Underserved Populations

Underserved populations are residents of catchment areas for whom the availability of health care limits the amount of care consumed to something less than what experts believe they should be using. Note some of the qualifications of that statement. The appropriate service level is not determined by market demand but by experts' estimates of need. People who decide not to go to the doctor because they choose to ignore their symptoms are not poorly served, but someone who lacks access is. That lack of access may be due to the inability to pay or to a lack of providers in the area.

The U.S. Department of Health and Human Service administers a number of programs aimed at protecting and improving the health of underserved populations. Therefore, it has developed guidelines for designating Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs). Areas and populations that meet these guidelines are eligible to receive grant funding for Community Health Centers and, if rural, as Rural Health Centers and have personnel assigned by the U.S. Public Health Service. Eligible health centers that meet the guidelines but do not receive grants may be certified as Federally Qualified Health Centers and become eligible for cost-based Medicaid reimbursement.

The population of individuals whose attributes are used to determine whether an area is underserved is the whole population of a set of counties, minor civil divisions, or census tracts that represent a homogeneous socioeconomic or demographic neighborhood. The population for the MUP is a subset of the individuals in an area who experience economic, linguistic, and/or cultural barriers to private medical care.

The four basic criteria for MUA or MUP designation are the percentage of the area population at or below 100% of the federal poverty level, the percentage over 65, the infant mortality rate over the last five years, and the ratio of full-time–equivalent physicians per thousand population. The values for each of these variables are assigned a score and these four scores are added to form an Index of Medical Underservice. A cutoff score is then applied to determine eligibility. Populations that do not meet the cutoff score may also apply based on the existence of “barriers to access to or the availability of personal health services” if they have the support of the state's governor and local health officials. Note that these determinations are not based directly on measures of health needs or utilization, but on available secondary data often associated with poor access to services.

The uninsured are a major group of the underserved, making up roughly a sixth of the under-65 population. For the most part they are working members of minorities, Hispanic and black, and young. Although their age makes them a generally healthy population, they also are closed out of preventive medical services. Most states have special Medicaid programs for children with less stringent eligibility requirements that the program for adults, although they often have waiting lists due to lack of funding.