MUAs in United States and California

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Hi,

Interesting questions! Let's take a closer look through discussion and illustrative example, which you can draw on for your specific area for Medical Underserved Areas (MUAs). Please see attached response for best formatting of Tables and Charts (which is also presented below).

RESPONSE:

1. List the number of MUAs in the United States and the number in your city/town. If you live outside the United States, pick a city similar to yours and do the research for that one.

This question is straightforward. You need to research a specific area to determine how many Medical Underserved Areas (MUAs) are in that area or city, either urban or rural areas.

To help in this process, search the MUA/MUP data base (live, updated continuously) (http://muafind.hrsa.gov/).

Also see MUA/P data dictionary (http://bhpr.hrsa.gov/shortage/muadatadict.htm).

ILLUSTRATIVE EXAMPLE: Rural areas in North Carolina e.g., effective recruitment based on MUA designation, federal programs, etc.

AHECs involve urban under-served locations also. Arkansas has also had similar improvements in physician-population ratios. North Carolina's success may not be the AHEC admissions component so much as it is impact on recruitment and support of physicians. NC has superior recruitment efforts as noted in recruitment of family physicians from most other states. Patterns of Rural Workforce NC is matched only by Wisconsin in this. North Carolina rural born students have one of the lowest ratios of admission in the United States, although this ratio is improving. Probability of admission tables State education must be improved if NC hopes to "grow its own" and reduce dependence on other states and nations. NC efforts to support physicians in practice are unmatched, including outreach efforts from medical schools (http://www.unmc.edu/Community/ruralmeded/commentary_season_of_account.htm).

2. Include an explanation of what MUAs represent and the reasons for them.

Medically Underserved Area (MUA) represents areas that meet specific criteria. In other words, a MUA is an area that meets the following criteria as seen in the illustrated example below e.g., percentage below the poverty line, ratio of physicians to population, percentage of people 65 years and over, etc. by categorizing these areas, the medical profession can target them for unique programs and identify areas that need improvement e.g., recruit more general practitioners to practice in these areas, etc.

For example, one expedited method for obtaining a green card is through a "National Interest Waiver," which does not require employers to go through the labor certification process. Instead, they must show that their communities historically have had a difficult time recruiting physicians. Generally, employers must be in a Health Professional Shortage Area (HPSA) or a Medically Underserved Area (MUA) to obtain a National Interest Waiver on behalf of an IMG. Congress and the President recently restored the ability of certain physicians to obtain National Interest Waivers.

The following illustrated example is fairly lengthy, but provides an excellent coverage of the types of criteria that designate an area as a MUA.

ILLUSTRATED EXAMPLE: Guidelines for Medically Underserved Area and Population Designation

· Search the MUA/MUP data base (live, updated continuously)
· MUA/P data dictionary

These guidelines are for use in applying the established Criteria for Designation of Medically Underserved Areas (MUAs) and Populations (MUPs), based on the Index of Medical Underservice (IMU), published in the Federal Register on October 15, 1976, and in submitting requests for exceptional MUP designations based on the provisions of Public Law 99-280, enacted in 1986.

The three methods for designation of MUAs or MUPs are as follows:

I. MUA Designation

This involves application of the Index of Medical Underservice (IMU) to data on a service area to obtain a score for the area. The IMU scale is from 0 to 100, where 0 represents completely underserved and 100 represents best served or least underserved. Under the established criteria, each service area found to have an IMU of 62.0 or less qualifies for designation as an MUA.

The IMU involves four variables - ratio of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population age 65 or over. The value of each of these variables for the service area is converted to a weighted value, according to established criteria. The four values are summed to obtain the area's IMU score.

The MUA designation process therefore requires the following information:
(1) Definition of the service area being requested for designation. These may be defined in terms of:
(a) a whole county (in non-metropolitan areas);
(b) groups of contiguous counties, minor civil divisions (MCDs), or census county divisions (CCDs) in non-metropolitan areas, with population centers within 30 minutes travel time of each other;
(c) in metropolitan areas, a group of census tracts (C.T.s) which represent a neighborhood due to homogeneous socioeconomic and demographic characteristics.
In addition, for non-single-county service areas, the rationale for the selection of a particular service area definition, in terms of market patterns or composition of population, should be presented. Designation requests should also include a map showing the boundaries of the service area involved and the location of resources within this area.

(2) The latest available data on:
(a) the resident civilian, non-institutional population of the service area (aggregated from individual county, MCD/CCD or C.T. population data)
(b) the percent of the service area's population with incomes below the poverty level
(c) the percent of the service area's population age 65 and over
(d) the infant mortality rate (IMR) for the service area, or for the county or subcounty area which includes it. The latest five-year average ...