II. Rational Service Areas

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II. Rational Service Areas
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(HPSA - RSAs)
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HPSA - Rational Service Areas (HPSA - RSAs)
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Objective Participants will understand 1)
The characteristics of a health professional
shortage area/rational service area 2)
The criteria used to determine if a service area
is rational.
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Health Professional Shortage Area (HPSA)
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Origin National Health Service Corps
(NHSC) (Measures the shortage of health
professionals in an area)

• Componentsa) Rational Service Area
  (RSA)b) Population to Provider
  Ratioc) Contiguous Area Analysis
• Disciplinesa) Primary Medical Careb) Dental
  Health Carec) Mental Health Care
• Type of Designationsa) Areab) Population
  Groupc) Facility

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Types of Rational Service Areas(Applies to all
types HPSA and MUA/MUP designations)
--------------------------------------------------

• Medical Service Study Areas (MSSAs) recognized
  by HRSAs Shortage Designation Branch (SDB) as
  rational services areas
• Whole County
• Sub-County

• Catchment Areas
• (mental health only)

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Rational Service Areas
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• Cannot
• 1)  Overlap
• 2) Have more than one HPSA designation per
  discipline (e.g., geographic and low-income
  population)
• 3) Be smaller than a census tract
• Exceed travel time between population centers
• Have interior portions carved out
•  

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What is an MSSA?

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A. MSSA Definitions
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Adopted by the California Healthcare Workforce
Policy Commission on May 15, 2002

• Each MSSA is composed of one or more complete
  census tracts.
• MSSAs will not cross county lines.
• 3) All population centers within the MSSA are
  within 30 minutes travel time to the largest
  population center.

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A. MSSA Definitions (Continued)
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Urban MSSA

• Population range 75,000 to 125,000
• Reflect recognized community and neighborhood
  boundaries
• Similar demographic and socio-economic
  characteristics

Rural MSSA

• Population density of less than 250 persons
  per square mile
• No population center exceed 50,000

Frontier MSSA

• Population density of less than 11 persons per
  square mile

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Why MSSA?

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Problem MSSAs Address

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California has 58 counties with wide ranging
differences in size and population

• U.S. Census Bureau recognizes whole counties as
  rural or urban.
• Rural portions of counties such as San
  Bernardino, Riverside, Los Angeles, and Butte are
  declared as urban.
• Californias cities have wide disparities in
  income and health status.

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Rationale for MSSAs

--------------------------------------------------
Advantages of sub-county / sub-city areas

• Better means of determining rural and urban areas
  in California
• Better means of determining demographic/socio-econ
  omic differences and recognizing health
  disparities
• Better means of identifying healthcare access in
  medically underserved communities

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Major Uses of MSSAs
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• U.S. Public Health Service recognizes MSSAs as
  rational service areas for purposes of
  determining Health Professional Shortage Areas
  (HPSAs) and Medically Underserved
  Areas/Medically Underserved Population
  (MUAs/MUPs).
• MSSAs are a principal component for display of
  large databases through OSHPDs Geographic
  Information System (GIS).
• MSSAs have the potential for assisting in needs
  assessment, health planning, and health policy
  development.

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Types of MSSA

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• Whole County MSSA
• Sub-County MSSA

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Whole County
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Sub-County
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Service Area Travel Calculation
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Primary Health CareInterstate Roads 25 miles
X 1.2 30 minutes Primary Roads (include
surface streets) 20 miles X 1.5 30
minutes Secondary Roads (mountainous terrain or
unpaved road) 15 miles X 2.0 30 minutes
Dental and Mental Health CareInterstate Roads
30 miles X 1.33 40 minutes Primary Roads
(include surface streets) 25 miles X 1.6 40
minutesSecondary Roads (mountainous terrain or
unpaved road) 20 miles X 2.0 40 minutes
Mapping Sources Used By SDB Rand McNally Road
Atlas, Maps On Us (www.mapsonus.com)
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Mapping Sources
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Rand McNally Road Atlas or Rand McNally
on-line www.randmcnally.com or Maps on Us
on-line www.mapsonus.com
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(Use travel calculation from Pages II-16)
Primary Care 17 miles x 1.5 min 26
minutes Dental Mental 17 miles x 1.6 min 27
minutes
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B. Mental Health Catchment Area
--------------------------------------------------
Since California does not have mental
health catchment areas, MSSAs are used for
purposes of designating mental health HPSAs.
Service areas can be 1)   An MSSA
2) One or more MSSAs combined travel time
between each MSSA must be within 40
minutes and population no more than
475,000 3) Whole county - maximum
population no more than 475,000.  
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Completion of the Census 2000 MSSA
Reconfiguration in Record Time

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Before

• Census 1990
• - 5,000 census tracts - 29.7 million
  population
• It took 2 years

Rural MSSAs 213 Urban MSSAs 274 Total MSSAs
487

--------------------------------------------------
After

• Census 2000
• - 7,049 census tracts - 33.8 million
  population
• It took 9 months with the GIS Redistricting
  Tool

Frontier MSSAs 56 Rural MSSAs 186 Urban MSSAs
299 Total MSSAs 541

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MSSA Reconfiguration Step-by-Step
--------------------------------------------------
1) Organized selected 2000 census data in 1990s
MSSA configuration 2) Examined total population,
square miles, income information, and demographic
data 3) Noted areas defined as rural and as
urban   a) The MSSA was rural if any census
defined place within the MSSA has a
population of 50,000 or more   b) The MSSA
was rural if the density exceeds 250
person per square mile
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MSSA Reconfiguration Step-by-Step
--------------------------------------------------

• 4) Determined if there were contiguous census
  tracts within a defined urban MSSA that, if
  separated from the urban MSSA, would stand alone
  as a rural MSSA. Determined if community
  stakeholders supported creating a new rural MSSA.
• 5) Determined the population and area (in square
  miles) of urban MSSAs within the county.
• Ascertained whether the urban MSSA was greater
  than five square miles. If it was not, then one
  or more adjacent census tracts was added to
  increase the area to five square miles or greater.

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MSSA Reconfiguration Step-by-Step
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• If the total population of the urban MSSA
  exceeded 200,000 it was divided into at least two
  urban MSSA subdivisions that had a population
  range no less than 75,000 and no more than
  125,000.
• Ascertained that each urban MSSA subdivision was
  within at least five square miles in area. If
  not, then one or more adjacent census tracts was
  added to increase the area to five square miles
  or greater, even if the resulting population of
  the urban MSSA exceeded 125,000

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MSSA Reconfiguration Step-by-Step
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7) Once consensus (or substantial agreement)
among the stakeholders was reached on MSSA
reconfiguration, OSHPD prepared a draft motion
for the California Healthcare Workforce Policy
Commission (CHMPC), which was circulated among
the stakeholders in the county.  
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MSSA Reconfiguration Adoption Process
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• Changes to the boundaries of MSSAs can only be
  made through motions adopted by the California
  Healthcare Workforce Policy Commission (CHMPC).
• Any such motions will be agenda items of CHMPC
  and should be accompanied support letters from
  community officials and stakeholders.

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