primary care interventions. Using expert panel methods, a group of public health professionals selected a set of 31 health status indicators that were available at the county level throughout the state. Next, the panel developed a weighting system for those indicators. These weighted values were then applied to the demographic and epidemiologic data from each of the counties to rank the counties on the basis of need. Indicators having the highest correlation with the weighted sum were the percent of the population enrolled in Medicaid, lung cancer mortality rate, general population mortality rate, proportion of population at poverty level, and percent of births to teens. Data also showed that the rural counties with the greatest needs clustered in five geographic regions. The identification of these five geographic clusters may facilitate collaborative efforts in meeting the primary care needs of these populations.
Facilities operated by public and nonprofit agencies have become increasingly important sources of primary care for Medicaid patients. These facilities are particularly important sources of care in segregated, competitive urban areas, where they are more geographically accessible than many private physicians and expand the availability of care to Medicaid patients rather than substituting for care provided by private physicians. In rural areas, in contrast, the availability of care from public facilities appears to reduce the level of care Medicaid patients receive from private physicians in the counties where these facilities are located. These findings suggest that policymakers can expand urban Medicaid patients' access to care by spending on public care, but at the cost of increasing the segregation of Medicaid patients into a two-tier system of care.
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