Can market-based solutions work for all of medicare? Barriers to reform in the medicare population residing in health professional shortage areas

The proportion of the Medicare-eligible population living in health professional shortage areas (HPSAs), their demographics, and three health status indicators were examined in relationship to market-based reform proposals. Medicare-eligible residents of Georgia and Kentucky were classified as living in an HPSA (n = 154,812) or non-HPSA (n = 556,602). Chi-squares were computed for demographic variables and health status indicators. A Mantel-Haenszel summary chi-square was computed after stratification of health status indicators by poverty level. Elderly residents of HPSAs accounted for 22% of the study population. Significant differences in all demographic variables except sex were detected. HPSA residents were more likely to have a mobility limitation, self-care limitation, or both a mobility and self-care limitation. Elderly residents in HPSAs are significantly more likely to have poorer health status and mobility limitations. Physician supply in HPSAs may be inadequate to support market-based reforms.