State Scholarship and Loan Forgiveness Programs in the United States: Forgotten Driver of Access to Health Care in Underserved Areas

Abstract

State-supported programs providing loans and scholarships in exchange for service in underserved areas provide an important source of financial support for medical students while encouraging them to select careers in primary care. The purpose of this research was to seek a better understanding of these often unheralded but important state sources of support, and learn if they have continued to grow in the twenty-first century. Administrative data were obtained on statesupported programs operating in 2008 that provided financial support to students, resident or practicing physicians, physician assistants, nurse practitioners, certified nurse midwives, dentists, and licensed mental healthcare providers in exchange for service in an underserved area. The authors identified numbers, types of state-supported programs, program workforce strength, and features of state programs. In 2008, 75 state programs, operating in 37 states, collectively had 5113 program participants under contract. Loan repayment programs (n = 42, 56%) were the most common type of state-supported programs. Practitioners signed initial contracts in 2008 totaled 1173, with more non-physicians (n = 681, 58%) signing initial contracts than physicians (n = 492, 42%). Additionally, 2803 practitioners were serving in programs in 2008. Field placement was also slightly greater among non-physicians in 2008 (n = 1433, 51%) than physicians (n = 1370, 49%). State support-for-service programs remains an important source of financial assistance for those willing to make service commitments in underserved areas. Moreover, these programs continue to increase in size, even amidst the economic malaise, and provide an obligated primary care workforce in underserved areas. K. W. Geletko et al.1995

Not Near Enough: Racial and Ethnic Disparities in Access to Nearby Behavioral Health Care and Primary Care

“…For instance, loan forgiveness programs and scholarships targeted toward providers practicing in underserved communities could improve the primary care and behavioral health workforce in underserved areas. 50 National Health Service Corps scholarships and loan repayment programs 51 in addition to Minority Fellowship Programs funded through the Substance Abuse and Mental Health Services Administration 52 explicitly place primary care and behavioral health professionals in underserved health professional shortage areas. Payment reform policies could support the provision of integrated primary care clinics that provide collaborative, team-based, same-day primary care services and behavioral health services in shared clinical space.…”

What Moves Physicians to Work in Rural Areas? An In-Depth Examination of Physician Practice Location Decisions

“…3 Numerous studies documented and assessed the effects of such programs. In 2008, 75 state programs operating across 37 states had more than 5,000 health providers under contract, including 492 newly contracted physicians (Geletko et al, 2014). In their systematic literature review on primary care physicians’ location choice predictors, Goodfellow et al (2016) found that financial incentives were among the most important underlying factors influencing primary care physicians.…”

Assessment of Dentist Participation in Public Insurance Programs for Children in the US

“…11 Overall, the percentage of dentists practicing in rural communities was low compared with the level of the state’s rurality status, for example, only 3% of the dentists practiced in rural communities in Georgia, and 40% of the state is considered rural. 11 This finding suggests that the supply of dental care for children was insufficient in rural communities during the study period; interventions such as loan forgiveness programs 12 , 13 or school-based mobile care may help address such shortages. 14 , 15 , 16…”