FINDING THE MEDICALLY UNDERSERVED - A NEED TO REVISE THE FEDERAL DEFINITION

The relationship between the primary service area (PSA) of an urban co mmunity health center (CHC) program and a federally defined ''medicall y underserved area'' (MUA) was assessed. federal guidelines that most reliably predicted medical underservice were identified. The service a rea was statistically defined by census tract penetration rates. The M UA was defined by an index of medical underservice (IMU) according to federal parameters of physician supply, poverty level, percentage elde rly persons, and infant mortality. An index score was calculated for t he county, service area, and each census tract. Analysis by tract dete rmined the most significant discriminating parameters. By excluding tw o tracts concentrated with managed-care physicians, the service area q ualified as an MUA. Tracts that fulfilled MUA and service area criteri a were highly associated (p < 0.0001). Only poverty level and infant m ortality were useful discriminating parameters. federal indicators of demand (elderly population) and supply (physicians) did not adequately address issues to access for the medically underserved in urban neigh borhoods. Other parameters that might serve as proxies of care access and underserved are discussed.