Featured Articles: Data Points

How Many Rural Health Centers are there in Region X?

Monday, May 14, 2018  
Posted by: Thomas Johnson
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Last month, we kicked this column off by looking at the number of patients served as a percent of the general population. The general question that article attempted to answer was "How many people in a given state are health center patients?"

This month we're shifting gears and focusing on the question of rurality. More specifically, "How many health center service delivery sites in Region X are located in rural areas?"

Because HRSA publishes a site directory that includes the facility setting for every health center service delivery site, you might think that answering this question is fairly straight forward. Unfortunately, as the chart below shows, a significant percentage of those sites have unknown settings (the dark purple):

Location Setting of Health Center Sites by State

Source: Health Center Site Directory, HRSA

Fortunately, we can get around this issue by reclassifying each site's facility setting using an alternative classification system. The map below, for example, shows the percentage of health center sites in each state that are eligible for grants awarded by the Federal Office of Rural Health Policy (click here to read more about their classification criteria).

Percent of Health Center Sites Serving Rural Communities

Source: Health Center Site Directory, HRSA; Federal Office of Rural Health Policy, FORHP Eligible ZIP Codes

Joining FORHP's classification with HRSA's site directory provides a clearer picture of how many delivery sites are located in rural areas. With a few exceptions, most states with a high percentage of rural sites are concentrated in the Southeast and Midwest. In Region X, the states with the greatest share of rural delivery sites are located in Idaho and Alaska, the latter of which has the highest percentage of rural sites throughout the country.

The map also shows the degree of misalignment between HRSA's designation and FORHP's designation. For many states, the percentage of rural health center sites is actually greater than what HRSA's site directory indicates. For health center staff, this means that regardless of how HRSA classifies your health center's delivery locations, you should still check each site's address using FORHP's Rural Health Grants Eligibility Analyzer. You may be eligible for a grant and not realize it!

The other benefit of using FORHP's classification is that it lets us answer the closely related question of "What percent of each health center's patient population live in a rural community?"

In the chart below, each health center in Region X is represented by a square. The color corresponds to the percentage of patients living in a rural postal code (as determined by FORHP). Bluer squares represent health centers that serve more urban populations and redder squares represent health centers that serve more rural ones.

Percent of Patients Living in Rural Communities

Organized by health center (hover for details)

Source: HRSA, Uniform Data Syste, 2016; Federal Office of Rural Health Policy, FORHP Eligible ZIP Codes

We typically think of health centers as being either completely rural or completely urban, and for Region X at least the data seems to bear this out. Most health centers in the chart are either a deep shade of red or a deep shade of blue. There are very few that serve both types of patients evenly (represented by the yellow squares). Even a health center like Sea Mar, which serves hundreds of thousands of patients across dozens of sites, serves a mostly urban population.

This degree of polarization highlights the importance of building partnerships between health centers that serve different types of populations. Nearby urban health centers may be able to provide services not readily available at sites serving rural populations.

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